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IntroductionNursing home staff want to provide end of life care that will maintain their residents dignity, comfort and best interests in the familiar surroundings of the nursing home. Education and support is a key part of this. The Hospice of St Francis provided a mentor education programme to two care homes to facilitate them in this care.AimTo enable the care staff to provide excellent end of life care for their residents encompassing all six steps described in the NHS National End of Life Care Programme.MethodsHome 1 is a nursing home for people with learning difficulties, caring for their complex needs. Home 2 is a nursing home for people with dementia with multiple co-morbidities. A mentor is made available to support the staff through an end of life blended learning 6 module and follow-up workshop experience. An audit of patients notes before and after the programme plus staff confidence questionnaires enables evaluation of the programme.ResultsBoth care homes have seen an increase in their confidence and competence in care.DiscussionThis project is innovative because of the flexibility of methods in delivering the support and training. Home 1 worked methodically through the blended learning. They were keen and ready to do the work shop and currently are gathering/developing tools to underpin this process. Home 2 were enthusiastic beginners but were unable to work through the programme. Now the staff have made time over 2 days to receive group face to face training before going on to gather the tools/action plan they need to achieve the relevant national quality markers. The mentor made herself available to work alongside the care staff, supporting, enabling and challenging their practice through the relationship of trust and support.ConclusionBlended learning using a mentor approach provides a flexible learner centred education programme.

Society is aging and we are living longer. By 2035, deaths in the over 85’s will represent 50% of all deaths in the UK and older members of our society will be more likely to die in a hospital or care home (Calanzani et al 2013).The NHS Health East of England ABC blended learning programme consists of 7 modules (face to face, e-learning or both), follow up workshops, resources, DVD’s, mentor support, audit materials and Train the Trainer project (http://www.endoflifecarelearning.co.uk/)A recent evaluation comparing the ABC care home programme in Hertfordshire vs 2 national equivalents in Suffolk, Bedfordshire, Peterborough and Luton concluded:Well-evaluated education, sustaining learners in practice resulting in athe most cost effective programme with highest completion rates (97%) and reduced hospital admissions.Recomended education programme‘Several features that have made the ABC Training Programme more accessible to nursing homes. These include the flexibility about when the training commences, and the fact that staff are able to complete modules within their own timeframe and at their own pace. This blended learning approach also combined the e-learning with visits to the nursing home where the trainers were able to provide additional support and encouragement to staff to complete the training’ (Pyper et al 2013).‘It is recommended that as currently nursing homes staff turn-over is very high, EoLC standards are more likely to be maintained by commissioning the trainers to continue their relationships with the nursing homes and offer infrequent on-going support sessions as required.’ (Pyper et al 2013).The ABC programme is now validated as an alternative end of life education programme making a difference combining learning with mentorship and site visits. This education model is recommended particularly for struggling care homes.

Three care home educators worked across nine care homes in East, North and West Hertfordshire to provide an End of Life Care Education Programme to care homes.496 staff took part in the education programme. (Isabel Hospice Project: 150 participants in 3 homes, Peace Hospice Project: 155 participants in 4 homes, Hospice of St Francis Project: 191 participants in 2 homes).Each education programme although designed differently contained the same education content and themes as well as measuring the education activity and impact of that education:▶Clarification of advance care planning terminology and documentation.▶Awareness of services and team working across organizations.▶Identification of residents at the end of life.▶Symptom control and assessment.▶Communication skills.▶Cultural care.▶Manager support for the end of life ethos.▶Support in policy writing.The education programme resulted in:▶An increase in the skills, confidence and competence of care home staff with the advance care planning process.▶Significant increase in the preferred place of care being achieved through the use of advance care planning with the residents.The three programmes focused on identifying, developing and sustaining the care home staff skills and confidence, thus enabling proactive advance care planning in the care home setting.This demonstrated that a flexible, learner centred and systematic approach to education can make a difference.

IntroductionThe Hospice of St Francis piloted advance care planning (ACP) documentation (September 2010 – February 2011). The pilot was in four phases including a consultation group, agreement re documents to be used, staff training required, target areas and numbers (up to 10 patients per In Patient Unit, Day Care and Community Specialist Nursing team).AimTo establish whether there was a need for Hospice of St Francis specific ACP documentation.MethodsPhases▶Multiprofessional working group to discuss, produce and pilot ACP documentation▶Evaluation of pilot and amend documents▶Implement amended documents over 6 months▶Evaluation and re-evaluate documentation.ResultsDocumentation was implemented with two community and three day care patients.Discussion▶Do the results reflect the need for more staff education or more confidence in using the skills and documents?▶Do the results relate to the voluntariness or fragility of patients in the advance care planning process or reticence of staff to use ACP documents?▶What is the impact of other ACP work in the hospice on this pilot (eg, ACP letters for patients with advanced respiratory and cardiac disease, ACP research interviews as part of a doctoral research programme).ConclusionThe ACP document pilot shed light on the process and documentation of ACP. Further work has subsequently been done to look at an ACP education model for Beds and Herts as well as ACP resources for care homes. It is important not to make assumptions about the skills and confidence of hospice staff in ACP as well as looking at the context of the patient's voluntariness and fragility. The pilot helped us look at the education needs of our staff.