Evaluation - Train-the-Trainer Program to Enhance Hospice
Increasingly, Americans are dying in nursing homes (NHs). In 2001, approximately one quarter of all deaths in the United States occurred in NHs. By 2040, an estimated 40% of Americans will die in this clinical setting. These statistics indicate that care providers in NHs will provide much of the end-of-life (EOL) care in the United States.

Despite this trend, NH staff often are ill-prepared to deliver this care. Several studies indicate that knowledge about EOL care is lacking among NH staff as evidenced by results of palliative care exams,4 dearth of training opportunities, and perceptions of NH staff and bereaved family members.

To address the problem of inadequate educational preparation of NH staff, the investigators developed the Palliative Care Educational Resource Team (PERT), an educational partnership to enhance EOL care in NHs. Initially, the PERT program was delivered directly to licensed nursing staff and certified nursing assistants (CNAs) working in NHs located in western Washington. This program was evaluated and found to be effective in increasing staff knowledge, skills, and confidence about providing EOL care. To enhance the dissemination of the curriculum, the investigators explored different ways to package and deliver the curriculum to NHs. One such vehicle is a Train-the-Trainer format in which the curriculum is taught to educators who then conduct inservice or classes in their own facilities or agencies. This format has been used successfully with other EOL curricula, including End-of-Life Nursing Education Consortium (ELNEC) and Hospice and Palliative Nurses Association's Clinical Review. The purpose of this article is to describe the development and evaluation of the PERT Train-the-Trainer program.