Mayrhofer Andrea, Goodman Claire, Smeeton Nigel, Handley Melanie, Amador Sarah, Davies Sue
Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
Marie Curie Palliative Care Research Department (MCPCRD), University College London (UCL), formerly Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK.
BMC Palliat Care. 2016 Jan 22;15:11. doi: 10.1186/s12904-016-0081-z.
The ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care. An evaluation that compared this programme with the Gold Standards Framework found that it achieved equivalent outcomes at a lower cost with higher levels of staff satisfaction. To consolidate this learning, a facilitated peer education model that used the ABC materials was piloted. The goal was to create a critical mass of trained staff, mitigate the impact of staff turnover and embed EoL care training within the organisations. The aim of the study was to evaluate the feasibility of using a train the trainer (TTT) model to support EoL care in care homes.
A mixed method design involved 18 care homes with and without on-site nursing across the East of England. Data collection included a review of care home residents' characteristics and service use (n = 274), decedents' notes n = 150), staff interviews (n = 49), focus groups (n = 3), audio diaries (n = 28) and observations of workshops (n = 3).
Seventeen care homes participated. At the end of the TTT programme 28 trainers and 114 learners (56% of the targeted number of learners) had been trained (median per home 6, range 0-13). Three care homes achieved or exceeded the set target of training 12 learners. Trainers ranged from senior care staff to support workers and administrative staff. Results showed a positive association between care home stability, in terms of leadership and staff turnover, and uptake of the programme. Care home ownership, type of care home, size of care home, previous training in EoL care and resident characteristics were not associated with programme completion. Working with facilitators was important to trainers, but insufficient to compensate for organisational turbulence. Variability of uptake was also linked to management support, programme fit with the trainers' roles and responsibilities and their opportunities to work with staff on a daily basis.
When there is organisational stability, peer to peer approaches to skills training in end of life care can, with expert facilitation, cascade and sustain learning in care homes.
“ABC临终关怀教育项目”对约3000名养老院工作人员进行了临终关怀培训。一项将该项目与“黄金标准框架”进行比较的评估发现，它以更低的成本取得了同等的效果，且工作人员满意度更高。为巩固这一经验，采用“ABC”材料的同伴促进教育模式进行了试点。目标是培养足够数量的训练有素的工作人员，减轻人员流动的影响，并将临终关怀培训融入各机构。本研究的目的是评估使用培训培训师（TTT）模式来支持养老院临终关怀的可行性。
采用混合方法设计，涉及英格兰东部18家有和没有现场护理的养老院。数据收集包括对养老院居民特征和服务使用情况的审查（n = 274）、死者记录（n = 150）、工作人员访谈（n = 49）、焦点小组（n = 3）、音频日记（n = 28）以及对工作坊的观察（n = 3）。
17家养老院参与其中。在TTT项目结束时，已培训了28名培训师和114名学员（占目标学员人数的56%）（每家养老院的中位数为6人，范围为0 - 13人）。三家养老院达到或超过了培训12名学员的既定目标。培训师包括高级护理人员、辅助工作人员和行政人员。结果表明，就领导力和人员流动而言，养老院的稳定性与该项目的参与度之间存在正相关。养老院的所有权、养老院类型、规模、之前的临终关怀培训以及居民特征与项目完成情况无关。与促进者合作对培训师很重要，但不足以弥补组织动荡。参与度的差异还与管理支持、项目与培训师角色和职责的契合度以及他们日常与工作人员合作的机会有关。
当存在组织稳定性时，在专家促进下，临终关怀技能培训的同伴互助方法能够在养老院中逐步推广并持续开展学习。
