Hospital and program description

Methodist Medical Center of Oak Ridge is a 300-bed community hospital serving a rural population of low to middle income patients. The Palliative Care Team is a volunteer group with a core made up of a physician, nurse coordinator, Clinical nurse specialist for critical care, dietician, social worker, and nurse manager of the Oncology Unit.

Problem

Some behaviors of the nursing support staff on the oncology floor were not congruent with the gravity of the situations patients and family members were experiencing. Loud talking and inappropriate joking often occurred within earshot of the dying patient and his/her family.

Processes to resolve the problem

A 4-hour educational program was developed for CNAs based on the premise that they spent more time with the patient and had more intimate contact with them during their routine duties. The syllabus included lectures on the CNA roles in excellence in basic care, pain and symptom management, nutrition and feeding patients with dysphagia, communication, spiritual and cultural issues, and providing care when death is nearing. At the end of the session, CNAs were encouraged to share their concerns regarding end of life care from their perspective.

Outcomes

Pre- and post-testing demonstrated a significant improvement in the knowledge base of CNAs who completed the course. CNAs who completed the course were observed to proactively seek a palliative care team consultation for families with members at the end of life. An improvement in attitude and delivery of respectful care to patients and their families was also noted. Satisfaction surveys of CNAs after the session were consistently excellent in regard to the content and delivery of the course.

Lessons Learned

Educating CNAs about important aspects of death and dying can influence favorably the attitudes of other health professionals and stimulate use of the palliative care team. CNAs have the same concerns about doing their job well and doing no harm as other members of the health care team. The Palliative Care Team members who presented the seminar have a deeper appreciation for the role of the CNA and the impact that they make in caring for this special patient population.