Expanding palliative care nursing education in California: the ELNEC Geriatric project.

In the past decade, the Robert Wood Johnson Foundation's 2002 report Means to a Better End: A Report on Dying in America Today and other studies brought attention to deficiencies in care of the dying in the USA. Palliative care's mandate is to promote a 'good death' through expert symptom management and compassionate care that addresses the psychosocial needs and dignity of persons at the end of life. The End-of-Life Nursing Education Consortium (ELNEC) Geriatric 'train-the-trainer' project was launched in 2007 to increase the knowledge and educational skills of nurses and unlicensed staff providing end-of-life care for older adults in nursing homes, skilled nursing facilities, long-term care, and hospices. From 2007 through 2009, 351 California-based nurses and nursing home staff attended one of four ELNEC Geriatric courses. This paper describes programme development, implementation, follow-up evaluations, and examples of participants' use of the ELNEC Geriatric curriculum.

Integration of Palliative Care in the Role of the Oncology Advanced Practice Nurse.

Numerous organizations have cited the increasing demand for palliative care in oncology and the challenge of a limited workforce to deliver specialty palliative care. Advanced practitioners in oncology can provide generalist or primary palliative care to complement the care provided by specialists and enhance the overall provision of care. This article reports on a National Cancer Institute-funded training program to prepare advanced practice nurses to incorporate palliative care within their practice. One-year follow-up of the first three national cohorts (N = 276) included evaluation of goal achievement as these nurses integrated palliative care within their oncology practice. Goal analysis reported here demonstrates the success of the training program in impacting practice as well as the barriers to implementation efforts. The advanced practice registered nurses' implemented goals included extensive training of clinicians across disciplines and numerous systems changes to improve delivery of palliative care. Advanced practice nurses will continue to be a valuable source of extending palliative care into oncology care to support patients and families across the disease trajectory.

Preparing Advanced Practice Registered Nursing Students to Provide Primary Palliative Care.

BACKGROUND: Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care. PROBLEM: There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content. APPROACH: In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate-Competencies and Recommendations for Educating Nursing Students in primary palliative care for master's degree and doctor of nursing practice students. OUTCOMES: During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions. CONCLUSION: Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.

Preparing Oncology Advanced Practice RNs as Generalists in Palliative Care.

OBJECTIVES: To train and support oncology advanced practice RNs (APRNs) to become generalist providers of palliative care. SAMPLE & SETTING: APRNs with master's or doctor of nursing practice degrees and at least five years of experience in oncology (N = 165) attended a National Cancer Institute-funded national training course and participated in ongoing support and education. METHODS & VARIABLES: Course participants completed a precourse, postcourse, and six-month follow-up evaluation regarding palliative care practices in their settings, course evaluation, and their perceived effectiveness in applying course content in their practice. RESULTS: The precourse results showed deficiencies in current practice, with a low percentage of patients having palliative care as part of their oncology care. Barriers included lack of triggers that could assist in identifying patients who could benefit from palliative care. Six-month postcourse data showed more APRNs participating in family meetings, recommending palliative care consultations, speaking with family members regarding bereavement services, and preparing clinical staff for impending patient deaths. IMPLICATIONS FOR NURSING: APRNs require palliative care training to integrate this care within their role. APRNs can influence practice change and improve care for patients in their settings.

Preparing New Graduate RNs to Provide Primary Palliative Care.

BACKGROUND: More than 90 million Americans are struggling to live with serious illness and are in need of palliative and end-of-life care. Yet, many novice RNs have not been adequately prepared during their undergraduate programs to care for them. METHOD: A large southwestern Magnet comprehensive cancer center piloted integrating the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum into their nurse residency program during 2018 with 55 new RNs. RESULTS: A pre-and posteducation evaluation questionnaire measured comfort with caring for patients with serious illness, competence, and knowledge in six areas of palliative care. All eight evaluation questions demonstrated statistically significant improvement posteducational intervention. Many nurse residents reported a change in clinical practice 1 month posteducation. CONCLUSION: The nurse residency is an opportune training time to prepare novice nurses to provide primary palliative care for all patients with serious illness and their families. [J Contin Educ Nurs. 2020;51(6):280-286.].

Appraisal of The Pediatric End-of-Life Nursing Education Consortium training program.

