IMPROVING RESIDENT OUTCOMES BY EDUCATING...
Transcript of IMPROVING RESIDENT OUTCOMES BY EDUCATING...
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