Educational needs of nursing home staff: does a needs-based palliative care course make a difference?

Correspondence to Dr Gillian Li Gek Phua, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore 169610; [email protected]

Introduction

By 2050, one in six people worldwide will be over the age of 65 years.¹ In Singapore, the proportion of residents aged 65 years and above increased from 13.7% in 2018 to 14.4% in 2019.² The ageing population and the lack of family support have led to more elderly living in nursing homes (NHs).³ In 2018, 7.1% of deaths in Singapore occurred in NHs and charitable institutions,⁴ highlighting the need to provide good palliative care in NHs. Two main factors affect palliative care in NHs: lack of knowledge, and attitudes and beliefs about death and dying.⁵ Education can better integrate palliative care into NHs,^{6 7} and end-of-life education has been shown to bring about positive changes in nurses’ attitudes towards care of the dying.⁸

In Singapore, 70% of NHs’ workforce are foreigners⁹ with varying nursing education and experience. Coupled with different cultural backgrounds, it becomes challenging for them to provide palliative care in multicultural Singapore. Nurses in Singapore undergo minimal palliative care training of 4–6 hours before graduation, and only 45% report being familiar with palliative care.¹⁰ Despite introducing the End of Life Nursing Education Consortium curriculum,¹¹ the need for certified nurse trainers remains a constraint, and the fixed curriculum is not always applicable to Singapore’s multicultural context.

Our study aimed to develop a needs-based course that focused on practical aspects of palliative care in Singapore’s NHs and to study its impact on the palliative care knowledge and attitudes of NH nurses.

Methods

Study design

Our mixed-methods study combined a pretest and post-test design to assess knowledge, and semistructured interviews to assess changes in attitudes and beliefs postintervention.

A multidisciplinary faculty of expert educators (palliative and geriatric specialists, nurses and a chaplain) with clinical experience in NHs and hospices was formed. They conducted a needs analysis with participating NHs to identify areas of deficiencies in palliative care, then developed the curriculum with adaptations to local culture.

The 8-week course over 10 3-hour sessions covered palliative and end-of-life care concepts, psychosocial and spiritual care, and symptom management (online supplemental table 1).

Data collection

Twenty-five participants...