Background: Palliative Care (PC), End –of-Life (EOL) care is evolving worldwide and in Lebanon. PC provides as good or better outcomes than curative care alone, is cost effective, and alleviates pain and suffering for patients and caregivers. Nursing educators and leaders, internationally and nationally indicate the need to include concepts of PC and EOL care in curricula of professional nurses to cope with death and dying as potential outcome for patients.
Purpose: Assess the effectiveness of PC continuing educational intervention for registered nurses (RNs) at the American University Medical Center (AUBMC) and recommend future educational programs.
Methods: Quasi experimental pre-post-test method. Questionnaire consisted of 34 multiple choice questions.
Participants: A convenient sample of 45 AUBMC RNs dealing with PC and ELO care assigned in a variety of clinical units.
Educational Program: The goal of the workshop was to equip nurses with, knowledge, attitudes, and skills to provide the best possible end-of-life care for their patients and their families: Control of pain, along with management of psychological, social and spiritual problems. In addition, foster collaborative practice between nurses, patients, families, physicians, social workers, chaplains, hospitals, home health care agencies, and long term care facilities to achieve the promise of current knowledge of PC. Specific objectives: at the end of the educational program the learners shall be able to:1) improve end-of-life care for clients under their care; 2) Identify facts and challenges of pain relief and palliative care; 3) critically analyze gaps, elements, models and key concepts of palliative and end of life care; 4) evaluate types of pain and accordingly implement pain management modalities;5) identify causes and management of physical and psycho-social symptoms in palliative care; 5) develop skills in communicating “bad news” to patients and care givers.
Content of the workshop included:
I- Overview of Palliative and End-of-life care,
II- Whole patient assessment,
III- Communication and information,
IV- Pain management and the other common symptoms management,
V- Psychiatric problems and their management,
VI- Ethical and legal issues,
VII- Quality of Life and Quality of Death.
Teaching/learning strategies included: lectures with power point presentations; discussion sessions with audio-visual aids; open questionning and, reflections on videos.
Program was prepared and delivered by a group of physicians and nursing faculty, experts in PC and ELO care. Content adapted from the Education for Physicians of End of Life Care Curriculum (EPEC). At the end of the workshop participants received one continuing education credit.
Analysis: Demographic characteristics were summarized using descriptive statistics. Differences between pre-post-tests were measured by means and standard deviations (SD) using the paired t test. A two-tailed test was used, p-value less than 0.05 considered significant.
Results: 39 participants completed the pre-post-test: Mean pretest score was 48.53 (SD = 9.23), range29-65, post- test 70.05 (SD = 12.35), range 47-88. Paired t test showed significant increase between pre and post test scores t (38) = 11.07, p < 0.001 with 95% confidence interval for the mean difference of (17.58, 25.45).
Strengths of the study: it added to the limited body of research in the area of PC education and evaluation for health professionals specifically nurses.Another strength is the collaboration between the school of nursing and, other health professionals and theAUBMC.
Limitations of the study were a convenient sample and test items were not validated. However, questions were selected by the expert panel based on PC and ELO care literature.
Conclusion and nursing implications: Results of this study were encouraging, as a first attempt, as no published evaluation studies, to this date, are available in Lebanon. In addition, it enhanced interdisciplinary partnership between physicians, nurses and nursing faculty. It is highly recommended to follow up on participants to find out if participation in the workshop stimulated changes in their practice. Continue provision of structured workshops to RNs all over Lebanon, for improving PC and EOL Care to clients and their families. This study can be replicated to train RNs in PC and EOL care in other countries with similar or different cultures, globally so that their patients need not suffer unnecessarily.