LA INYECCION ELECTRONICA JUSTIFICACION Y FUNDAMENTO

Not all projects provided comprehensive data on the evaluations of their educational activities; where this was available, however, the findings indicated positive outcomes for staff. From the evidence provided, it is clear that a large number of people working in residential aged care, health services and community care have benefited from the education and training provided under the sub-program. Their increased capacity has not only been in terms of skills development, but has also resulted from the increased confidence to make assessments, manage end of life care needs, and participate in discussions with clients and family members around these issues.

The extent to which confidence was enhanced is demonstrated in the findings of one project which reported that enrolled nurses and care staff had an improved confidence in answering questions on the dying process (16 out of 19 post-education, up from only 5 pre-education), reacting to reports of pain from patients (16 up from 6) and reacting and coping with limited patient decision making capacity (15 were confident to perform with minimal or no consultation, compared to 6 pre- education) (NSW-6).

Another project reported that staff training program survey results revealed that the large majority reported improvement in confidence and skill as a result of the education: 23% mild; 46%

moderate and 16% very large improvement (NSW-5). The increase in knowledge and confidence in the use of relevant tools and guidelines was also evidenced in the findings of another project

were well attended by participants, who rated their usefulness as high, and the education also raised awareness of the Guidelines amongst RACFs, some of which previously were not aware of their existence. It went on to say that there was increased use in those facilities that were aware of the Guidelines but had not previously applied them to their care practice (VIC-4).

The quality of the education and training provided by the Care Planning projects was also

evidenced in the number which sought to develop, deliver and/or facilitate training which provided specific competencies for participants. One project noted that the project supported two staff completing their Palliative Care Certificate; two staff completing the Certificate IV ‘Plan and provide care services using a palliative approach’; and four week-long clinical placements for staff (NSW- 5). Another project, which had previously received funding under the Local Palliative Grants Program Round 1 to develop competency based training, concluded that the combined projects had resulted in over 180 staff from within the host organisation undertaking the national palliative care competency training either as part of an entry level trainee ship or as a stand alone module delivered over six weeks with workplace assessment imbedded into the model. A further 35 staff from external facilities undertook the national competency from the community services training package (NSW-3). Fifteen registered nurses working in the acute and community sectors in the South East region took part in a 10-week distance education course in palliative care, while one local GP and two staff of the palliative care service undertook further specialist study in palliative care through Flinders University (SA-5).

There was demonstrable improvement in the capacity of staff to undertake care planning and provide end-of-life care, including evidence-based assessment and symptom management, most commonly in relation to pain management. Results of a resident file audit undertaken before and after the implementation of an end of life care pathway by one project found that analgesia prescribed at 72 hours prior to death was 40% in the pre-test data, compared to 76% in the post- test data. Similarly, PRN (as required) medication for breakthrough pain was recorded at 35% in the pre-test data, compared to 73.3% in the post-test data. The latter audit also found that 36.6% of residents were on an end-of-life care pathway (NSW-6). The project went on to report that these audit findings were supported in feedback provided during focus groups, in which staff agreed that, due to the education, providing palliative care was more structured, there was better recognition of the phases of care and use of assessment tools, improved ability to identify

symptoms and provide evidence when someone required pain or symptom management. This was echoed in another project’s report, where feedback from staff revealed their perceptions that the quality of end-of-life care provided by their facility had significantly improved as a result of the enhanced capacity of staff due to the education provided to support the pathway following the introduction of end of life care pathway (QLD-2).

Greater confidence and competence in the use of standard assessments tools also resulted in improvements to the way services and professional groups related to each other. A number of projects indicated that there was greater confidence of generic services in dealing with, and referring clients to, palliative care specialist services, and also with RACFs engaging general practitioners in palliative care provision, due to their use of common assessment tools such as Palliative Phases, Karnofsky Scale, Resource Utilization Groups for Activities of Daily Living (RUG-ADL), Palliative Care Problem Severity Scale and the Symptom Assessment Score (e.g. NSW-3, SA-5, NSW-1).

The benefit of the use of link nurses or champions was not well demonstrated in the project reports; the focus of evaluation was primarily on the education provided rather than the strategies used to support it. However, one project did report on the link between consistency of staff and outcomes for residents. It observed that amongst the RACFs involved in the project, the two facilities with the highest percentages of dying residents commenced on the end of life pathway were the only ones to retain the same link nurses throughout the project; these were also the facilities that had the highest number of staff attending education sessions, suggesting higher levels of management support (QLD 2).