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Table 3 Pre-post course shifts in participants’ understandings of/attitudes towards end of life care (author questionnaire)

From: Blended e-learning and end of life care in nursing homes: a small-scale mixed-methods case study

Item and content

Non-carer

Non-carer

Carer

Carer

Carer

Carer

1. Appropriate time to initiate end of life care

Shift from physical to more holistic definition of appropriate timing for initiation of end of life care

Pre-course questionnaire left blank; post questionnaire defined end of life as the last year of life and/or initiated at any time, according to preferences

Shift from generic awareness of need for EoL care when ‘condition starts to deterioriate’ to a more precise ‘within the last year to six months of their life’

Shift towards more precise definition of timing for EoL care (from ‘upon admission’ to ‘1 yr prior to expected death’)

Shift from generic ‘upon admission’ statement to patient-focused concern – end of life care initiated when required and on advice of medical team

Shift towards broader understanding of timing for initiating end of life care (i.e. at point of admission rather than with diagnosis of impending death)

2. Main aims of end of life care

Shift from idea of keeping residents physically and emotionally comfortable to wider understanding incorporating ideas of dignity and respect

Pre-course questionnaire left blank; post questionnaire set out aims as ensuring residents’ needs are met and holistically treated

Slightly fuller definition of the aims of EoL care, from keeping residents ‘comfortable’ to keeping them ‘comfortable and happy’

Shift from minimal definition of EoL care as carrying out residents’ and families’ wishes to ensuring ‘that the person can have the best death possible’ and ‘to die with dignity and die how they want to’

Pre-course questionnaire gave fuller definition of end of life care aims, perhaps reflecting this carer’s previous nursing training

Shift towards more content in idea of end of life care, from ‘best care and understanding’ to ‘dignity, comfort, and meaningful life’

3. Tasks and tools involved in end of life care

Little shift; non-carer already recognised the wide range of tasks that can be involved in EoL care

Pre-course questionnaire left blank; post questionnaire showed awareness of pain relief, wellbeing, social inclusion, LCP, GSF, PPC

Mention in the post-course questionnaire of one of the EoL tools (LCP)

Left blank in pre-course questionnaire; in post-course questionnaire, substantial content including talking to patients, assessment, planning, implementation and evaluation of care, including aftercare

Both left blank

Fuller content in the pre-course questionnaire; post course merely states ‘EoL[end of life] is a vital tool to give meaningful life to a person’

4. Responsibility for end of life care

Post-questionnaire blank; pre-questionnaire recognises that everybody has a role in EoL care

Pre-course questionnaire left blank; post questionnaire stated that end of life care is everyone’s responsibility, but care staff in particular

Slight shift towards wider definition of who is responsible for EoL, from nurses, carers and doctors to nurses, carers, GPs, and families

Shift from staff looking after residents and family, to wider understanding of responsibility – ‘whatever organisation/home/hospital… it is a collective team…[with] responsibility to carry out EoL care’

Pre-questionnaire blank; post-questionnaire acknowledges that all staff involved with resident have responsibility for end of life care

No shift; carer already recognised the need for all occupations to be involved

5. National guidelines and policies

Post-questionnaire blank; ‘Not sure’ in pre

Pre-course questionnaire left blank; post questionnaire mentioned the Mental Health Act

Both left blank

Significant shift from ‘government [web]sites’ to mention of Gold Standards Framework, Advanced Care Planning, Preferred Priorities of Care, Mental Capacity Act, powers of attorney, deprivation of liberty

Pre-questionnaire blank; post-questionnaire notes Gold Standards Framework and the Liverpool Care Pathway

Shift towards recognition of importance of dementia and vulnerable adults guidelines, and relevance of end of life to a wide range of policy areas

6. Necessity for specialist training in end of life care

Post-questionnaire blank; pre-questionnaire recognises training as important

Pre-course questionnaire left blank; post questionnaire stated that training was ‘very necessary… to understand our residents preferences to ensure they have the best possible care’

No shift: both pre and post stated that end of life care training was ‘useful’, without elaborating

No shift in recognition of importance of course (‘very important’) but carer added ‘I have learnt so much from this course’

Pre-questionnaire blank; post-questionnaire recognises the need for specialist training in end of life care, as ‘it is the last thing you can do for somebody before they die’

Little shift; carer had already recognised the importance of training

7. Sources of information on end of life care

Post-questionnaire blank; pre recognises internet, in-house training, policies

Pre-course questionnaire left blank; post questionnaire mentioned books, leaflets, and video

Both left blank

Shift towards wider awareness of resources, from ‘internet, books etc’ to ‘videos, books, government websites, internet, colleagues, policies’

Both left blank

Slight shift from internet resources to ‘all sources of info’

8. Contribution of e-learning to end of life training

Post-questionnaire blank; pre-questionnaire emphasises the need for time to carry out e-learning

Pre-course questionnaire left blank; post questionnaire mentioned e-learning as a source of information

Both left blank

Little substantive shift; pre questionnaire stated that e-learning can make a ‘big contribution’ while the post questionnaire stated that e-learning allows users to ‘be educated and learn about certain topics’

Both left blank

Shift from generic remark on the importance of training towards recognition of e-learning in particular – ‘easy and convenient’