Education

Evaluation of the end-of-lifenursing education consortium

project in the USABetty R Ferrell, Rose Virani, Pam Malloy

Abstract

Care of patients at the end of life is contingent on adequatepreparation of health care providers. Nursing, as the

predominant caring profession in end-of-life (EOL) care, mustachieve competence in physical and psychosocial care ofpatients and families facing terminal illness. Previous research hasdemonstrated that nursing education has not prepared nurses toprovide optimum EOL care. To date, there has not been a unifiedor organized effort to broadly address the preparation of nurses inEOL care. This article describes one national project, the End-of-Life Nursing Education Consortium (ELNEC), which was developedas a comprehensive effort to improve EOL care by nurses in theUnited States. The ELNEC project consists of EOL education forvarious nursing audiences: the undergraduate faculty; continuingeducation providers; pediatrics; oncology; and the graduatefaculty. This organized effort is a major step towards strengtheningnursing knovi/ledge in EOL care to improve care of the dying.

Betty R Ferrell is ResearchScientist and Rose Virani isSenior Research Specialist,City of Hope NationalMedical Center, 1500 EastDuarte Road, Duartc, CA91010 and Pam Malloy isDirector, Special Projects,American Associationof Colleges of Nursing(AACN), One DuponiCircle, NW, Suite 530,Washington, DC 20036

Correspondence to:Betty k Ferrell

Email: bferrcll@coh.org

The End-of-Life Nursing EducationConsortium (ELNEC) project isa national education initiative to

improve end-of-life (EOL) care in theUSA. The project provides trainingfor undergraduate and graduate nurs-ing faculty, continuing education (CE)providers, staff development educators,pediatric and oncology-specialty nurses,and other nurses in EOL care so they canteach this essential information to nurs-ing students and practicing nurses. Theproject, which began in February 2000,received a major grant from The RobertWood Johnson Foundation and addi-tional funding from the National CancerInstitute, the Aetna Foundation, and theArchstone Foundation. The purposeof this paper is to describe the ELNECproject as an example of palliative carenursing education.

To date, over 2 445 nurses represent-ing all 50 states have received ELNECtraining and are sharing this new exper-tise in educational and clinical settings.ELNEC trainers are hosting professionaldevelopment seminars for practicing

nurses, incorporating ELNEC contentinto nursing curriculum, partnering withlocal hospice groups and student asso-ciations to share resources, writing edi-torials about the need to improve EOLcare, hosting regional training sessionsto expand ELNEC's reach into ruraland underserved communities, present-ing ELNEC at national and internationalconferences, and improving the qualityof nursing care in other innovative ways.Over the next few years, project lead-ers estimate that ELNEC trainers willtouch the lives of 8.75 million peoplefacing the end of life.

The ELNEC project is administeredby the American Association of Collegesof Nursing (AACN) and the City ofHope National Medical Center of LosAngeles and the faculty includes a cadreof nurse leaders from around the coun-try. Prior to implementing the ELNECcurriculum, the City of Hope investiga-tors had done extensive work document-mg the deficiencies in EOL care. A studyconducted and published in 1999 docu-mented that 50 of the leading textbooksused in the United States nursing schoolsincluded only 2% of content with anyrelationship to EOL care (Ferrell et al,1999a). Additional studies by the inves-tigators documented the extensive con-cern by practicing nurses of the need forimproved care for patients facing the endof life (Ferreli et al, 2000). The ELNECcurriculum also builds extensively onmajor national reports such as work bythe Institute of Medicine documentingthe importance of professional educa-tion in improving EOL care (Field andCassel, 1997).

The curriculum was developed throughthe work of nationally recognized pal-liative care experts with extensive inputfrom the advisory board and reviewers.The curriculum is revised regularly based

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on participant recommendations andnew advances in the field, and is modi-fied for each distinct audience. The cur-riculum focuses on core areas in EOLcare reflecting AACN's 1998 publica-tion Peaceful Death: RecommendedCompetencies and Curricular Guidelinesfor End-of-Life Nursing Care (AmericanAssociation of Colleges of Nursing,1998). This document outlines specificaspects of professional nursing care con-sidered requisite for each graduate. TheELNEC-core content is divided intonine modules (Table 1).

