Evaluating end-of-life care capacity building training for home care nurses

Abstract

Background: With the rapidly aging population, the quality of end-of-life (EOL) care has become a significant issue. As the majority of deaths in Hong Kong (HK) currently occur in public hospitals, promoting palliative home care can relieve hospital burden and provide good deaths. There is a practical need to properly educate and train nurses on the skills to provide EOL care in home care settings. Objectives: To evaluate the effect of the first EOL care training program for nurses working in home care settings or nursing homes on quality of life at work, orientation toward dying and death, and self-competence in death work. Design: A pre-experimental research design was utilized to conduct this study using a one-group pretest and posttest approach. Settings and participants: A convenience sample of 153 nurses working in home care settings or nursing homes in HK was selected. Methods: Participating nurses attended two-day entry-level and seven-day advanced-level courses. Quality of life at work, multidimensional orientation toward dying and death, and self-competence in death work were assessed using questionnaires at baseline and immediately after entry- and advanced-level training. Results: The results revealed that nurses reported a higher level of compassion satisfaction (d = 2.52, p < 0.001), less burnout at work (d = −3.25, p = 0.045), less fear about their own death (d = −1.33, p = 0.019), and more acceptance of others' deaths (d = 1.07, p = 0.004) in post-advanced-level courses. In general, participants were satisfied with the delivery method, duration, and logistical arrangement of the courses. Conclusions: Nurses reported improved professional quality of life, less fear, and more acceptance toward death and dying after the training program. More educational strategies, such as role-play and case study discussions, are needed to improve the overall learning experience and effectiveness of the program. Future studies could add a qualitative component to yield deeper insights through the findings. As training programs allow nurses to cultivate their skills in clinical situations, there is an undeniable need to continue implementing standardized education and training for palliative care nurses to improve EOL care quality.