Deb Rawlings

Using palliative care assessment tools to influence and enhance clinical practice.

The Palliative Care Outcomes Collaboration focuses on supporting palliative care services in Australia to measure service- and patient-level outcomes, and to use these data to drive continuous quality improvement. The introduction of a suite of clinical assessment tools nationally has resulted in important enhancements to care provision at individual service level. Improved communication, enhanced assessment of patient needs, and improved identification of triggers for the need to change care plans or for referral have resulted from this change.

Never say die: death euphemisms, misunderstandings and their implications for practice

BACKGROUND A Massive Open Online Course (MOOC) on death and dying was conducted to open the dialogue around death and dying. In one activity, participants were asked to engage with language and to think of alternative words (or euphemisms) that are used to describe death. AIM To reflect from a nursing perspective how language enables and sometimes disguises important messages and conversations. METHODS Four hundred and seventy one participants provided 3053 euphemisms. FINDINGS Euphemisms were varied, with many providing commentary on their purpose and use. DISCUSSION As a society we have become quite creative in the use of euphemisms, but need to be mindful of misunderstandings and misinterpretations which can cause embarrassment and distress in clinical situations. CONCLUSION This paper describes some of the euphemisms that were provided, examining why they are used and how their use can be easily misconstrued in daily life and in clinical practice.

Supporting service change in palliative care: a framework approach

BACKGROUND Palliative care services are increasingly identifying areas for improvement, then trying to create appropriate changes in response. Nurses in particular are often expected to take leading roles in quality improvement (QI) but are not necessarily trained or supported in these processes. METHODS A framework approach to change was developed to guide services through a change cycle and delivered via workshops by representatives of three Australian national projects. Participants were predominantly nurses (80%), with the majority (63.7%) over the age of 50. FINDINGS The workshops and the framework were positively evaluated, with participants feeling confident in a number of QI-related activities following workshop training. CONCLUSION Recognising and addressing problems in clinical practice and service delivery is an important way for nurses to ensure quality care for patients; however, they need support in developing the skills and knowledge that are essential to successful QI activities.

The contribution of a MOOC to community discussions around death and dying

BackgroundAdvances in medicine have helped many to live longer lives and to be able to meet health challenges. However death rates are anticipated to increase given the ageing population and chronic disease progression. Being able to talk about death is seen to be important in normalising death as part of life and supporting preparedness for death. Massive Open Online Courses (MOOCs) provide opportunities for the community to engage in collaborative learning. A 5 week MOOC was developed covering four main topics (language and humour, representations of death, medicalisation of dying, and digital dying) aiming:To enable participants to openly and supportively discuss and learn about issues around living, death and dying,To explore the normally unheard opinions and views of Australians around death and dying, andTo determine what effect online learning and discussions offered through the MOOC had on participants’ feelings and attitudes towards death and dying.MethodsData was captured on engagement rates in the various MOOC activities. Death Attitudes were measured by five items representing the MOOC’s learning objectives and completed at enrolment and conclusion. MOOC Satisfaction was measured with six items at the end of the MOOC. Descriptive statistics were produced for each variable and Chi-Square Tests of Independence assessed the extent of the relationship between categorical variables. Socio-demographic variables were examined as predictors of the outcome variables of MOOC engagement, MOOC satisfaction, and death attitudes. Ethical approval was received from Flinders University Social and Behavioural Research Ethics Committee (Project No. 7247).ResultsOne thousand one hundred fifty six people enrolled in the Dying2Learn MOOC with 895 participating in some way. Enrolees were primarily female (92.1%). Age ranged from 16 to 84 (mean = 49.5, SD = 12.3). MOOC satisfaction scores were high. Responses to the experience of participating in the MOOC were very positive, with mean scores ranging from 4.3 to 4.6 (aligning with agreement and strong agreement to statements on the value of participating). Death Attitudes were positive at commencement but increased significantly following participation.ConclusionsThe Dying2Learn MOOC provided an environment that enabled open and supportive discussion around death and dying and influenced attitudinal change.

Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course:

A Massive Open Online Course, Dying2Learn, was designed to foster community death conversations and strengthen community awareness of palliative care and death as a normal process. This exploratory study used a pre–post prospective design to determine if participation in Dying2Learn and exposure to online conversations about death and dying resulted in any significant influence on death competence in 134 participants who completed the Coping-with-Death-Scale both at the beginning and end of the course in 2016. Death competence refers to a range of attitudes and capabilities people have for dealing with death. Results at the end of the course indicated that engagement in Dying2Learn led to significant improvements in death competence scores over time (medium-to-large effect size). The positive impact was greater for those who completed more of the course, and effectiveness did not depend on sociodemographic characteristics. In conclusion, this study found that an online learning platform in the form of a Massive Open Online Course could engage community members in meaningful social discussion about death and dying, and that exposure to these conversations was beneficial for all participants regardless of previous exposure to death. Further exploration is required to determine whether this change in death competence will have an impact on participant’s behavior in the community regarding death conversations and preparedness.