The Palliative Care Training Program for Caregivers; Culture Change Training for Care Teams
To order this product, contact:
Mary Hamil Parker, Ph.D.
MKHP Associates, L.L.C
820 Gibbon Street, Suite 206, Alexandria, VA 22314
Phone: (703) 519-8621;
Toll Free: 888 650-0024
Fax: (703) 683-3759
Product Web Site: N/A
A multimedia training package to improve caregivers' palliative care.
$250 per one-hour training module CD/DVD
CD-ROM, Power Point; Distance Learning
Who Is This Product For?
Employers in long term care, assisted living and senior housing, who want to implement culture change and person-centered care teams.
Where Is This Product Supposed to Be Used?
Senior Housing, Continuing Care Retirement Communities, Assisted Living, Home health agencies; hospices; nursing homes; hospitals; community colleges interested in distance training programs.
Outstanding Achievement Award: Commonwealth of Virginia,1998
- Parker, Mary Hamil. "Palliative Care Gets Person-Centered", Pioneer Network, Spring 2006
- Workshop: ¿Culture Change Training¿, Pioneer Network Conference, Philadelphia, PA August 3, 2006. Paper, ""A Quality Palliative Care Training for Direct Care Staff"", UICC World Cancer Congress, Washington, D.C., July 11, 2006. Paper,¿Palliative Care Training for Direct Care Workers¿, Kaleidoscope Conference, St. Francis Hospice, Dublin, Ireland, May 30, 2006.
Organizations/Consortium Worked with During Project
Northern Virginia Community College, Alexandria Campus, Alexandria, VA.
Commercial Collaborations/Actual Purchasers
Institute for Palliative & Hospice Training, Inc., Alexandria, VA.
Goodwin House Foundation, Alexandria, VA., 9-hour training for 52 staff, Nurses, Nurse Aides, Social Work, Chaplian, Dietary, Maintenance, Housekeeping, Beauticians, 2005
Patent, License, Trademark
Societal or Research Contribution/Success Story
Fan Fox and Leslie R. Samuels Foundation Research Project Institute for Palliative & Hospice Training, Inc.; Principal Investigator: Mary Hamil Parker, PhD
EXECUTIVE SUMMARY: "Testing and Evaluating the Effectiveness of Palliative Care Training Received by Paraprofessionals"
This research was conducted under a grant from the Fan Fox and Leslie R. Samuels Foundation in eleven New York City nursing homes from February 1, 2001 to February 28, 2002.
The research proved that the Palliative Care Training program is measurably effective in teaching nursing assistants and nurses to communicate the care needs of nursing home residents. It demonstrated that the 5-POINT Guide to Communication and palliative care indicator reporting provide a systematic form of communication that results in intervention by a physician or a nurse. This result verified the research hypothesis that paraprofessional caregivers could be trained to provide significant information for clinical care in nursing homes. Post-test training evaluations demonstrated positive improvement at a statistically significant level of change (p=.000), in observation and reporting skills, without regard to the trainees' ethnicity or native language, level of education or work experience. Four months after training evaluation found that a majority of trainees reported daily use of the 5-POINT Guide and indicator reporting. The observation and reporting process created by the training enhanced attitudes vital for employee retention, such as a sense of providing better care, and finding caregiving work more interesting and rewarding.
Under the Fan Fox and Leslie R. Samuels Foundation initiative directed to "moving palliative care upstream" in the care continuum, the Institute for Palliative & Hospice Training, Inc. evaluated and validated the effectiveness of a specialized training program for paraprofessionals and other caregivers. The Palliative Care Training program teaches a method, based upon clinical research material, of observing and reporting the care needs of patients and families. This training method and curriculum were developed by MKHP Associates, L.L.C. of Alexandria, VA., under a Small Business Innovation Research grant from the National Cancer Institute, National Institutes of Health, (2R42CA73284-04). MKHP Associates contracted with the Institute to conduct the evaluation research.