Course participants were selectedusing a competitive application proc-ess. Each participant received a compre-hensive 1 000 page syllabus, textbooks,and a wealth of resources and strate-gies to teach the course content to oth-ers. Teaching materials are furnished inhard copy as well as on a compact disk(CD) so nurse educators can use themefficiently for their own instructionalpurposes. An example agenda from a 3-day course is included {Figure 1). TheELNEC programmes are 'train-the-train-ers' courses, meaning that participantsare taught both the content of palliativecare as well as teaching methods. Allparticipants are expected to disseminatethe education to teach others. Therefore,it is not intended for nurses wishing toadvance their own knowledge only, butrather for those who will also teach oth-ers ahout palliative care.

ELNEC project componentsUndergraduate educationUndergraduate faculty members wereprioritized as the first group to be tar-geted in the ELNEC project. The inves-tigators believe that impacting on the

Nursing care at the end of Life

Pain management

Symptom management

Cultural considerations in end-of-life care

Ethical/legal issues

Communication

Loss, grief, and bereavement

Achieving quality care at the end of life

Preparation for and care at the time of death

education of nurses as they enter practicewill improve EOL care. A paper pub-lished by Ferrell et al (2005) provided1-year follow up of the faculty mem-bers attending the first five conferencesfocusing on undergraduate education.Data from the 502 faculty members whorepresented 461 different nursing pro-grammes were reported. The partieipantsrepresent all 50 states in the USA. Theattendees rated the ELNEC curriculumat the 1-year follow up as 8.45 on a scaleof 0 (helpful) to 10 (very helpful). Facultyhad taught an average of 50 students perprogramme in the ELNEC programmein this first year of follow up.

In addition, the amount of time in thecurriculum devoted to any EOL topicincreased from the pre-course meanof 18.59 hours to a post-course meanof 28.72 hours (P < 0.001). Evaluationalso included a follow up of 617 nurs-ing students who were taught the cur-riculum in participating schools in orderto document their mastering of EOLcontent. There was significant improve-ment in knowledge in six of the ninecontent areas and in the overall knowl-edge of EOL care following their receiv-ing the ELNEC content through theircurriculum. The undergraduate facultywas also very active in other areas as aresult of attending the ELNEC curricu-lum including teaching ELNEC outsideof the nursing programme in the com-munity and faculty members attendingother continuing education conferenceson palliative care. There are now a totalof 646 baccalaureate and associate degreefaculty members who are ELNEC train-ers (Ferrell et al, 2005).

CE providersFollowing the launch of the ELNEC cur-riculum for undergraduate education, thenext target audience was CE providers.The intent of this training programmewas to reach nurse educators or staffdevelopment coordinators in clinicalsettings in order to impact on practic-ing nurses. The curriculum was modifiedslightly from the focus on undergraduatestudents to the education for practicingnurses. A 1-year follow up has been con-ducted on the first three national confer-ences for CE providers, which included261 educators attending these courses.A study by Malloy et al (2006a) sum-marizes the key results of this educa-tional endeavour. Attendees came from

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Day I1730- 18001800- 18101810- 18201820- 19001900-2000

2000-2100

Day 20730 - 08000800 - 0845

0845 - 09450945- 10051005- 10501050- 1150

1150-13001300- 14151415- 14351435- 1545

1545 - 16001600- 16151615- 1630

Day 30730 - 08000800 - 0900

0900- 1015

1015- 10301030- 1215

1215- 13151315- 1415

1415- 15001500 - 15151515- 1615

1615 - 1645

49 of the 50 states in the USA. Primarily,they represented clinical staff develop-ment In hospital settings but there werealso attendees from specialty nurseorganizations, independent CE provid-ers, and state nursing associations. Otherclinical settings such as home health, out-patient, long-term care, and hospices,were also represented.

One month follow up of these partici-pants also indicated overall helpfulness ofthe ELNEC curriculum as 9.0 on a scaleO=not helpful to 10=very helpful.

