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