Sharing best practice in palliative care

Nigel’s using teleconferencing technology to help train clinically isolated district nursing staff

Nigel Dodds, a consultant nurse and member of the RCN Pain and Palliative Care Forum, has worked in palliative care for 25 years. He currently leads a team of clinical nurse specialists at St Christopher’s Hospice, delivering end-of-life care to people in their own homes in south-east London.

During his career, Nigel witnessed the potential for nurses administering end-of-life care to feel isolated and lose out on opportunities for training and sharing best practice. “Delivering regular education is a challenge,” he says. “We needed an approach that was more user-friendly, enabling people to receive education in their base, to maximise time and reduce obstacles.”

Now, technology has provided a solution. Project ECHO is a system created by an American liver specialist to upskill doctors and nurses in remote areas. It uses Zoom, a teleconferencing tool, to connect health care professionals in different places for group learning sessions. In each session, a specialist gives a presentation to the group. Two participants then share real-life case studies, looking to their colleagues for advice.

Nigel Dodds and colleague running Project ECHO at St Christopher's Hospice Lewisham

Creating a virtual community

“It’s about democratising learning,” Nigel explains. “By involving everybody in discussions, everybody recognises that they’ve got knowledge and skills to share with one another. It also helps to break down barriers: with everyone seeing each other on screen, you develop this real sense of community.”

The system was introduced here by Hospice UK, but now nurses such as Nigel are leading their own virtual groups. “I’m working with district nurses across the borough of Lewisham,” he says. “We held a big meeting with all of them and said: ‘It’s difficult for you to get education regularly because of where you’re based and clinical commitments. Why don’t we deliver education in a different way?’

Nigel asked the district nurses to come up with 12 topics they’d like to explore. “Last week, we had a session on dementia care,” he says. “Someone from the mental health charity Mind presented. Then two of the district nurses in different parts of the borough presented a case study of a patient who had dementia and the challenges of looking after them. We then threw that out to the group. There were 45 people all located remotely who discussed how they would’ve managed that case, what they learned, and their advice.”

Nigel Dodds poses outside St Christopher's Hospice Lewisham

As the nurses have got to know one another better, trust has grown. “People have been braver about presenting problems,” Nigel says. “They want to hear from colleagues about how they might have managed the case.”

Virtual sessions are recorded and stored in a library for project members. Nurses can re-watch particularly useful sessions, or catch up if they miss one.

Nigel is now looking to expand Project ECHO to palliative care clinical nurse specialists across the whole of south-east London, and do more work with care home staff. “There are already national hubs connecting people in different parts of the country,” Nigel says. “Geography is no problem.”

Words by Rachael Healy. Pictures by Gareth Harmer

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