3-day course agenda

Registration/hospitality receptionWelcome/introductionOverview of participantsOverview of the ELNEC — core curriculum and resourcesModule I: nursing care at the end of life lecture•Video segment — Final BlessingHospitality reception

Registration/continental breakfastModule I: nursing care at the end of life training session• Listening exercise• Loss exerciseModule 2: pain management lectureBreakModule 2: pain management lecture (cont)Module 5: cultural considerations in end-of-tife care lecture•Video segment—AngolaLunchModule 3: symptom management in the elderly lectureBreakModule 2 and 3: pain and symptom management trainingSession• Individual case studies discussion

RoundtablesGoal refinementImplementing ELNEC in your facilityDaily evaluation/wrap up

Registration/continental breakfastModule 6: communication lecture•Video segment—WitiThe ShootistModule 4: ethical issues in palliative care nursing lecture•Video dramatization — Claire's StoryBreakModule 4, 6. 7 and 9: training session: role play —application of ethical issues; communication; loss, grief andbereavement; and preparation for and care at the time ofdeathLunchModule 9: preparation for and care at the time of deathlecture•Video segment -— My LifeModule 8: achieving quality care at the end of life lectureBreakModule 7: loss, grief, and bereavement lecture•Video segment — Steel MagnoliasProgram summary/evaluation

Figure 1. End-of-Life nursing education consortium

PediatricsAdapted from the ELNEC-core cur-riculum, a pediatric-specific course,ELNEC-Pediatric Palliative CareTraining Programme was developed by20 pediatric palliative care experts andpiloted in 2003 (Malloy et al, in 2006b).The national course has been offered inAugust 2003, 2004, and 2005 with over280 nurses in attendance, representing44 states in the USA plus the District ofColumbia. One additional course will beheld in August 2006 with partial fundingfrom the Aetna Foundation.

The pediatric curriculum requiredmajor revision from the original core cur-riculum in order to address the uniqueneeds of seriously HI children and theirfamilies. ELNEC-pediatric extends to allsettings of pediatric care, from neonatesto pediatric intensive care, pediatriconcology and acute care settings.

One-year follow up was conducted onthe 296 nurses attending the first threenational training programmes {Malloyet al, 2006b). This course has also beenextremely successful and the pediatriceducators have been extremely gratefulfor this resource as there has been lim-ited focus on pediatric palliative carein the past. This curriculum was alsorated at 9.06 on a scale of O=not help-ful to 10=very helpful at the 12-monthevaluation. The pediatric educators alsoreported significant involvement follow-ing attendance of the ELNEC in pallia-tive care organizations and collaborationwith other organizations to implementthe ELNEC-pediatric curriculum.

OncologyThe National Cancer Institute alsofunded the ELNEC-oncoIogy trainingprogramme. This programme, whichbegan in 2003, trains oncology nurseswho are members of the OncologyNursing Society (ONS) to disseminatepalliative care education through theirlocal ONS chapter to improve care ofcancer patients and their families. Todate, 206 oncology nurses, represent-ing 111 out of 204 ONS chapters haveattended. One more course will be heldin September 2006.

This project builds on the ELNEC-corecurriculum, but focuses on the uniqueneeds of cancer patients. Oncologynurses are encouraged to integrate pal-liative care into all aspects of cancer carefrom survivorship through EOL care.

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Table 2. List of ELNEC trainers involved in internationai outreach

Name of ELNEC Trainer

Margaret Barton Burkebartonburkem@prodtgy,nGt

Carmen Erickson-HurtCJ Erickson @nmcsd,med.navy, mil

Martha HighfieldMartha.highfield@csun.edu

Aden ike OnibokunNike 1955@yahoo.com

Marie Sinesmariesines@jiJno.com

Continent/CountryAFRICASouth Africa

Zambia

Nigeria

Nigeria

KenyaHospice

ASIA

Activities

Presented ELNEC and consulted at University ofWitswaters

Presented ELNEC to four Zambian military nurses.These nurseswill begin a pailiative care programme in a military hospital in Zambia-

Provided pain management information to the owner & ChiefMedical Officer of Maranatha Hospital in Aba, Nigeria

Lecturer at the University of Ibadan

Presented ELNEC modules to the program director at Eldoret

Katherine Crabtreecrabtree@ohsu-edu

Thailand Developed a proposed master's curriculum in palliative care foradvanced practice nurses in Thailand,Developed a certificate program in palliative care for baccalaureatenurses in Thailand.Taught end-of-life content at 2 universities in Thailand.

