Facing the Inevitable

Preparing Nurses to Deliver End-of-Life Care

Shelly Orr, PhD, RN, CNE; Mary Falk, MSN, RN, CCRN; R.K. Elswick, PhD


Journal of Hospice and Palliative Nursing. 2021;23(5):462-468. 

In This Article


The Hospice and Palliative Nurses Association sponsors 2-day ELNEC Core "Train-the-Trainer" courses. The project's investigators attended this training course to receive further education in palliative care and preparation to teach the information learned to others. After training, the investigators received formal approval from the ELNEC Project Office for approval to host the training workshop for others. In addition, project approval was received from the institutional review board at Virginia Commonwealth University (VCU).


A flyer detailing the 9-hour training workshop was distributed via email to senior-level students at the VCU School of Nursing. In addition, the flyer was distributed via email to VCU Health System nurses and posted on the Richmond area chapter of the American Association of Critical Care Nurses Association website. Interested participants were asked to voluntarily register online for 1 of 2 workshop dates offered via a Research Electronic Data Capture (REDCap) survey. Completion of the registration also indicated their informed consent to participate in the study.

Workshop Details

The 9-hour training workshop, taught by both investigators, was initially offered on a Saturday in February and a Saturday in April in the spring of 2020. However, because of COVID-19, the second offering in April was changed to a virtual format via zoom to abide by social distancing mandates. There was no charge for participants for the training workshops for this initial offering year. Completion of the workshop resulted in an ELNEC training certificate for all participants, continuing education (CE) credits for practicing nurses, and a jump drive that contained a copy of the materials covered throughout the day. In addition, all February participants received breakfast and lunch at no charge.

To achieve the stated aims and objective of this project, each workshop was limited to 30 participants (total N = 60). Although projects typically aim to include at least 30 participants to examine feasibility, the investigators targeted a sample of 60 because of potential attrition rates. In addition, the investigators considered the space available and number of trainers (2), as recommended by ELNEC,[8] when designing the workshop participant limit.

Feasibility Assessment

To evaluate the feasibility of the workshop, the investigators collected data regarding recruitment and retention rates, including whether they were able to obtain the desired 60 participants and whether all participants who enrolled in the workshop completed it. In addition, the investigators ascertained whether the workshops were implemented without any issues (ie, registration, space, food, technical, etc).

Effectiveness Assessment

The workshop's effectiveness was evaluated through a REDCap survey, which participants were asked to fill out within 2 weeks before and within 2 weeks after the workshop. This survey evaluated participants' knowledge levels regarding EOL care principles. The investigators received permission to use the ELNEC–Knowledge Assessment Test (KAT) from the survey's primary author, Jean W. Lange. The ELNEC-KAT is a validated 50-item version of an original 109-item knowledge assessment instrument developed by ELNEC to evaluate knowledge gained from EOL training programs.[12] It contains multiple-choice questions with 4 possible responses; only 1 response is correct. Individual scores are based on the number of correct answers (range, 0–50). In addition, each participant who completed the ELNEC-KAT was asked to complete a demographic survey (age, gender, race/ethnicity, student vs practicing nurse, previous experience with EOL) through REDCap.

Satisfaction Assessment

Lastly, each participant was asked to complete a satisfaction survey through REDCap after completion of the workshop so that the investigators are well informed regarding satisfiers and dissatisfiers when considering the design of subsequent workshops. To glean the most information possible, the satisfaction survey contained structured and open-ended questions. To assist with retention, workshop completion and CE certificates were not distributed until a participant completed the postworkshop surveys.

Data Analysis

Descriptive statistics were used to examine the feasibility and satisfaction of providing the workshops. Utilizing JMP, a mixed-effects linear model[13,14] was used to test for changes from the preworkshop to postworkshop ELNEC-KAT scores. The mixed-effects linear model included fixed effects for time (preworkshop vs postworkshop) and conference date (February vs April). A random effect for subject was included to model the correlated data within an individual. Modeling assumptions such as normality and homoscedasticity were checked for each model. Finally, because of the pilot nature of the study, no correction for multiplicity occurred and all tests were tested at α = .05.