IMPROVING RESIDENT OUTCOMES BY EDUCATING...

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Design: Quality Improvement Project. Se*ng: Two LTC facili:es in NJ, one urban, one suburban Sample: Convenience sample of 11 nurses and 18 CNAs. Records of 139 residents examined for Advance Direc:ves (AD) and hospital transfers. Method: EOL educa:on adapted based on End-of-Life Nursing Educa:on Consor:um (ELNEC)-Geriatric curriculum. Three 30 minute weekly EOL educa:onal sessions Data Collec6on: Pre-educa:on baseline data on residents’ ADs and transfers collected from September-October, 2014. Post-educa:on data collected for December 2014-January 2015. Baseline staff data gathered immediately pre and post-educa:on. Measures: Staff EOL knowledge on the adapted ELNEC test or Hospice and Pallia:ve Nurses Associa:on (HPNA) test. Staff self-evalua:on of the educa:on on knowledge and future prac:ce. Rutgers University IRB approved Project Pro20140000491. 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 It is projected that by 2030, nearly 40% of Americans over 65 years of age, will die in a long term care (LTC) facility (CAPC, 2008) 35% of residents living in LTC facili:es do not have an advance direc:ve (Jones, 2011). Nursing staff (RNs, LPNs, and cer:fied nursing assistants) in LTC facili:es are inadequately prepared in end of life (EOL) care (Wholihan & Anderson, 2013). Residents in LTC facili:es where nursing staff receive educa:on on EOL care and communica:on receive beber EOL care (Temkin-Greener, 2009). Few studies focus on improving EOL educa:on of cer:fied nursing assistants (CNAs) in LTC facili:es. The impact of EOL educa:on of nursing staff on rates of advance direc:ves among LTC residents is unknown. IMPLICATIONS FOR NURSING PRACTICE Nursing Staff Demographics Nursing staff of both units was mostly female, and predominantly African American. > 50% of nursing staff had 6 or more years experience. Nursing Staff Knowledge of EOL 67% of CNAs had increased post-educa:on test scores, 33% remained the same. 36% of nurses demonstrated an increase in post- educa:on test scores, 46% remained unchanged, and 18% had decreased scores (Fig.1). Nursing Staff Self-Evalua6on Post-educa:on EOL knowledge was rated higher (Fig. 2). More than 80% of nursing staff related that the educa:on would change their prac:ce “quite a lot”. LTC Resident Demographics Urban LTC: Predominantly male, African-American, ages ranged from 38-91 years. Suburban LTC: Predominantly female, Caucasian, ages ranged from 29-104 years (Table 1). Resident Outcomes Pre-educa:on: 70 residents had an advance direc:ve. Post-educa:on: 73 residents had an advance direc:ve. = 2.15% increase in rate of AD Pre-educa:on: 16 residents transferred to Hospital/ED. Post-educa:on: 9 residents transferred to Hospital/ED. = 43.8% decrease in rate of transfers to Hospital/ED. CONCLUSIONS EOL knowledge competencies of nurses and CNAs improved aler receiving educa:on. Documenta:on of resident EOL preferences improved minimally, and rate of transfers to the hospitals was drama:cally reduced. CNAs benefit from combined educa:on sessions with the nurses. Need strategies to empower nurses and CNAs to ac:vely par:cipate in EOL discussions in LTC facili:es. Ins:tu:onal DNR policies addressing the role of nursing staff in EOL discussions should be developed. Rutgers University School o f Nursing To examine whether EOL knowledge of nurses and CNAs improves aler receiving educa:on in EOL communica:on. To examine whether there is a related increase in the rate of LTC residents with advance direc:ves, and a decrease in the rates of the residents’ transfers to the Emergency Department (ED) and hospital. Table 1: LTC Resident Demographics increased 36% unchanged 46% decreased 18% Nurses’ Post-Educa6on Test Scores increased 67% unchanged 33% CNAs’ Post-Educa6on Test Scores 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-evalua6on of EOL Knowledge Rate knowledge aler educa:on 0 2 4 6 8 10 12 14 Excellent Good Sa:sfactory CNAs' Self-evalua6on of EOL Knowledge Rate knowledge aler educa: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

Transcript of IMPROVING RESIDENT OUTCOMES BY EDUCATING...

Page 1: IMPROVING RESIDENT OUTCOMES BY EDUCATING ...dnpconferenceaudio.s3.amazonaws.com/2016/Posters/KunteV...Empowering nursing assistants to improve end-of-life care. Journal of Hospice

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