Carmen Erickson-Hurt SumatraCJErickson@nmcsd.med, navy, mil

Worked with those affected by the December 2004 tsunami-Educated Thai nurses regarding pain assessment and management-

Martha HighfieldMartha.highfietd@csun,edu

China Was a guest lecturer and consultant on palliative care issues atMunicipal Health Bureau in Guangzhou. China• Lecture 1-2 times/year to health administrators and professionals

from Guangzhou. China during educational sessions at CSU/Northridge.

Carol Longcarollong@cox.net

Marianne Matzommatzo@ouhsc.edu

Sayaka Sakamotosakamotosayaka@hotmail,com

Roger Strongrstrong@SDHospice.org

Carole KennerCkenner835@aol.com

Carole KennerCkenner835@ao!.com

Carole KennerCkenner835@aol.com

Marianne Matzommatzo@ouhsc-edu

Carla DiascaHagdias@uot.com.br

Carol Longcarollong@cox.net

Melanie 5teilenMelanie@cicateili.org

Marilyn Stonermstoner@Exchange.futlerton.edu

Philippines

Japan

Japan

China and Japan

AUSTRALIANew Zealand

Australia

EUROPERussia

Russia

SOUTH AMERICABrazil

Colombia

Guyana

Brazil

INTERNATIONAL

Taught ELNEC. sponsored by Global Caring Nurses Foundation.Manila and Cebu, Phitippines

Master's program development and teaching in Paltiative CareNursing atTenshi Graduate School utilizing ELNEC modules-Sapporo. Japan and tnternationat Cancer Nursing Seminar in Tokyoand Osaka.

Translating ELNEC ethics module into Japanese

Presented ELNEC as an exampte of teaching EOL care

Presented at Neonatal, Flight and Emergency Nurses Conference,Christchurch, New Zealand.

Presented at Women's and Children's Hospital. Adelaide. SouthAustralia

Presented at International Russian Nurses Conference on pediatricend-of-life issues.

Taught ELNEC in St Petersburg for physicians and nurses.

Translating Cure4Kids ELNEC curriculum into Portuguese.Instituto de Oncologia Pediatrica - GRAACC in Sao Paolo. Brazil.

Taught ELNEC at XVI Coloquio Nacional de Investigacion enEnfermeria in Colombia,

Uses portions of ELNEC curriculum for courses Home BasedCare for People Living with HIV/AIDS and Palliative Care/End-of-Life Care for People with AtDS.

Lectured and consutted at the Universidade Federal do RioGrande do Sul-Escota de Enfermagem in Porto Alegre, Brazil.

Ayda NambayanAyda.nambayan@stjude.org

This on-line presentation of ELNEC - Pediatric Palliative Care wasa collaborative effort among Cure4kids of the InternationalOutreach Program of St.Jude Children's Research Hospital, theCity of Hope Medical Center and the American Association ofColleges of Nursing, In the first four months since it has goneworldwide, this site has been accessed by 2627 peopte with themajority from tow resource countries, vwvw,Cure4Kids-org

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The 1-year follow-up evaluationof these oncology attendees is still inprogress. However, feedback from the12-month evaluation indicates that thesenurses have also been very effective andproductive in their ELNEC dissemina-tion activities. The original intent wasdissemination through the ONS chap-ters but it appears that these nurses arealso actively disseminating the ELNEConcology curriculum within their ownwork settings.