Major deficiencies continue to exist in pediatric palliative and end-of-life nursing education. The End-of-Life Nursing Education Consortium (ELNEC)-Pediatric Palliative Care (PPC) train-the-trainer curriculum was developed to create a nursing education program to improve care for children and their families confronted with life-threatening illnesses (www.aacn.nche.edu/ELNEC). Two ELNEC-PPC training programs were held in August 2005 and August 2006. The purpose of this article is to present data from the precourse and 12-month postcourse follow-up of participants who attended the two courses. Findings from these assessments demonstrate a positive link between educational initiatives and clinical outcomes.

End-of-Life Nursing and Education Consortium Communication Curriculum for Nurses.

Nurses have unique clinical responsibilities and opportunities with patients that require strong communication skills. However, many nurses lack effective communication skills and often receive inadequate palliative care communication training and education. To promote communication education for palliative care nurses, the End-of-Life Nursing and Education Consortium created a Communication Curriculum for nurses and developed an in-person train-the-trainer course. Organized by the 8 domains of the National Consensus Project Guidelines for Quality Palliative Care, a 1-day course was provided in August 2018 to 46 nurses representing 38 institutions. Completion of precourse surveys demonstrated participants' institutional resources for palliative care communication education and their greatest communication challenges. Immediate postcourse evaluations demonstrated that the course improved nurses' knowledge and confidence in communication and their ability to educate others. Palliative care nurses can incorporate communication skills into their practice and provide communication skills training to their institution.

National guidelines for palliative care: A roadmap for oncology nurses.

Patients with cancer have significant needs for palliative care, including pain and symptom management and psychosocial and spiritual support. The experience of cancer has an impact on family caregivers as well, and palliative care needs exist from diagnosis through survivorship and end-of-life care. Oncology nurses have opportunities to integrate palliative care into disease-focused care. Clinical practice guidelines developed by the National Consensus Project for Quality Palliative Care and preferred practices defined by the National Quality Forum serve as a framework to guide nurses in this area. These national guidelines can serve as a roadmap to develop clinical services that will serve patients and families.

End-of-Life Nursing Education Consortium. Geriatric Training Program: improving palliative care in community geriatric care settings.

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.

Promoting Palliative Care Internationally: Building Leaders to Promote Education, Practice, and Advocacy.

In February 2000, nine nursing educators, practitioners, and researchers met in Nashville, Tennessee, to develop a palliative care curriculum specifically for nurses. The following month, 22 advisors from nursing organizations across the United States convened in Washington, DC to review the recommended curriculum development and dissemination plans for end-of-life care throughout nursing schools, hospitals, hospices, home care, and geriatric settings. The Robert Wood Johnson Foundation provided funding for curriculum and competency development and for six national train-the-trainer courses to be held from 2001 to 2003. The curriculum entitled the End-of-Life Nursing Education Consortium was designed to meet the needs of nurses caring for patients with serious and complex illnesses at the end of their lives. This work, beginning in 2000 with the development of the End-of-Life Nursing Education Consortium curriculum, has been taught in every state across America and in 91 countries around the world and has been translated into eight languages. Over 21,400 trainers have returned to their institutions and educated over 642,000 colleagues.

An Innovative End-of-Life Nursing Education Consortium Curriculum That Prepares Nursing Students to Provide Primary Palliative Care.

Research has demonstrated that patients facing serious, life-limiting illnesses and their families benefit from receiving palliative care. Increasingly, however, specialty palliative care has limited resources. Prelicensure nursing students who are educated to provide primary palliative care to patients with serious illness and at the end of life can fill that gap. This article describes the development and implementation of an innovative online nursing curriculum that prepares students with essential primary palliative nursing knowledge and skills.

A Framework for Integrating Oncology Palliative Care in Doctor of Nursing Practice (DNP) Education.

Doctor of Nursing Practice (DNP) faculty play a critical role in preparing students to meet the complex needs of the nation as the number of cancer rates and survivors rise (National Cancer Institute, 2018) and as an unprecedented number of older Americans enter into the healthcare system with complicated comorbidities (Whitehead, 2016). Palliative care has dramatically expanded over the past decade and has been increasingly accepted as a standard of care for people with cancer and other serious, chronic, or life-limiting illnesses. Advanced practice registered nurses (APRNs) are recognized as important providers of palliative care (Walling et al., 2017). A 2-day course was held with support from the National Cancer Institute to enhance integration of palliative oncology care into DNP curriculum. The course participants (N = 183), consisting of DNP faculty or deans, practicing DNP clinicians, and students, received detailed annotated slides, case studies, and suggested activities to increase student engagement with the learning process. Course content was developed and delivered by palliative care experts and DNP faculty skilled in curriculum design. Participants were required to develop goals on how to enhance their school's DNP curriculum with the course content. They provided updates regarding their progress at integrating the content into their school's curriculum at 6, 12, and 18 months post course. Results demonstrated an increase in incorporating oncology palliative care in DNP scholarly projects and clinical opportunities. Challenges to inclusion of this content in DNP curricula included lack of: perceived time in curriculum; faculty educated in palliative care; and available clinical sites.

