Congress Abstracts 2003

23

TESTING OUTCOMES OF PALLIATIVE CARE AND SYMPTOM MANAGEMENT TRAINING FOR PARAPROFESSIONALS (NURSING ASSISTANTS AND HOME HEALTHCARE AIDES) IN THE NURSING HOME AND REHABILITATION SETTING. Barbara Joyce Murphy, RN, MN, AOCN^®, Self-employed, Ashburn, VA; and Mary Hamil Parker, PhD, Institute for Palliative and Hospice Training, Inc., Alexandria, VA.

Paraprofessional caregivers (nursing assistants and home health care aides) provide the most frequent and intimate care to individual patients in nursing homes and are in the best position to observe changes in a resident that signal new symptoms, pain, or other problems. Eighty-four nursing assistants and 70 other staff were trained to observe and report pain, other symptoms, psychosocial, and spiritual needs of residents they cared for, including the use of a 5-POINT Guide to Palliative Care Communications. The nursing assistants were trained to report their observations on a two-page Palliative Care Indicator Report attached to the daily report completed about care given to individual residents. The overall group profile of these CNA trainees was African-American/American Indian, 70%; born outside the United State, 88%; 47% graduated from high school; 40% some college; and 56% 10 or more years of experience in long term care. Post training, 87% showed improvement in understanding and application of observation and reporting skills. The highest amount of change occurred with trainees who had low scores on the pretest, and CNAs who used their native language at home, showed a higher mean level of change. But this was not statistically significant. Data analysis of implementation of the Palliative Care Indicator Report showed that 148 nursing assistant reports of pain or other symptoms, affecting 109 residents, resulted in one or more interventions by clinical staff. Several nursing assistants reported indicators of approaching death for residents who died unexpectedly. More importantly, 76% of nursing assistants stated the reporting process made it easier to report to nurse supervisors, 71% said they were much more aware of resident needs, 83% said reporting helped them give better care to residents, and 54% said it made their work more rewarding. Ninety-eight percent of the nursing assistants said they would continue to observe and report resident palliative care needs, and many voluntarily continued to use the Palliative Care Indicator Report after the conclusion of the study, stating they found it a valuable tool.