Orientation, Training and Education

Orientation

All staff about to start work in a new hospice/specialist palliative care unit will need orientation and training in two subjects:

The new unit – how it will operate

All new staff members should be in possession of the Staff Handbook before coming to these tutorials. The aim of the classes is to familiarise them with how the unit will be operated daily. The topics will include:

The Staff Handbook

Each hospice/palliative care unit must produce its own handbook to be given to every member of staff whether they work at the bedside or in the background, whole time or part-time. It will not be the same as the Useful Information for Patients and Visitors Booklet which will be described later. The two will have several sections in common, however.

Staff need to know about the following (not listed in any priority)

Training

Pre-service training of staff

No matter how qualified and experienced in palliative care, new staff members should have a short period of training before they start work in the palliative care service, whether it is an in-patient one, a community one or a day care unit. For some it need be no more than a few days, for others less experienced, 3-4 weeks. So important is administration and management, this applies also to non-clinical staff whose courses will be tailored to their need.

The need for this aspect of preparation to be clinical and practical rather than theoretical and academic cannot be sufficiently stressed. Each new staff member must be left in no doubt that the unit will aim for the highest possible standard of care, something that is achievable when everyone works as a team.

Experience has shown that most professionals coming into this work feel that they know much of it already, only to be surprised at how little they know and must now learn. Again, experience suggests that teaching mixed professional groups (e.g. doctors and nurses) can be profitable and, some sessions conducted by both a doctor and a nurse, are a timely reminder of the mutual dependency and valuable cooperation possible in palliative care.

There is no need to develop a palliative care manual. There are many available in print and some may be downloaded from the internet (such as the IAHPC Manual on this website). Having such a resource facilitates standardisation of care on evidence-based principles.

The topics covered should include:

  • The principles of palliative care
  • The philosophy of the service
  • The management structure of the service
  • How the service operates
  • Communications within the service
  • Confidentiality
  • Legal aspects of work in the service
  • Day to day routines, paperwork, etc
  • Staff support mechanisms in the service
  • Health and safety regulations and routines
  • Security matters
  • Relationship with other health professions

Different disciplines may need additional subjects, depending on their work, experience, and the responsibilities they will have:

  • Ward routines
  • Working with syringe drivers, nebulisers and iv lines
  • Communications between teams and members
  • Data collection and record systems
  • Team meetings
  • Meals and food handling
  • Policy regarding DNR orders, CPR, euthanasia, and PAS
  • Issues related to visitors, counselling and giving information
  • Discharge planning and policy
  • Medication storage, handling, administering and records

In-service staff training

Topics that might usefully be included in sessions held every 6 - 8 months include:

In addition, members of staff may be sent for further training in patient handling, counselling, teaching technology, computer skills, bereavement work, time utilisation, and other topics raised by members of staff with their line managers.

If, as is recommended, each member of staff has a record book covering all the time they work in the palliative care service (in addition to records routinely kept on data bases of management). They can record all the additional information felt needed, and then raise it in their in-service study days.

Tutorial staff for pre-service and in-service training

All the above training can be organised and taught by heads of departments – nursing, medical, and administration. It need not be the responsibility of education staff.

Training for volunteers will always be under the direction of the Volunteer Service Manager (VSM) with co-opted tutors for special topics. [See separate chapter]

Education

Education in the palliative care unit for health care professionals

It is common for those planning a palliative care service to focus exclusively on the clinical aspects of the work and to ignore education. Only after the clinical work has been progressing for several years do they begin to think about their responsibility to educate others. This is a bad policy. The palliative care needs of the world will only be met when sufficient physicians and nurses are aware of and practise its principles. Education needs advance planning, space allocation, appropriate staffing, budgeting, equipment, and well negotiated cooperation with other educationists. The time to start planning is when the palliative care service itself is being planned.

When training others in palliative care the most difficult task is to change attitudes and to acquire the right communication and practical skills. So practical training is a vital part of the education project and an in-patient unit is the place where this can best be done. Indeed, it can be questioned whether any palliative care service should ever be started if there are no plans to engage in education and training.

Key questions to be asked in the early planning days:

Which professional groups will need to be taught?

  • medical students
  • family physicians
  • oncologists and surgeons
  • trainee specialists
  • hospital nurses
  • community nurse
  • clinical pharmacists
  • clinical psychologists
  • pastoral care workers
  • Social workers
  • Some therapists
  • Nurse tutor

It is immediately apparent that a decision will need to be made about priorities! (see later).

Which kind of teaching?

At this stage of planning this decision need not be made except if there is a question about a tutorial room being provided near the patient care area. It can often be multi-functional doubling as a team meeting room, a library reading room.

It might be clinical (using patients and at the bedside), theoretical in a tutorial room or in the community in patient’s homes.

The talks/lectures might be formal didactic or informal workshops and discussions. They each need different types/sizes of rooms. Contrary to what many people say, patients in hospices and palliative care units much appreciate being asked to speak with and share their experiences and insights with students and are highly effective teachers.

What space and equipment will be needed for educational activities?

This is a crucially important question at the planning stage.

Ideally there needs to be:

It should be noted that the lecture room provided its use is well planned, can be used for staff meetings, committees, research groups, board meetings, fund-raising events, and much else in addition to its educational role.

What staff will be needed?

Provided use is made of the clinical and teaching skills of physicians, senior nurses, therapists, pastoral care staff and social worker a large comprehensive educational programme can be run with

How will this education relate to other educational centres?

When there are so few palliative care workers and so many to educate and train it is essential to use the limited resources carefully and

In other words, find what others are doing. Identify gaps in education n and training. Find if you can employ staff able to fill those gaps. Start small and let the work grow.

Other questions often asked at this planning stage

Are there curricula and syllabi already available?

Yes, look at the websites listed in 'Getting Started'. Excellent syllabi have been drawn and are in use in Europe, Asia, Africa, Eastern Europe and Latin America. There is no need to produce a new one for your unit!

How can doctors and nurses learn how to teach?

Several short courses (1-2 weeks in length) are run for this purpose. Details can be obtained from national palliative care organisations and the IAHPC. They are often called 'Teaching the Teachers' courses. In that short time future teachers/lecturers learn

Who makes the decisions about whom to teach and train?

Ideally there should be an education team/committee/group within every hospice/palliative care service. The members would be the senior doctor, the senior nurse, the tutor, and a manager. They should have the responsibility of

Are external advisers useful?

Much is said elsewhere in 'Getting Started' of the benefits of having a Professional Advisory Committee (PAC) for all clinical and professional matters. A subgroup of the PAC can act as education and training advisors, just as yet another small group can advise on research. Having such external experts to advise also raises the profile, credibility, and authority of the hospice/palliative care service when fellow professionals and academics see the calibre of those lending it their support and expertise. It is seldom difficult to recruit them for terms of service not exceeding three years.

What are the dangers and 'risk' implications of doing educational work?

Is there one message that best describes the aim of education and training in palliative care for health care professionals?

Yes. Strive to change attitudes rather than instilling facts and figures.

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