The Palliative Care Training program is intended to be an advanced level of training. The Training implements the theory that because paraprofessional caregivers (Nursing Assistants and Home Care Aides), provide the most frequent and intimate care to individual residents/patients, they are in the best position to observe the changes in a resident that signal new symptoms, pain or other problems. The Training is based on the four domains of quality of life (physical, psychological, social and spiritual) and provides information based on clinical research about pain and symptoms, psychological, social and spiritual needs. The Training Program meets new requirements to treat pain as the "fifth vital sign" and staff training requirements of the Joint Commission on Accreditation of Health Care Organizations (JCAHO). The training can be used to meet in-service requirements under Medicare/Medicaid.
The Palliative Care Training program implements a method based upon case studies and the 5-POINT Guide to Communication which teaches caregivers how to organize their observations and how to report these in a concise, systematic and consistent way that provides the information needed for nurses and other members of the interdisciplinary care team to follow up with assessment and care. The program places equal emphasis on pain and other symptoms and the psycho-social and spiritual needs of patients and families. The 5-POINT Guide helps caregivers to organize their observations and to report these in a concise, systematic and consistent way that provides the information needed for nurses or physicians to take action.
The Institute's research was conducted at 11 nursing facilities in New York City, most of which were accredited by the Joint Commission on Health Care Organizations (JCAHO). Six hours of palliative care content training was given to 84 nursing assistants and to 70 nurses, interdisciplinary care team members and other staff. The training reviewed how nursing assistants would report their observations on a two-page Palliative Care Indicator Report attached to the accountability report they completed daily about care to individual residents.
SUMMARY OF RESEARCH FINDINGS:
Post-test training evaluation showed 87 percent of nursing assistant trainees had positive improvement in understanding and application of observation and reporting skills. This change exceeded chance by over a thousand to one (p=<.000). The greatest change occurred with trainees who had low scores on the pretest. Data analysis showed that personal traits of trainees did not influence response to the training and the training was equally effective with trainees of different ethnic backgrounds, language, level of education and experience. Of the 84 nursing assistant trainees, 70 percent were African-American/American Indian; 88 percent were born outside the United States; 47 percent graduated from high school; 40 percent had some college, and 56 percent had 10 or more years of experience in long-term care.
Data was collected from 148 Palliative Care Indicator reports, affecting 109 residents, of whom 72 percent had a diagnosis of dementia and 61 percent required total care. The Indicator Reports were the first time the nursing assistants had recorded reports of pain and symptoms. Pain was the single most frequent indicator reported, 30 percent. The 22 symptom categories totaled 56 percent of reports. The 7 psychosocial indicators represented 24 percent of reports, including sadness and depression, 14 percent. There were four reports of spiritual needs. The majority of reports indicated multiple symptoms or needs, which often were reported over several days. Many of these indicator reports were followed immediately by one or more interventions by clinical staff and documented in case records with a note of a nursing assistant's report. Clinical responses were pain medications, 22 percent, medications or treatment of symptoms, 56 percent, and medications, treatments or case note responses for psychosocial symptoms, 20 percent. Several nursing assistants reported indicators of approaching death for residents who died unexpectedly.
On a post-research evaluation questionnaire, about three-fourths of nursing assistants stated they used the 5-POINT Guide reporting method daily, that the reporting process made it easier to report to nurse supervisors and that it had made them much more aware of resident needs. Over 80 percent said reporting helped them give better care to residents, while over 70 percent said it made their work more interesting and rewarding. Of most importance, 98 percent of the nursing assistants said they would continue to observe and report resident palliative care needs. Over one-third of the nursing facilities continue to use the Palliative Care Indicator Report as part of resident care documentation, at the request of nurses and nursing assistants.
Palliative Training for Caregivers of Cancer Patients
The aim of this project was to team with Northern Virginia Community College to produce a multi‑media training package incorporating recent research and techniques to assist cancer patients to improve their functioning, better communicate symptoms to improve pain and symptom management, and enhance their quality of life. This program is for use by community colleges, long term care facilities and hospice programs to train paraprofessionals, volunteers, and family caregivers. Phase I will research and develop a detailed training program outline, including descriptions of multi‑media training elements to be developed in Phase II. Expert Panel approval of the training program outline and criteria for evaluating the training program will prove the feasibility of Phase II. In Phase II, multi‑media materials to implement the training program and a train‑the‑trainer module will be produced. The training package will be tested in classes at a community college, long term care facilities and hospices. Trainee knowledge and skills performance will be evaluated. The products to be marketed in Phase III will be a multi‑media training package consisting of: a palliative care and hospice training curriculum and a train‑the‑trainer module for instructors.
