FINnish PALliative care education trial. (FINPAL) to improve nursing home residents' quality of life

Staff working in units which are randomized to intervention group will be able to take part to educational sessions in palliative and end-of-life care over 3 months. The focus of these sessions will be on the importance of familiar and safe surroundings in end-of-life care, encountering a dying patient and his/her family members, communication skills, advance care planning, assessing symptoms and symptom alleviation, working in a way to anticipate complications to avoid crises, life sustaining treatments, and the principles of good quality end-of-life care. The staff are encouraged to assess their residents' needs and wishes concerning to improve and maintain their well-being. The educational sessions include analyses of real-life decision-making regarding transfers to hospital emergency department. Different ways on how the care unit can be prepared to help residents suffering from acute symptoms, on how to relieve symptoms, and when to consult the physician of the unit or the emergency department, will be discussed. Local hospice-at-home care and home nursing services will be collaborated in the education. The possibilities of receiving treatment, assistance and services from hospice-at-home care to the sheltered housing communes, will be collaboratively decided. After receiving the education all the nursing staff and the consulting physicians will be encouraged to approach elderly residents and/or their family members for advance care planning. The educational sessions will be performed in small groups of 10-20 staff members. The teaching method will be interactive encouraging discussions and questions. Sessions will encourage the staff members to share and learn from previous experiences and patient cases in their own units to help them enhance a more successful team work. Methods used will also include thorough assessments of real life situations to enable learning from successful cases as well as from possible past mistakes. These sessions are based on constructive learning theory and experiental learning of adult student. While the adult learner has already gained the basic knowledge of the subject, his/her educational needs are complementary to this basic knowledge. The education given to the nursing staff and doctors of the intervention group will include: - symptom assessment, symptom relief and good palliative care - how to anticipate complications and to avoid unnecessary crises in residents' condition - assessing residents' needs and wishes concerning their well-being - importance of teamwork, consulting strategies, working with hospice-at-home care - hospital transfers and their effect on well-being of residents, acute situations: when is it necessary to refer a patient to emergency department; - communication with patient and family members; - advance care planning in practice; advance decision-making, Do-Not-Resuscitate and other physician orders for life sustaining treatments - end-of-life care and support to family members. The aducational sessions will be administered by geriatricians. There will be 4 or5 sessions depending on the educational needs of the staff. The educational needs will be assesssed by a survey before the education is administered. The education will be tailored according to these needs and wishes. The durations of each session will be 3 hours. The fidelity and adherence of education will be assessed: how many sessions the members of the staff participate. Their feedback of the sessions will be assessed and in this way their motivation will be supported.