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FAN FOX AND LESLIE R. SAMUELS FOUNDATION RESEARCH PROJECTEXECUTIVE SUMMARY: This research was conducted under a grant from the Fan Fox and Leslie R. Samuels Foundation in eleven New York City nursing homes from February 1, 2001 to February 28, 2002. OUTCOMES: The research proved that the Palliative Care Training program is measurably effective in teaching nursing assistants and nurses to communicate the care needs of nursing home residents. It demonstrated that the 5-POINT Guide to Communication and palliative care indicator reporting provide a systematic form of communication that results in intervention by a physician or a nurse. This result verified the research hypothesis that paraprofessional caregivers could be trained to provide significant information for clinical care in nursing homes. Post-test training evaluations demonstrated positive improvement at a statistically significant level of change (p=.000), in observation and reporting skills, without regard to the trainees' ethnicity or native language, level of education or work experience. Four months after training evaluation found that a majority of trainees reported daily use of the 5-POINT Guide and indicator reporting. The observation and reporting process created by the training enhanced attitudes vital for employee retention, such as a sense of providing better care, and finding caregiving work more interesting and rewarding. BACKGROUND: Under the Fan Fox and Leslie R. Samuels Foundation initiative directed to "moving palliative care upstream" in the care continuum, the Institute for Palliative & Hospice Training, Inc. evaluated and validated the effectiveness of a specialized training program for paraprofessionals and other caregivers. The Palliative Care Training program teaches a method, based upon clinical research material, of observing and reporting the care needs of patients and families. This training method and curriculum were developed by MKHP Associates, L.L.C. of Alexandria, VA., under a Small Business Innovation Research grant from the National Cancer Institute, National Institutes of Health, (2R42CA73284-04). MKHP Associates contracted with the Institute to conduct the evaluation research. The Palliative Care Training program is intended to be an advanced level of training. The Training implements the theory that because paraprofessional caregivers (Nursing Assistants and Home Care Aides), provide the most frequent and intimate care to individual residents/patients, they are in the best position to observe the changes in a resident that signal new symptoms, pain or other problems. The Training is based on the four domains of quality of life (physical, psychological, social and spiritual) and provides information based on clinical research about pain and symptoms, psychological, social and spiritual needs. The Training Program meets new requirements to treat pain as the "fifth vital sign" and staff training requirements of the Joint Commission on Accreditation of Health Care Organizations (JCAHO). The training can be used to meet in-service requirements under Medicare/Medicaid. The Palliative Care Training program implements a method based upon case studies and the 5-POINT Guide to Communication which teaches caregivers how to organize their observations and how to report these in a concise, systematic and consistent way that provides the information needed for nurses and other members of the interdisciplinary care team to follow up with assessment and care. The program places equal emphasis on pain and other symptoms and the psycho-social and spiritual needs of patients and families. The 5-POINT Guide helps caregivers to organize their observations and to report these in a concise, systematic and consistent way that provides the information needed for nurses or physicians to take action. The Institute's research was conducted at 11 nursing facilities in New York City, most of which were accredited by the Joint Commission on Health Care Organizations (JCAHO). Six hours of palliative care content training was given to 84 nursing assistants and to 70 nurses, interdisciplinary care team members and other staff. The training reviewed how nursing assistants would report their observations on a two-page Palliative Care Indicator Report attached to the accountability report they completed daily about care to individual residents. SUMMARY OF RESEARCH FINDINGS: Post-test training evaluation showed 87 percent of nursing assistant trainees had positive improvement in understanding and application of observation and reporting skills. This change exceeded chance by over a thousand to one (p=<.000). The greatest change occurred with trainees who had low scores on the pretest. Data analysis showed that personal traits of trainees did not influence response to the training and the training was equally effective with trainees of different ethnic backgrounds, language, level of education and experience. Of the 84 nursing assistant trainees, 70 percent were African-American/American Indian; 88 percent were born outside the United States; 47 percent graduated from high school; 40 percent had some college, and 56 percent had 10 or more years of experience in long-term care. Data was collected from 148 Palliative Care Indicator reports, affecting 109 residents, of whom 72 percent had a diagnosis of dementia and 61 percent required total care. The Indicator Reports were the first time the nursing assistants had recorded reports of pain and symptoms. Pain was the single most frequent indicator reported, 30 percent. The 22 symptom categories totaled 56 percent of reports. The 7 psychosocial indicators represented 24 percent of reports, including sadness and depression, 14 percent. There were four reports of spiritual needs. The majority of reports indicated multiple symptoms or needs, which often were reported over several days. Many of these indicator reports were followed immediately by one or more interventions by clinical staff and documented in case records with a note of a nursing assistant's report. Clinical responses were pain medications, 22 percent, medications or treatment of symptoms, 56 percent, and medications, treatments or case note responses for psychosocial symptoms, 20 percent. Several nursing assistants reported indicators of approaching death for residents who died unexpectedly. On a post-research evaluation questionnaire, about three-fourths of nursing assistants stated they used the 5-POINT Guide reporting method daily, that the reporting process made it easier to report to nurse supervisors and that it had made them much more aware of resident needs. Over 80 percent said reporting helped them give better care to residents, while over 70 percent said it made their work more interesting and rewarding. Of most importance, 98 percent of the nursing assistants said they would continue to observe and report resident palliative care needs. Over one-third of the nursing facilities continue to use the Palliative Care Indicator Report as part of resident care documentation, at the request of nurses and nursing assistants. For additional information contact: Mary Hamil Parker, Ph.D., Principal Investigator Site Map Purchasing Policies and Procedures Institute for Palliative & Hospice Training, Inc. | |
2004 © Institute for Palliative & Hospice Training, Inc. All rights reserved. |