End-of-life nursing education consortium for pediatric palliative care (ELNEC-PPC).

Pediatric nurses must often care for children with life-threatening illness. Although the child may be a neonate with multiple organ failure, a young adolescent diagnosed with HIV, or a 7-year-old child involved in a serious bicycle accident, pediatric nurses are an essential part of the interdisciplinary team that plans, organizes, implements, and manages the care of these children and their families. To date, more than 600 pediatric nurses have attended a national End-of-Life Nursing Education Consortium-Pediatric Palliative Care (ELNEC-PPC) training program. Many of these nurses have returned to their institutions dedicated to making a difference in the palliative care provided to children and their families. Because pediatric palliative care education is so important, many trainers have incorporated ELNEC-PPC into their nursing orientation, annual competencies, and undergraduate and graduate nursing education. They are developing standards of care and serve on key hospital/hospice committees, such as policy, education, clinical care, and ethics committees. This article showcases various activities of ELNEC-PPC trainers and demonstrates their commitment to improve pediatric palliative care not only in their institutions but also on local, state, national, and international levels.

Appraisal of the Graduate End-of-Life Nursing Education Consortium Training Program.

BACKGROUND: Advanced practice nurses (APNs) are crucial in the provision of quality end-oflife care. However, little attention is devoted to palliative care in most graduate nursing curricula, leaving advanced practice nurses poorly prepared to meet the needs of those approaching the end of their lives. OBJECTIVE: The purpose of the graduate version of the End-of-Life Nursing Education Consortium (ELNEC-Graduate) Training Program is to provide nursing faculty with the knowledge and materials necessary to include palliative care throughout the graduate nursing curriculum. DESIGN AND SETTINGS: Sixty graduate nursing faculty members attended the first ELNECGraduate training course. Prior to attending the course, each participant completed surveys regarding the adequacy of end-of-life (EOL) content within their curriculum, as well as overall perceptions of EOL education in their university. Participants were asked to respond to these same questions immediately and at 12 months after completion of the course. RESULTS: Respondents reported significant improvements in the adequacy of eight areas of EOL content taught within their settings. Participants noted improved effectiveness in their ability to teach EOL care, of their curriculum in including EOL care, and of their graduate nursing students in providing care to the dying. The total hours of EOL content added to graduate nursing curricula as a result of attending ELNEC-Graduate was 18.4 +/- 17.4 standard deviation (SD) hours. Additional unintended consequences were noted. CONCLUSION: The ELNEC-Graduate Program is a national initiative that effectively improves faculty expertise in EOL care and expands palliative care content within graduate nursing curricula.

Evaluation of the end-of-life nursing education consortium project in the USA.

Care of patients at the end of life is contingent on adequate preparation of health care providers. Nursing, as the predominant caring profession in end-of-life (EOL) care, must achieve competence in physical and psychosocial care of patients and families facing terminal illness. Previous research has demonstrated that nursing education has not prepared nurses to provide optimum EOL care. To date, there has not been a unified or organized effort to broadly address the preparation of nurses in EOL care. This article describes one national project, the End-of-Life Nursing Education Consortium (ELNEC), which was developed as a comprehensive effort to improve EOL care by nurses in the United States. The ELNEC project consists of EOL education for various nursing audiences: the undergraduate faculty; continuing education providers; paediatrics; oncology; and the graduate faculty. This organized effort is a major step towards strengthening nursing knowledge in EOL care to improve care of the dying.

Palliative care education for pediatric nurses.

Of all the various healthcare professionals that provide care to children and their families facing life's end, no one spends more time at the bedside observing, critically thinking, consulting, and providing direct care than the pediatric nurse. Previous research, however, demonstrates that undergraduate education has not prepared nurses to provide optimum end-of-life (EOL) care (Ferrell, Grant, & Virani, 1999; Ferrell, Virani, & Grant, 1999). Although many reasons have been cited in the literature for this inadequacy, the fact remains that when nurses complete their basic education and enter practice, they often are grossly unprepared to care for children and families in need of end-of-life care (Field & Behrman, 2003).