Mary Hamil Parker, Ph.D.
Mary Hamil Parker, Ph.D., Managing Director, MKHP Associates, L.L.C., was the small business owner and Principal Investigator of Phase II of the Palliative Care Training Project funded by the NCI. She has over 30 years of research experience in senior housing, long-term care, and health care training.
The Phase I STTR was awarded to Dr. Parker’s sole proprietor company: Senior Housing Research Group (SHRG), Alexandria, VA, in 1995. In 1996, MKHP Associates, L.L.C., a woman-owned, small research firm received the Phase II STTR Grant. MKHP Associates specializes in programs for elderly community residents, technology and passive monitoring applications, as well as training programs for health care staff. In 2000, Dr. Parker founded the Institute for Palliative and Hospice Training, Inc., a 501(c) 3 non-profit foundation, to conduct the training programs developed by MKHP Associates under the STTR grant.
MKHP Associates has received positive recognition and support for the STTR research, stemming from presentations at a number of national and international conferences. These include: The Pioneer Network,The National Association for Home Care, The American Association of Hospices, The National Hospice and Palliative Nurses Association (HPNA), the National Hospice and Palliative Care Organization (NHPCO), National Council on the Aging (NCOA), American Association of Homes and Services for the Aged (AAHSA), The Gerontological Society of America (GSA), the Alzheimer’s Association International, Hospice of Ireland, International Association of Homes and Services for the Aged and the UICC World Cancer Congress. MKHP Associates received an Outstanding Achievement Award in 1998 from The Office of the Secretary of Technology for the Commonwealth of Virginia.
Research Team & Affiliations
• Margaret E. Larose, MSN, RN. Principal Investigator, SHRG
• Carmen Burrows Goodman, M.Ed. Northern Virginia Community College Program Administrator,
• Mary Hamil Parker, Ph.D., Evaluation Director, SHRG
• Mary Hamil Parker, PhD. MKHP Associates, LLC
• Carmen Burrows Goodman, M.Ed. Northern Virginia Community College Program Administrator
• Madelon O’Rawe Amenta, DrPH, Hospice Nurses Association;
• Rita Munley Gallagher, Ph.D., RN.C. American Nurses Association;
• Gerald Holman, MD, Chief of Staff, Veterans Administration Medical Center, Amarillo, TX, Academy of Hospice Physicians,
• Jeanne Martinez, Ph.D., Hospice and Palliative Nurses Association.
Provide a method of enhancing the quality of palliative care for cancer patients.
Increase the knowledge and skills of caregivers providing hands-on-care to cancer patients in assisting health professionals in pain management and palliative care.
Promote better interaction and functioning of paraprofessional and family caregivers as the conduit for information required by professionals in care planning and symptom management.
Develop, test and demonstrate ad curriculum, implementing multi-media applications and self-learning methods.
Direct caregivers—Certified Nurse Aides, Home Health and Hospice Aides—are the eyes and ears of the clinical care team and are in the best position to provide person-centered palliative care.
Development of a training curriculum implementing adult learning principles and problem-based learning, using case study examples and self-directed learning in application of a targeted communications method and based upon research-based clinical information. Testing the curriculum modules in face-to-face and distance training sessions.
Final Sample Size & Study Demographics
Between 1998 and 2001, the project provided direct face to face or distance training programs to a total of 452 people, located in Virginia, Maryland, Tennessee, Georgia and the District of Columbia. Two distance learning programs were presented at a total of nine sites by the two programs. One program linked sites on the Eastern Shore of Virginia, Alexandria, Richmond and the Tennessee/Virginia Mountain border.Evaluation data was collected from 80 distance trainees and six month post training data, was received from 33 trainees, 41 percent.