Graduate educationA grant from the National Cancer

Institute began in 2002 to meet the spe-cial needs of faculty teaching in gradu-ate nursing education programmes. Thefirst of four ELNEC-graduate coursesoccurred in June 2003. To date, a totalof 220 graduate nursing faculty mem-ber, representing every state in the USAand 210 out of 400 graduate nursingprogrammes, have attended. One addi-tional ELNEC-graduate course will takeplace in June, 2006. These courses areintended to support faculty in integratingthe important role of advanced practicenursing in EOL care. Clinical specialists,nurse practitioners, managers, adminis

Table 3. PrincJDies of Drofessional education

Characteristics of effectiveprofessional education Application to the ELNEC curriculum

Education is based on a current, evidence-based curriculum. The ELNEC curricuium resulted from extensive input fromexpert nurses using best availabie literature and evidence.The curricuium is continuously updated with revised versionsmade avaiiable to previous participants.

Adult learning is facilitated by diverse and interactivelearning strategies.

The 3-day ELNEC training programme includes about9 hours of lecture time v/ith the remaining time devoted tointeractive activities including case studies, small group discussion,role play, videos, journaling and non-drug labs, (AQ In full?)The syllabus includes the interactive learning activities andmaterials to facilitate use in dissemination efforts.

Professional education in palliative care recognizes theinfluence of personal experiences and grief.

The consistent experience across all ELNEC courses is thatmany participants have recent or current personal loss and/orillness experiences. Courses include loss exercises andopportunities for personal reflection and individual support.

Training programmes acknowledge limited funds areavailabie to educators.

Project funding has been allocated to provide the greatestsupport to the participants including no cost/minimal cost forcourse registration, materials and travel support.

Success in dissemination efforts is dependent upon accessto user friendly, efficient teaching resources.

The ELNEC materials consists ofa 1000 page syllabus whichincludes extensive faculty lecture outlines, Pov^erPoint slides,bibliographical, case studies, resource lists, etc.Al! material is provided in hard copy and on compact disk.

ELNEC Connections quarterly nev/sletter is distributedEducational projects require methods of reinforcement.

electronically to all ELNEC trained nurses.Formal evaluation at 6 and 12 months provides reinforcement.Project staff/investigators are available by phone.Web site provides updated information and also a network toconnect trainers.

Interdisciplinary collaboration is important in education efforts. ELNEC has been designed as a nursing educationprogramme, the investigators have collaborated closely withcolleagues in medical education, primarily through the Educationon Palliative and End-of-life Care (EPEC) project.The ELNEC curricuium strongly emphasizes interdisciplinarycare and has worked collaboratively with other disciplines inregards to EOL education (i,e. medicine, social work, etc.).

Flexibility and continuous improvement is important foreducational programmes.

The ELNEC curriculum is a consistent Vork in progress'.Evolution of the project has resulted in separate curriculum andprojects for graduate education, pediatrics and oncology.

Structured evaluation is necessary to insure qualityprogrammes.

Acceptance into an ELNEC course is by competitive selectionbased on an extensive application.Formal written evaluation at 6 and 12 months documentsoutcomes.

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trators and clinical educators are criticalto the advancement of palliative care.

The graduate educators have beenextremely productive and it has beengratifying to see not only the inclusionof palliative care content within an exist-ing curriculum but also several gradu-ate programmes initiating palliative carespecialties within their graduate nursingprogrammes. A paper has been publishedbased on the follow up of the first 60graduate nursing programmes repre-sented in the ELNEC graduate trammg.A very encouraging finding was that themean hours of EOL content added to thegraduate nursing curricula as a result ofattending ELNEC graduate courses wasa 18.4 (Paice et al, 2006).Graduate facultymembers have also reported additionaloutcomes from attending the ELNEC-graduate training course such as contin-uing their education through other CEconferences on palliative care, becominginvolved in committees or task forcesfocused on palliative care, and joining apalliative care organization.

