The hospice nurse arrives at the patient’s home after receiving a phone call that he has died. She greets his wife and mother-in-law, offers her condolences, and proceeds to begin the necessary phone calls and paperwork. The chaplain then arrives to provide the distraught family with emotional support.
Despite what it seems, this isn’t a typical ‘hospice death’ visit. The patient isn’t real, the staff and family members are actors, and the home is really a learning lab. It’s part of a new orientation program at the Hosparus Center for Performance Excellence, based in Louisville, KY.
Nursing can be stressful, both emotionally and professionally. Hospice care, in particular, can be especially challenging since clinicians are dealing with patients and families in the face of terminal prognoses. Because of this, it is just as important to provide real-world experiences for new hospice nurses as it is to provide traditional classroom training, given that most nurses entering the field do not have previous hospice or home health experience. Going into the homes of patients is much different than entering their hospital rooms, and it takes time to feel comfortable in these intimate surroundings.
Hosparus, Inc. recognized the need for a new and-improved orientation process a few years ago, based on feedback from both management and new hires. The new program, which is now going into its second year, is comprised of traditional classroom training and patient care simulations, followed by several weeks of preceptorship.
The training takes place in a 385-square foot space that has been designed to resemble a real patient’s home. For example, the outside of the lab looks like a front porch, complete with a shingled roof and porch light. Inside, furniture such as a bed, couch and table make up the living room. There is a simulated kitchen area which has a table and chairs. To make the environment even more like the one that staff will encounter (and be required to maneuver around), the home also contains medical equipment, including an oxygen concentrator, nebulizer machine, oxygen tanks, and a walker and wheelchair.
State-of-the-art technology, complete with recording capabilities, is also in place to support learning within this “home-like setting,” In one small room there are two-way mirrors, allowing Center staff to view the participants without being a distraction. There are also three cameras in place to capture all angles of the room. Adult- and pediatric-size mannequins are on hand for clinical skills practice and to serve as patients in some of the simulations. A separate clinical skills lab provides an additional 240 square feet of space to practice hands-on nursing skills.
Week one of the program is a general orientation for all new employees that includes two different hospice ‘home’ visits to observe. Real actors, who are volunteers within the organization, participate in the scripted scenarios as the new employees look on. The first visit is what is called a routine visit. It depicts the nurse visiting a patient who is living independently but beginning to have a few issues. After a brief break and debriefing, the employees are led to the lab again to attend a death visit, where the patient has just died and the nurse is called out to the home.
Week two of the program provides clinical training and more-in-depth patient care simulations for new nurses. During this part of the orientation they come face to face with symptom management challenges such as severe pain, dyspnea, and delirium. They are also presented with scenarios to help educate them on falls, oxygen safety, and managing difficult conversations about end-of-life care. This gives the nurses a chance to practice these new skills in a safe, controlled environment, with the hospice educators on hand to provide helpful cues as well as feedback on what went well and what needs improvement. The new nurses are also expected to document their sessions just as they will need to do on the job.
The overarching goal of this new orientation program is to help new nurses improve their skills in crisis management, communication and documentation. Their responses, to date, have been very positive. They say it has helped them “to better understand the nature of hospice care” and has made them feel “less nervous about entering a patient’s home.” This, in turn, leads to greater confidence when they enter the real world of hospice care.
Amber Kirchner has worked in the hospice field for eight years, and received certification as a hospice and palliative care nurse in 2011. She is currently a nurse educator at Hosparus, Inc, where she has worked since 2007.
This article originally appeared in NHPCO’s NewsLine, Spring 2015.