Creative Solution:

This innovative initiative was undertaken by the Baptist Health Palliative Care Steering Council in an effort towards improving the practice of healthcare providers and the overall environment of care in meeting the needs of the culturally diverse population served. This training represents a strategic step towards meeting the NQF Preferred Practice Standards 3 and 4 to provide education to all healthcare professionals, provide adequate training and clinical support to staff to ensure confidence in their ability to provide palliative care for our patients in an intercultural hospital setting.

Short Description:

• Baptist Health (BH) received grant support of $280,950 from Health Foundation of South Florida in 2006, for our palliative care training project.
• Nurse researcher, Susan Golembeski, PhD, conducted focus groups of healthcare providers to gather their understanding and comfort with providing quality palliative/end-of-life care to our diverse community.
• Nurse researcher, Susan Golembeski, PhD, conducted focus groups of the community, using family members who lost loved ones at Baptist Health, to gather information on how well BH met the cultural needs of their loved ones during palliative/end-of-life care.
• Qualitative and quantitative data were analyzed and nurse researcher Susan Golembeski, PhD developed a theory which emerged from the qualitative analysis titled: Caregiving Together: Synergy on the Journey to a Good Death. This clarified that despite the diversity of the population we serve, each patient brings into our hospital their own unique cultural differences and desired that healthcare providers expect, accept and respect differences in an intercultural hospital setting.
• Permission was granted from a curriculum consultant, Hilarie Davis, Ed.D to use an ethical reasoning process she developed in addressing differences among individuals which we titled a “Think Through” process.
• As EPEC (Education for Physicians on End-of-Life Care) and ELNEC (The End-of-Life Nursing Education Consortium) trainers, we received permission to use the core competencies from these training to develop e-Learning modules.
• Palliative Consultant Dr. David Weissman was contracted to work with the team as consultant to program development.
• Collaboration between multiple departments (bioethics & palliative care, research, organizational learning, media services, medical education, marketing, and IT) occurred over a year and a half to facilitate program development.
• External palliative experts from Stanford and Pittsburg University reviewed the training following development.
• Prior to implementation internal testing was done by representatives from all 6 disciplines targeted for the training (physicians, nurses, nursing care technicians, respiratory therapist, social workers/care managers and chaplains).
• Communication strategies were developed and implemented through collaboration with Corporate Chief Quality Officer, Marketing/Public Relations, Bioethics & Palliative Care, Medical Education, Organizational Learning, and Information Technology.
• BH Palliative Care Training Project was uniquely developed as a blended learning program and implemented in January 2008, utilizing the theme of expecting, accepting and respecting differences and the “Think Through” process that were both weaved into e-Learning modules covering EPEC and ELNEC evidence-based core competencies in palliative care. Part 1 offers a total of 17 modules with specific required modules for each discipline. Part 2 consists of a 2-hour interactive classroom session where participants apply the skills learned from the e-Learning.
• BH Palliative Care Training Project was designed to increase healthcare professionals’ knowledge, skills, ability and comfort level in providing palliative/end-of-life care to racially and ethnically diverse populations. Our goals are to train 1034 healthcare professionals (physicians, nurses, nursing care technicians, respiratory therapists, social workers/care managers and chaplains) by March 2010.
• As of August 17, 2009 the total numbers of healthcare providers that have completed Part 1 are 669 and those who have completed Part 2 are 516.

Summary of Results/What Worked and Why:

To date, the summary evaluation responses that have been analyzed are listed below.

What continues to work well is the ongoing commitment and collaborative effort of all departments, BHSF leadership and staff's commitment to palliative care training and education.

Final e-Learning evaluation – Overall, all questions asked received responses in Strongly Agree and Agree. No significant differences between hospitals, age groups, disciplines and item mean.

Classroom evaluations – mean scores were all very high with little standard deviation indicating almost all respondents “Strongly Agree” with items on evaluation tool. The qualitative analysis indicated that participants thoroughly enjoyed the interactive classroom sessions.

90-Day post evaluations – The mean scores were 4.6 and above indicating respondents “Strongly Agree” that they were able to apply skills learned in the clinical setting and there were no environmental barriers preventing them from doing so.

This training will be validated by the end of the grant period March 2010 and once validated we plan to share this training with other healthcare organizations in South Florida.

All Team Members

Rose Allen, R.N., MSM/HM, CHPN  
DeDe Austin, ARNP, MSN, CHPN
Emilio Carullo, M.D.
Patricia Collins, R.N./MSN, AONC, CHPN
Hilarie Davis, Ed.D.
Guillermo Escalona, M.Div.
Susan Golembeski, Ph.D.
JoAnn Gottlieb, ARNP, B.C., MS, Ph.D., CHPN
Linda Long, R.N., MBA, MSN, CHPN
Rosie Rodriguez, R.N., MHL
Luisa Pacheco Zayas, LCSW, Psy.D.

Palliative Expert
David Weissman, M.D.

Curriculum Consultant
Hilarie Davis, Ed.D.

Instructional Design
Donna Wilson, R.N., MSN, CNS, CCRN
Yvonne Brooks, R.N.
Jimmy Espinosa
Jose Guitian, MSN, ARNP
Carlin Murray
Helen Slaven, Ph.D.
Valerie Pierre
Sheila Fyfe (Editing Assistance)
Paulo Castro
Kristi Lozano, M.Ed.
Patricia Tobin, Ph.D., LCSW

Media Production
Meivys Perez
Javier Albornoz
Ronald Pelham

Medical Education/CME
Arturo Fridman, M.D.
Gabriela Fernandez
Linda Santos

Marketing & Communication Plan
Thinh Tran, M.D, Corporate Chief Quality Officer
Anne Streeter