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Objective-To investigate whether the accident and emergency department (

Background The hospice model of care is held as the model of excellence for delivering high quality care to dying patients. However, only a small number of patients in the UK actually die in a hospice with the majority of patients dying in hospital. The major challenge faced by specialist palliative care services has been the transfer of best practice from the hospice setting to other care settings such as the acute hospital. At the Hollier Simulation Centre an end of life care course has been developed for all band 5 and 6 nurses within the Heart of England NHS Foundation Trust, using the novel teaching modality of high fidelity simulation. Aim To look at the impact high fidelity simulation teaching has on participant confidence and their perception of their knowledge and skills in end of life care. Method The study used a mixed method approach with a combination of pre and post course focus groups and pre and post course questionnaires. The focus groups transcripts were analysed using thematic analysis. The free text information from the questionnaires were used to support the themes developed from the focus group analysis. Two separate cohorts were used for this study. Results Analysis of the data revealed that the use of high fidelity simulation to teach end of life care did have a significant impact on the participants confidence, knowledge and skills. Additionally, the facilitated debrief sessions within the course were found to be beneficial these encouraged self reflection, peer teaching and constructive feedback within a safe environment. Conclusion The use of high fidelity simulation to teach end of life care does have a positive impact on the participants' confidence and their knowledge and skills. Further studies are needed to compare the use of high fidelity simulation to teach end of life care with other teaching modalities.

Background High Fidelity Simulation Training originates in the aviation industry and has been shown to improve safety. Within healthcare, it is increasingly utilised to reproduce clinical situations and train multi-disciplinary professionals in technical skills and human factors. A fundamental role for clinicians of all disciplines, is the provision of end of life care. However limited work has been undertaken within the UK to develop the high fidelity simulation training model within Palliative and End of Life Care. Collaborative work between the Heart of England Hospital Palliative Care Team and the Hollier Simulation Centre has begun to explore the role of simulation training in end of life care. Methods During 2010, a pilot of six 1-day courses were undertaken for hospital nurses. A simulated ward provided an accurate clinical environment within which participants could monitor, investigate and treat a sophisticated patient mannequin in real time. In addition role-play of trainers enabled realistic interaction with other healthcare professionals and relatives. Appropriate signs and symptoms were replicated including pain, breathlessness, vomiting, distress, respiratory secretions, agitation and bleeding. Participants were facilitated to develop skills in symptom control, advanced care planning, hand-overs and communication. Evaluation was undertaken via participant questionnaires completed before and after the course. Visual analogue scales enabled nurses to rate their confidence in performing aspects of end of life care. Results The confidence of nurses increased in all areas of end of life care, demonstrated by increased mean visual analogue scores after the course. Free text responses indicated that nurses were apprehensive about undertaking simulation training but felt it was extremely effective. Discussion Following the success of the pilot, end of life care simulation courses are continuing within the Heart of England Trust and work is in progress to extend the model of simulation training to hospice staff and primary care clinicians.

Background The hospice model of care is the model of excellence for delivering high quality care to dying patients. However, only a small number of patients in the UK actually die in a hospice with the majority of patients dying in hospital. The major challenge faced by specialist palliative care services has been the transfer of best practice from the hospice setting to other care settings. At the Hollier Simulation Centre an end of life course has been developed for band five and six nurses within the acute trust, using the novel teaching modality of high fidelity simulation. High risk industries such as aviation and the armed forces have been using this type of simulation as an integral education tool for years and using this form of teaching to train healthcare professionals is becoming increasingly common. Aims The study aimed to look at what impact high fidelity simulation teaching had on the participants' confidences and their perception of their knowledge and skills in end of life care. Method The study used a mixed method approach with a combination of pre and post course focus groups and pre and post course questionnaires. Two separate cohorts were used for this study. Results Using thematic analysis, the focus groups' transcripts were analysed. Free text from the questionnaires was used to support the focus group analysis. Conclusion Using high fidelity simulation to teach end of life care did have an impact on the participants' confidence, knowledge and skills. Participating in the scenarios was felt to be more beneficial then didactic teaching. This course allowed the study groups to both participate and observe their peers in the scenarios. The facilitated debrief sessions were found to be beneficial and the participants felt they learnt a number of new skills within these sessions from their peers.