Reinforcement effortsThe ELNEC project has included sev-eral reinforcement efforts to supportthe trainers following the courses. Thisincludes: a website; a newsletter; publica-tions; and awards.Web site: The ELNEC project isdescribed in detail at www.aacn.nche.edu/ELNEC. ELNEC Trainers use thecomplete list of trainers found on theweb site to locate colleagues with whomto consult and partner. Those outside theELNEC network can also use this list tocontact EOL experts as consultants andinstructors.Newsletter: The quarterly newsletter,ELNEC Connections is sent to ELNECtrainers, deans/directors of AACN mem-ber schools, various end-of-life agenciesand projects, and media representatives.ELNEC Connections provides infor-mation on end-of-life care and offers aforum through which the network ofELNEC trainers can stay in contact andshare successful education strategies. Thenewsletter is available online at www.aacn.nche.edu/ELNEC/connections.htm.Publications: The American Journal ofNursing (AJN), the official journal of theAmerican Nurses Association, launcheda bimonthly continuing education serieson palliative nursing care that featuredthe ELNEC project (Ferrell and Coyle,

2002). The series used actual case studiesto improve the way nurses care for dyingpatients. The series can be viewed onlineat www.aacn.nche.edu/ELNEC/ajn.htmor www.ajnonline.com.

In addition to the actual courses,the investigators have been committedto sharing their experiences throughthe ELNEC teaching with other col-leagues. While conducting these numer-ous courses over the past 5 years, theinvestigators have learned much aboutthe importance of educational strate-gies to best teach the palliative care con-tent. As illustrated in the example courseagenda {Figure 1) the investigators use avariety of learning strategies in coursesincluding round table discussions, use ofvideos, laboratory experiences, as wellas lectures. Table 2 includes a summaryof the principles of professional educa-tion that have applied throughout theELNEC curriculum. The ELNEC inves-tigators and staff have published a seriesof articles that have shared experiencesin teaching palliative care content acrossthe courses (MatEO et al, 2002; Matzo etal, 2003a; Matzo et al, 2003b; Sherman etal, 2002; Sherman et al, 2003; Sherman etal, 2004a; Sherman et al, 2004b; Shermanet al, 2005)

Awards: Excellence in ELNECEducation Awards are presented toELNEC trainers who have made par-ticularly noteworthy contributions toELNEC education.

EvaluationThe ELNEC investigators have beenaware since the inception of this project,that having evaluation data is critical todetermine the outcomes of this extensiveproject. The ELNEC evaluation acrossthe courses has consisted of several com-ponents. Initially, in the applicationprocess, attendees complete a detailedapplication form and an evaluation ofcurrent practice and education in pallia-tive care in their setting. This evaluationtool is organized according to the ninecomponents of the ELNEC curriculum.Prior to attending an ELNEC course, theparticipants also complete a goal form inwhich they identify goals they would liketo achieve if selected to participate in theELNEC project.

While attending the ELNEC confer-ence, the attendees complete daily evalu-ation forms to provide feedback to thefaculty and the content presented. These

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evaluation data have been extensivelyreviewed following each course and theinvestigators have considered ELNECto be a constant 'work in progress' asthe investigators continue to improve thecurriculum based on participants' feed-back.

Throughout the course, the partici-pants revise their goals as they becomemore aware - through their interac-tion with others and through learningstrategies from the faculty for integrationof the ELNEC curriculum. The attend-ees are then sent follow-up evaluation at6 months and 12 months post-comple-tion of the ELNEC curriculum in orderto again rate the effectiveness of theireducational programme and to docu-ment progress in achieving their goals.These evaluations are conducted by mailor email. A rigorous follow-up processhas been accomplished so that the inves-tigators have been able to achieve morethan 90% 12-month evaluation acrossall the courses. This extensive evaluationhas been critical to obtaining continuedfunding for the project and for awarenessof the strengths and weaknesses of theprogramme.

LimitationsThe ELNEC project has been a workin progress through a constant processof programme evaluation. The projecthas been very successful but there havebeen some limitations. One of the great-est challenges has been to determinethe most effective teaching strategies.The investigators have strived to movebeyond traditional lecturing to includediverse teaching strategies such as roleplay, case studies and small group work.The curriculum continues to evolve andthe most effective methods are continu-ally sought.

