Hospice creates ideal tool kit for staff to use in caregiver education

Focus on clients' needs and building rapport

Hospice staff must provide spend a significant amount of time educating patients and caregivers, but the dilemma is how to do it efficiently and effectively.

The Community Hospice Inc. of Albany, NY, may have the solution in its newly-developed professional education tool kit.

"One activity that everybody in hospice does is patient education," notes Carol Shenise, MS, RN, corporate education specialist for the hospice.

"We wanted to support our staff with patient education and help them become more effective," Shenise says. "We began to think about what we could do that would support our staff and provide them with the tools that would make their patient teaching effective."

The result is a well-organized tool kit that is divided according to a list of principles and suggestions for enhancing patient/caregiver education. There are 26 "tools," which essentially create a framework for how to teach patients and their family caregivers. (See sample of tools below).

"There is a tremendous amount of information that we need to communicate to patients and family caregivers, and what we needed were some tools to help staff members better understand how to communicate," says Patricia Martino, RN, CHPN, AAS, case manager/team leader. Martino and Shenise spoke about building a professional education tool kit at the National Hospice & Palliative Care Organization's (NHPCO's) 7th Clinical Team Conference & Scientific Symposium, held April 26-28, 2006, in San Diego, CA.

The tools are meant to be used by any hospice health care professional, and they can build upon them, Shenise says.

The idea is to change hospice professionals' thinking and approach to teaching, Shenise says.

"The social worker or chaplain would use the same tools, but just gear them toward their own discipline and the purpose of their visit," Shenise says.

It's not a tangible tool, but a philosophical approach to dealing with a given educational opportunity, Martino says.

Here is how Shenise and Martino developed the tool kit and its main features:

1. First focus on nursing assessment.

With nursing experience, both Shenise and Martino knew that the first step was to look at the nursing process and nursing assessments at the initial visit.

"Assess, plan, evaluate—we needed to do assessments and learn the needs from both the staff and the patient and family," Shenise says.

"What I've observed from working with new staff members is we have a lot of information we need to communicate to new patients and caregivers, a lot of medical jargon," Martino says. "We needed some tools to help our staff members learn how to communicate better with patients and families."

The pair worked to marry the caregiver education piece and the clinical piece together so information can be presented to patients and their caregivers in a way that they easily can understand, Martino adds.

For example, one of the tools included in the tool kit is the advice to "Ask open-ended questions requiring more than a 'yes,' 'no,' or 'nod' answer."

2. Consider the patient and family care giver's learning needs.

The tool kit encourages nurses to assess the patient's and family caregiver's needs and to determine how they are dealing with the disease, including the emotional and physical aspects, Shenise says.

"I reviewed the literature and pulled together all of the best practices in the literature for patients, caregivers, and families," Shenise says. "We spent time reading, digesting the information and deciding how best to use it with our staff."

One of the common problems with hospice nurses and staff who educate families is that they will give out a wealth of information, without knowing how the patient and family are absorbing it, Shenise notes.

"We're so intent on what our needs are that we don't step back and say, 'Assess and really determine what the patient/family already knows and what they want to know,'" Shenise says.

So the tool kit is designed to base the family caregiver/patient education on the family's needs, she adds.

"One of the things we both feel very strongly about is that emotions and feelings are very important considerations when we're taking care of patients at the end of life," Shenise says. "These play a big role in their learning, so we're trying to keep the education as simple as possible."

Educating hospice patients and caregivers is a growth process that should be fine-tuned according to individual needs, Marino says.

"When I'm sitting in my car before going into someone's home, I debrief myself and think about the situation I'm going into and what I know about it already, and I think about what my approach needs to be and what my primary goals are for that day," Marino says.

Then when Marino enters the home and begins to use the tool kit, she has a good foundation for family education, but she can adjust it according to what she knows are some particular issues.

"It takes time and commitment and the ability to change focus," Marino adds.

3. Design tools to assist in establishing rapport.

The 26 tools are designed to encourage more depth in the assessment conducted by the health care provider, Marino says.

The tools also help the provider make the philosophical switch from teaching clients what they think the client should learn to teach what the client would like and is ready to learn.

The typical hospice approach is for the nurse to meet the clients and then launch into their prepared speech about hospice care, Marino says.

Shenise has witnessed this teaching approach, and what typically happens next is that the patient and family caregiver will begin to stare with eyes glazed over, and they cannot absorb the information, Shenise says.

Instead, hospice professionals should assess the situation, give it some thought, adjust the education to the client's needs, and allow for feedback, Marino explains.

"Staff should start a conversation with the patient, find out what they want to know, and then establish a rapport with them in a safe and comfortable environment," Marino says.

One of the tools talks about creating a safe environment and establishing rapport with clients.

"When I meet the family and introduce myself and ask where they'd like to sit and talk about things, I make a general statement so I can ask about their needs and what they know about hospice care," Marino says.

Some conversation-openers that can be asked to help build rapport are as follows:

* Tell me about how you first heard about hospice.

* How have things been going?

* What have you heard about hospice from your family or friends?

* What have you heard from the doctor?

* What are you worried about?

"So nurses use the first few tools to establish a safe environment and find out some information," Marino says.

4. Use teaching sheets and bullet points.

The hospice has teaching sheets that are part of the tool kit, and these have been used on a trial basis. The teaching sheets are simple with the key information on the front page and medication information on the back page, Shenise says.

Some are longer. The teaching sheet for chronic obstructive pulmonary disease (COPD), which is called the respiratory or dyspnea teaching sheet, for example, is four pages long.

Teaching sheets make use of bullet points to emphasize specific instructions, Marino says.

Hospice nurses show patients and their families the teaching sheets, and they go over the main points, emphasizing certain points. For instance, the respiratory teaching sheet explains how patients can breathe easier, and it includes tips on how to get medical control of a situation.

The nurse will write down the name of a drug, along with the amount that the patient will need, and the nurse provides very simple and individualized instructions, Shenise says.

Simplicity and accessibility are key, Marino notes.

"What I see in the field is that when patients are new they receive a lot of information, and we give a lot of information verbally," Marino says. "Then the nurse leaves, and at 2 a.m. when Mr. Jones can't breathe, Mrs. Jones wakes up and is nervous because she can't remember all the things the nurse said."

Even if the nurse wrote out some instructions, the caregiver might have trouble finding the handwritten note, so the teaching sheets provide an easy solution with simple, clear instructions, Marino adds.

6. Educate staff to use the tool kit.

The Community Hospice has been teaching staff how to use the tool kit, with the goal of educating everyone through team meetings, informal and formal sessions, orientations, and inservices, Shenise says.

"For the most part, it's been informal," Shenise explains. "For instance, when Pat teaches an orientation, she incorporates the tool kit into the content of her discussion."

The 26 tool kit items are handed out to staff for discussion purposes.

"At team meetings we talk about individual family characteristics and how we can structure our approach to meet their needs," Marino says.

Ongoing training will involve new tools, sharing important literature, and other items that will be added to the tool kit, Shenise says.

"We'll bring new items forward and communicate with staff about them," she adds. "It's continual and the education doesn't end."

Need More Information?

  • Patricia Martino, RN, CHPN, AAS, Case Manager/Team Leader, The Community Hospice, Inc., 159 Wolf Road, Albany, NY 12205. Telephone: (518) 285-8124.
  • Carol Shenise, MS, RN, Corporate Education Specialist, The Community Hospice, Inc., 159 Wolf Road, Albany, NY 12205. Telephone: (518) 694-4987.