Enhancing the Educational Capacity of Rural Nursing Care Providers
to Care for Patients and Families with Serious Chronic Illness
What is BCNRI?
As our population ages it is important for the nursing workforce, regardless of their context of work, to provide high-quality supportive care for persons with chronic life-limiting illness. Incorporating supportive principles early in a person’s illness trajectory and within the context of primary health care allows for care providers to engage in discussions around goals of care, to address needs related to symptom management and to provide psychosocial, spiritual and practical support. This approach has been referred to as a palliative approach to care and in our previous research studies we have learned that many nurses in rural areas do not feel prepared to provide this specialized care within their generalist model of rural health care delivery.
The goal of this study was two-fold:
- to use the best evidence to develop curriculum and provide education to Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and health care assistants (HCAs) from residential, community and acute care
- to provide an adapted version of the curriculum from phase 1 for students taking their undergraduate nursing degree and students in a HCA program, as well as to pilot an innovative clinical experience, for the students to practice collaboratively and establish competency in providing supportive care for older adults living at home with advanced chronic illness
Objective 1. A curriculum was presented in two separate 1.5 day workshops in which RNs, LPNs and HCAs came together to learn the principles of a palliative approach. After the workshop, follow up sessions were offered to participants, some of which took place in person and some via teleconference. In these sessions, participants had an opportunity to discuss what they learned at the workshop and how they saw it unfolding in their different workplaces. To evaluate the education, the participants completed surveys before and after the education in which they rated their attitudes and competencies. At the conclusion of the study, participants were invited to take part in interviews to share their experiences receiving the education.
Objective 2. A curriculum was presented in a 2-day workshop in which third- and fourth-year undergraduate nursing students and HCA students came together to learn the principles of a palliative approach. A smaller cohort of these students then collaborated together, under the supervision of a clinical field instructor, to visit individuals and families in the community who were living with a serious chronic illness to learn if there were ways in which the students could support them. As well, the nursing students who took part in the clinical experience with individuals and families in the community were able to reflect on a palliative approach in a medical unit following their community experience. To evaluate the education, all the students who took part in the workshop and those who took part in the supervised clinical experience were asked to complete a survey before the workshop, immediately following the workshop and a final survey when the students completed their clinical experience under the supervision of the clinical field instructor. At the conclusion of the study all the participants, including the individuals and families in the community living with a serious, chronic illness, were invited to take part in interviews to share their experiences being part of the project.
Project Conclusion
Findings from this research suggest that an educational workshop can improve RN and HCA students’ self-perceived competence and knowledge in caring for those with advanced chronic illness. Further, an innovative clinical experience can maximize reciprocal learning while providing nursing services to a population that is not receiving home-based care.
Funding
Funding for this project was provided by MSFHR’s BCNRI program that was established to enhance BC’s capacity for excellent nursing research and build connections between researchers, health care providers, and policy-makers.