CARES: AACN's New Competencies and Recommendations for Educating Undergraduate Nursing Students to Improve Palliative Care.

Nurses spend the most time of any health care professional caring for patients and families dealing with the challenges of serious illness. The demand for nursing expertise in palliative care is growing as more people are living with chronic, life-limiting illnesses. Nursing faculty must prepare future nurses to meet this demand. The new American Association of Colleges of Nursing Palliative Competencies And Recommendations for Educating undergraduate nursing Students document, released February 2016, identifies the 17 competencies that all undergraduate nursing students should achieve by the time of graduation. This historic document is a revision of the 1998 American Association of Colleges of Nursing Peaceful Death document and is now the guiding framework for undergraduate nursing education. In an effort to support nursing faculty and prepare nursing students to deliver quality palliative care, an innovative, interactive on-line undergraduate End-of-Life Nursing Education Consortium (ELNEC) curriculum is under development and will be released in January 2017. This new curriculum will meet the competencies and recommendations for achieving those competencies outlined in the Competencies And Recommendations for Educating undergraduate nursing Students document.

Evaluation of the End-of-Life Nursing Education Consortium undergraduate faculty training program.

BACKGROUND: Previous research has demonstrated that nursing education has not prepared nurses to provide optimum end-of-life (EOL) care; and yet, care of patients at the EOL is contingent on adequate preparation of nurses. To date, there has not been a unified or organized effort to broadly address the preparation of nurses in EOL care. OBJECTIVE: The purpose of the End-of-Life Nursing Education Consortium (ELNEC), a Robert Wood Johnson Foundation funded project (2000-2004), was to develop and implement a comprehensive national effort to improve EOL care by nurses through a joint collaboration between the American Association of Colleges of Nursing (AACN) and the City of Hope Cancer Center. DESIGN AND SETTING: Based on the AACN Peaceful Death document, the ELNEC curriculum focuses on nine EOL core areas. This project is a synthesis of research and knowledge in EOL care and is intended to assist clinical nurses with implementing scientifically based care in practice. Eight national training courses followed the development of the core training curriculum to enhance EOL expertise in faculty in undergraduate nursing programs (five courses) as well as in continuing education programs (three courses). Development of the ELNEC program included detailed teaching materials to integrate EOL content into existing nursing curricula and clinical teaching and extensive follow up evaluation. RESULTS: The data revealed significant outcomes in the report of implementation in the nursing curriculum including an increase in the amount of content, perceived effectiveness of new graduates, and of faculty expertise in EOL care, and a broad dissemination of all modules geographically. CONCLUSION: This national organized effort is a major step toward preparing nurses in EOL care to improve care of the dying.

The End of Life Nursing Education Nursing Consortium project.

In 2000, the City of Hope Medical Center and the American Association of Colleges of Nursing (AACN) developed the End-of-Life Nursing Education Consortium (ELNEC)-Core curriculum to educate nurses and other healthcare professionals on end of life care, so that attention to the dying could be improved and their unique needs addressed. Since its inception, over 19,500 nurses and other professionals have attended the ELNEC train-the-trainer courses. Upon course completion, the participants, often nurse educators, returned to their schools, healthcare systems, and communities and introduced the ELNEC content into nursing curricula, annual competencies, and new employee orientation. In 2005, the national ELNEC Project Team concluded that an international curriculum should be developed. The first ELNEC International course was launched in 2006 in Salzburg, Austria. Since that time, trainers have come from 85 countries world-wide, and the curriculum has been translated into eight languages. In 2015, three international courses will be presented: in Beijing, China, Kipkaren, Kenya, and Salzburg, Austria.

Achieving quality care at the end of life: a focus of the End-of-Life Nursing Education Consortium (ELNEC) curriculum.

This article introduces the didactic content and teaching strategies presented in the End of Life Nursing Education Consortium (ELNEC) curriculum on the topic of "Achieving Quality Care at the End of Life." The American Association of Colleges of Nursing joined forces with the City of Hope National Medical Center to begin a national education initiative, entitled the, "End of Life Nursing Education Consortium" (ELNEC) (available: http://www.aacn.nche.edu/elnec/). Funded for nearly $3 million from the Robert Wood Johnson Foundation, ELNEC was launched in February 2000 as a consortium of many organizations to ensure a collective professional approach to improve end-of-life care. The ELNEC curriculum is a train the trainers course with the expectation that those trained in the ELNEC curriculum will disseminate knowledge related to end-of-life care.