title: Education and training to enhance end-of-life care for nursing home staff: a systematic literature review.
abstract: BACKGROUND
  The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles.
  
  
  OBJECTIVE
  To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care.
  
  
  METHODS
  Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically.
  
  
  RESULTS
  Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported.
  
  
  CONCLUSIONS
  There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Anstey
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Powell
authors.affiliation: Cancer Research Wales (CRW) Library, Velindre National Health Trust, Cardiff, UK.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Coles
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hale
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Dinah
authors.initials: D
authors.lastname: Gould
mesh_terms: D006801:Humans; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education*; D011787:Quality of Health Care; D013727:Terminal Care / Q000592:standards*
keywords: Education and training; Intervention Studies; Nursing Home care