Another challenge had been the lim-ited time available for the conferences.The field of palliative nursing is verycomplex and it is difficult to cover all ofthe aspects of palliative care in a shortperiod of time. However, given the nurs-ing shortage and costs to institutions torelease nurses for continuing education,time limitations must be adhered to.

Finally, there are many challenges asthe course participants attempt to imple-ment ELNEC back in their own worksettings. The limited resources, heavyclinical demands and shortage of nursesoften make it difficult to implement

ELNEC training. The authors have alsofound it very important to provide ongo-ing support in the form of the ELNECweb site, newsletters and phone supporttrainers. While enthusiasm is high duringthe course, the realities of the clinical set-ting often limit maximum implementa-tion of course goals.

Future plansThe ELNEC project began as an initialeffort with priority given to undergradu-ate educators and second priority of con-tinuing education providers. However,over the past 5 years, the investigatorsand faculty have been keenly aware of thespecial needs within the very vast field ofnursing. The specialty programmes thathave been created for oncology, graduatenursing education, and pediatrics havebeen extremely successful.

In 2006, the ELNEC investigatorshope to launch two additional areas. Thefirst is the area of critical care nursing.The investigators believe that there is anextensive need for addressing EOL carein critical care units, emergency rooms,cardiac care units, and other areas ofacute care for critically ill patients andfamilies. The first ELNEC-critical carecourse is scheduled for implementationin November, 2006.

A second area targeted for the futureof ELNEC is the elderly. Geriatric carehas been extensively covered in the corecurriculum for faculty and CE provid-ers as well as through the graduate edu-cators and oncology projects, but theinvestigators believe that there are specialneeds of the older population that shouldbe addressed. Pilot work has begun todevelop an ELNEC curriculum specificfor the elderly. One of the priority areastargeted for this endeavor will be long-term care settings. The investigators hopeto initiate a pilot course of the ELNEC-geriatric curriculum in early 2007.

International implicationsSince the inception of the ELNECproject, the investigators have been com-mitted to sharing the resources of theELNEC curriculum whenever possible.Several guests from outside the USAhave attended various ELNEC coursesand the investigators have had extensivecommunication with other nursing col-leagues internationally who are inter-ested in palliative care education. Onemajor international dissemination effort

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The challenge of providing palliative care in the nursing home: part 1 external factors

Key wordsfe Nursing

education

k Palliative care

» End-oMife

careI Evaluation

I Curriculum

development

has been the investigator's collabora-tion with the St. Jude's Hospital website (www.CureforKids.org), which hasposted a version of the ELNEC pedi-atric curriculum on this wide-reachingsite. Table 3 includes a summary of otherinternational outreach efforts that havebeen accomplished by ELNEC trainersThe ELNEC investigators are very eagerto seek continued activities to collabo-rate with international colleagues. Thereare unique aspects within palliative carewithin various countries and cultures,but many of the basic principles andstrategies for improvement are universal.The investigators encourage internationalcolleagues to visit the ELNEC web siteand to communicate with them regard-ing ideas for further dissemination ofthe ELNEC curriculum. Improved EOLcare is a universal priority for nurses andinternational collaboration through theELNEC project wiil help achieve thataim.

American Associatioti of Colleges of Nursing(1998) A peaceful death: Recommended compe-tencies and curricular guidelines for end-of-Iifenursing care. Washington DC, AACN

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Ferrell BR, Virani R, Grant M et al (2005)Evaluation of ihe End-of-Life Nursing Education

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Field JI, Cassel CK (Eds) (1997) Approachingdeatn: Improving care at the end-of-life(Report of the Institute of Medicine Task Force)Washington, DC, National Academy Press.

Mailov P, Ferrell BR, Virani R et al (2006)Evaluation of end-of-life nursing educaiicn forcontinuing education and clinical staff develop-ment educators. / Nurses Staff Dev (in press)

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Sherman DW, Matzo ML, Pitorak E, Ferrell BR,Malloy P (2005) Preparation and care at the timeof death: Content of tbe ELNEC curriculumand teaching strategies./ Nurses Staff Dev 21(3):93-100

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276 International Journal of Palliative Nursing, 20O6, Vol 12. No 6