Training was provided for 22 hospices (61%); 8 Home Health Agencies (22%); 5 Nursing Homes (14%) and one Assisted Living facility. The positions of those trained were: CNA, 36%; RN, 17%; LPN, 11%; Patient Care Volunteer, 12%; Home Health Aide, 9 %; Home Health Aide/CNA, 6%; Other, 8% and No Answer, 1%. Demographics: Gender: Female, 88%; Male, 6%; No Response, 6%. Ethnicity: White, 52%; African-American Black, 38%; Hispanic, 1%; Asian-Pacific Islander, 1%; American Indian-Alaskan, 1%; Other, 4%; No Answer, 3%.
Data Collection Methods
Evaluations were received from site trainings. Forms were completed by 452 people who received one or more of the curriculum training presentations.
Evaluations of the two separate two-hour distance training programs on Observing and Reporting Pain and Other Symptoms were received from 80 participants. Because the names of trainees were available from agency registration lists, it was possible to send a post-evaluation to each agency, with individual letters addressed to the trainees requesting that they complete the evaluation and return in the enclosed addressed envelope to MKHP. Employers were asked to distribute the evaluations and collect them for return. If the trainee had left the agency, it was not possible to obtain a post-evaluation. Post evaluations were received from 33 trainees, 41% of the original trainee group.
In the post-training evaluations, participants were asked to answer seven questions scored on a 1 to 5 scale, with 1 being the lowest score and 5 the highest.
The questions were:
1) Did you learn something in this session you will use in your job? (1 Nothing............................... 5 A Lot)
2) Were the handout materials easy to read and understand? (1 Not easy...............................5 Very Easy)
3) Did the case examples help you to understand more about the topic?
(1 Not Helpful..........................5 Very Helpful).
4) Did the case examples help you learn to use the 5-POINT Guide?
(1 Not Helpful.........................5 Very Helpful).
5) Will you use the 5-POINT Guide when reporting patient/family needs? (1 Not use................................5.Always use)
6) Will using these materials make it easier to communicate with other staff? (1 Not easier............................5 .Much Easier)
7) Would using these materials help provide better care for patients at the end of life? (1 Not helpful...........................5 Very Helpful)
In the face-to-face trainings, participants evaluated the training experience and utility of training principles in daily care. The same data was received for all training programs presented. Since several different programs were offered at the same sites, evaluations of different programs were received from the same trainees. However, due to human subjects requirements, none of the participants in any of the training programs were identified by name. Therefore, it is not possible to do an extensive analysis of these data due to overrepresentation of some participants and groups.
Since the training was particularly targeted to paraprofessional health care staff and also to health care staff without experience in hospice, separate analyses were done by employment position and work experience. The response of paraprofessionals to the program materials and the use of the 5-POINT Guide was very favorable. The training was well received and perceived as useful by the majority of Home Health Aides and Certified Nurse Aides, particularly those with no work experience in hospice. Hospice nurses, RN and LPN, were least likely to find the training useful. An analysis of variance showed significant differences between responses of nurses with no hospice experience and those with hospice experience. Nurses with no hospice experience considered the training useful in their jobs, the case studies helpful in understanding the topics and in learning to use the 5-POINT Guide and the materials contributing to easier communications with other staff. In general, nurses were less interested in using the 5-POINT Guide, comments indicated that some felt they were already using this method. High assessments were received from the new hospice volunteers trained by the project. New volunteers and those with 4-16 years of hospice experience more highly ranked the training, usefulness of materials and 5-POINT Guide then did volunteers with 1-3 years of experience.
Evaluations of the two separate two-hour distance training programs on Observing and Reporting Pain and Other Symptoms were overwhelmingly positive. In the evaluation at the time of the training, 78 percent of trainees said they would use the 5-POINT Guide when reporting patient/family needs. In the post-evaluation responses to the evaluation questions, 57 percent reported using the 5-POINT Guide to Communications 50 percent or more of the time when reporting patient and family needs. Of these, 54 percent said using the 5-POINT Guide helped them to provide better care for patients at the end of life. This is a very encouraging result from a single two-hour training with no additional follow-up or reinforcement.
Barriers & Solutions
One of the major barriers encountered was the inability to do more distance learning presentations, as a result of a change in transmission software by the Virginia Department of Education, which eliminated interactive multi-point presentations. A solution was not available during the remainder of the project.
Products Developed from This Research