B. Education of health care students and professionals
A. Pre-service training of staff
No matter how well qualified and experienced in palliative care, new staff members should be expected to 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.
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
- Relationship with other health professions
- 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
Different disciplines may need additional subjects, depending on their work, past experience and the responsibilities they will have :
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Ward routines
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Team meetings
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Communications between teams and their members
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Data collection and record systems
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Meals and food handling
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Drug storage, handling, administering and records
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Working with syringe drivers, nebulisers and iv. lines
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Policy with regard to DNR orders, CPR, euthanasia and PAS
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Issues related to visitors, counselling and giving information
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Discharge planning and policy
In-service staff training
Topics that might usefully be included in sessions held every 6 - 8 months include:
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Update on the statistics of the service
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Therapeutic advances
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Changes in therapeutic routines
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New clinical and management routines
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New legislation and regulations
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Staff changes
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Local and national developments in palliative care
In addition members of staff may be sent for further training in patient handling, counselling, teaching technology and methodology, 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 provided 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, 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.
B.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 doctors 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 if when the palliative care service itself is being planned.
Key questions to be asked in the early planning days
Who will need such education?
The answer is
- medical students
- family physicians
- oncologists and surgeons
- trainee specialists
- hospital nurses
- community nurses
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- clinical pharmacists
- clinical psychologists
- pastoral care workers
- interested social workers
- some therapists
- Nurse tutors
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It is immediately apparent that a decision will need to be made about priorities! (see later).
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.]
Will there be bedside instruction?
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.
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
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A room to hold 25-30 with comfortable seats
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At least one smaller room to hold up to 10
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The ability to darken the rooms for films, slides, etc.
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A slide / PowerPoint projector
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An overhead projector
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A screen or a wall made to act as a screen
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A suitably equipped office for tutors and clerical assistants
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A library for journals and textbooks (essential, not a luxury)
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A DVD / video cassette recorder and player
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A laptop computer
Useful but note essential is a heated food trolled for serving meals.
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 doctors, senior nurses, therapists, pastoral care staff and social worker a very 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
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not to duplicate what others are doing (and probably doing well)
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not to do what someone else can do equally well (For example it does not need a palliative medicine physician or nurse to teach ethics, spirituality or communication skills just because they are important in this work)
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not to take on an educational project solely because it is prestigious (For example running a degree course useful for few people)
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only teach a group or subject for which there are the necessary skills in the education team (Remember that most doctors and nurses have not had any training in teaching techniques and methodology).
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, USA, Canada, Hong Kong, Australia and New Zealand, Singapore, Taiwan and many other countries. There is not 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, Help the Hospices and the IAHPC. They are often called "Teaching the Teachers" courses. In that short time future teachers / lecturers learn
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how to prepare lectures and talks,
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how to produce and use PowerPoint slides
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how to give public lectures
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how to set examinations
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how to do “role play”
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how to conduct workshops and discussion groups
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how to evaluate their teaching and courses
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how and when to use acetates
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how to use “hand-outs”
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how to conduct interviews
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when to use didactic teaching, small groups, one-to-one, workshops, role play and discussion groups for different subjects and students
Who makes the decisions about who 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
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deciding what courses and study days to run
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deciding the content of the courses and study days
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estimating the financial implications
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defining the target audiences
Are external advisers useful?
Mention is made 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 an 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?
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Trying to do too much with very limited human resources
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Trying to teach subjects in which you have insufficient experience
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Using members of staff eager to help but without being able to supervise them or monitor their input
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Making the teaching too sophisticated rather than keeping it simple
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Assuming that the ‘students’ (even long qualified) have more knowledge or experience than is the case
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Forgetting that the clinical staff helping with education have fulltime, stressful jobs as well as teaching
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Leaving the senior tutor / lecturer isolated without sufficient support or well-defined lines of accountability
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Under funding the educational work
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Expecting large amounts of money to come in from course fees, study days and conferences
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Failing to win the hearts of the pharmaceutical industry to subsidise / under pin educational events
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Failing to send key staff members to as many relevant courses in their specialties as possible.
Is it a useful thing to have junior medical and nursing staff (and even experienced family physicians) working in the hospice / palliative care service to gain valuable experience?
This question can be left until the service is up and running. The experience can be a very valuable one for them, and their contribution to the service a useful one but they must be supervised, taught, have time to ask questions and to study, and statutory time off .That can add greatly to the work load of the senior professional staff.
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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