Authors (including presenting author) :
Ng NHY(1), Chan CWH(4), Tsang WY(2), Man SL(3), Kung KN(2), Lam WM(3)
Affiliation :
(1)Nursing Services Division, (2)Department of Medicine and Geriatrics, United Christian Hospital, (3)Department of Medicine, Haven of Hope Hospital, (4)The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
A significant proportion of deaths occur in acute care wards in Hong Kong, nurses working in acute care settings(ACS) are expected to provide end-of-life(EOL) care and play important roles to initiate advance care planning(ACP) and act as decision coaches. However, nurses in ACS have a low involvement in ACP discussions due to limited training in ACP and EOL care conversation, therefore, a multi-media experiential ACP(MEACP) training programme guided by Theory of Planned Behaviour and experiential learning model was developed.
Objectives :
To examine the effectiveness of a multi-media experiential ACP(MEACP) training programme.
Methodology :
A cluster randomised controlled trial was adopted. Intervention group received the MEACP training programme including a mobile application, a training workshop with mini-lectures, role play with standardised patients and reflective journaling. Control group received a usual ACP training workshop. Outcome measures were nurses’ skill performance on decision support, attitude towards ACP, knowledge about ACP and advance directive(AD), level of confidence to conduct ACP, and actual experience in ACP discussion. Nurses’ utility of the online training component, their level of involvement and responses to the activities, and satisfaction with the training programme were also evaluated. The generalized estimating equations(GEE)model was used to compare the differential changes in each of the outcome variables between groups at T1(within 1-week post-intervention) and T2(12-week post-intervention) with respect to T0(baseline).
Result & Outcome :
From July 2020 to February 2021, 42 nurses from four medical and geriatric wards of United Christian Hospital and Haven of Hope Hospital participated in the study. Except gender, no significant difference in baseline outcome variables was detected between groups(all p>0.05). Intervention group had significantly greater improvement in nurses’ skill performance on decision support at T1 (p<0.001). Both groups had significant improvement in all outcome measures at T1(p≤0.001) and the improvement in the knowledge and confidence scores were still significant at T2(p<0.05). Control group had increased overall number of ACP discussions with patients in the past 12 weeks at T2(B=0.74) but no significant difference found between groups(p>0.05).Over 90%participants showed high levels of attention and interest in the workshop and nearly all participants(98%) gave positive response to the satisfaction survey. Conclusion: The MEACP training programme for nurses in ACS has positive effect in improving nurses’ performing skills, attitude, knowledge, and confidence in supporting patients’ decision-making on ACP. A future full-scale study with more sample is recommended.
