Design:QualityImprovementProject.

Se*ng:TwoLTCfacili:esinNJ,oneurban,onesuburban

Sample:Conveniencesampleof11nursesand18CNAs.

Recordsof139residentsexaminedforAdvanceDirec:ves

(AD)andhospitaltransfers.

Method:EOLeduca:onadaptedbasedonEnd-of-Life

NursingEduca:onConsor:um(ELNEC)-Geriatric

curriculum.Three30minuteweeklyEOLeduca:onal

sessions

DataCollec6on:Pre-educa:onbaselinedataonresidents’

ADsandtransferscollectedfromSeptember-October,2014.

Post-educa:ondatacollectedforDecember2014-January

2015.Baselinestaffdatagatheredimmediatelypreand

post-educa:on.

Measures:

•  StaffEOLknowledgeontheadaptedELNECtestor

HospiceandPallia:veNursesAssocia:on(HPNA)test.

•  Staffself-evalua:onoftheeduca:ononknowledgeand

futureprac:ce.

RutgersUniversityIRBapprovedProjectPro20140000491.

IMPROVING RESIDENT OUTCOMES BY EDUCATING NURSING STAFF IN LONG-TERM CARE FACILITIES ON END OF LIFE COMMUNICATION

Vera Kunte, DNP, APN-C, CNE, Mary L. Johansen, PhD, NE-BC, RN, Shari Isenberg-Cohen, DNP, APN-C

•  Itisprojectedthatby 2030, nearly40%ofAmericansover65yearsofage,willdieinalongtermcare(LTC)facility(CAPC,2008)

•  35%ofresidentslivinginLTCfacili:esdonothaveanadvancedirec:ve(Jones,2011).

•  Nursingstaff(RNs,LPNs,andcer:fiednursingassistants)inLTCfacili:esareinadequatelypreparedinendoflife(EOL)care(Wholihan&Anderson,2013).

•  ResidentsinLTCfacili:eswherenursingstaffreceiveeduca:ononEOLcareandcommunica:onreceivebeberEOLcare(Temkin-Greener,2009).

•  FewstudiesfocusonimprovingEOLeduca:onofcer:fiednursingassistants(CNAs)inLTCfacili:es.

•  TheimpactofEOLeduca:onofnursingstaffonratesofadvancedirec:vesamongLTCresidentsisunknown.

IMPLICATIONS FOR NURSING PRACTICE

NursingStaffDemographics•  Nursingstaffofbothunitswasmostlyfemale,and

predominantlyAfricanAmerican.•  >50%ofnursingstaffhad6ormoreyearsexperience.NursingStaffKnowledgeofEOL•  67%ofCNAshadincreasedpost-educa:ontestscores,

33%remainedthesame.•  36%ofnursesdemonstratedanincreaseinpost-

educa:ontestscores,46%remainedunchanged,and18%haddecreasedscores(Fig.1).

NursingStaffSelf-Evalua6on•  Post-educa:onEOLknowledgewasratedhigher(Fig.2).•  Morethan80%ofnursingstaffrelatedthatthe

educa:onwouldchangetheirprac:ce“quitealot”.LTCResidentDemographics•  UrbanLTC:Predominantlymale,African-American,ages

rangedfrom38-91years.•  SuburbanLTC:Predominantlyfemale,Caucasian,ages

rangedfrom29-104years(Table1).ResidentOutcomes•  Pre-educa:on:70residentshadanadvancedirec:ve.•  Post-educa:on:73residentshadanadvancedirec:ve.•  =2.15%increaseinrateofAD•  Pre-educa:on:16residentstransferredtoHospital/ED.•  Post-educa:on:9residentstransferredtoHospital/ED.•  =43.8%decreaseinrateoftransferstoHospital/ED.

CONCLUSIONS •  EOLknowledgecompetenciesofnursesandCNAs

improvedalerreceivingeduca:on.•  Documenta:onofresidentEOLpreferencesimproved

minimally,andrateoftransferstothehospitalswasdrama:callyreduced.

•  CNAsbenefitfromcombinededuca:onsessionswiththenurses.

•  NeedstrategiestoempowernursesandCNAstoac:velypar:cipateinEOLdiscussionsinLTCfacili:es.

•  Ins:tu:onalDNRpoliciesaddressingtheroleofnursingstaffinEOLdiscussionsshouldbedeveloped.

Rutgers University�School o f Nursing

•  ToexaminewhetherEOLknowledgeofnursesandCNAsimprovesalerreceivingeduca:oninEOLcommunica:on.

•  ToexaminewhetherthereisarelatedincreaseintherateofLTCresidentswithadvancedirec:ves,andadecreaseintheratesoftheresidents’transferstotheEmergencyDepartment(ED)andhospital.

Table 1: LTC Resident Demographics

increased36%

unchanged46%

decreased18%

Nurses’Post-Educa6onTestScores

increased67%

unchanged33%

CNAs’Post-Educa6onTestScores

Figure 1: Change in Nursing Staff Post-Education Test Scores

0 1 2 3 4 5 6 7

Excellent

Good

Sa:sfactory

fair

Nurses'Self-evalua6onofEOLKnowledge

Rateknowledgealereduca:on

0 2 4 6 8 10 12 14

Excellent

Good

Sa:sfactory

CNAs'Self-evalua6onofEOLKnowledge

Rateknowledgealereduca:on

Figure 2: Nursing Staff Self-evaluation of EOL knowledge

METHODS

BACKGROUND PURPOSE RESULTS

•  Jones A.L., Moss A.J., Harris-Kojetin L.D. (2011). Use of advance directives in long-term care populations. NCHS data brief, no 54. Hyattsville, MD: National Center for Health Statistics. •  Temkin-Greener, H., Zheng, N., Norton, S. A., Quill, T., Ladwig, S. & Veazie, P. (2009). Measuring end-of-life care processes in nursing homes. The Gerontologist, 49(6), 803-815. •  Wholihan, D & Anderson, R. (2013). Empowering nursing assistants to improve end-of-life care. Journal of Hospice and Palliative Nursing, 15(1) 24-32.

Table 2: LTC Resident Outcomes