Welcome to the Winter 2012 Edition!
The End-of-Life Nursing Education Consortium (ELNEC) is pleased to bring you the Winter 2012 issue of ELNEC Connections, a quarterly newsletter to showcase efforts in end-of-life nursing education and practice. This newsletter spotlights project developments and provides resources that may be useful to you as an ELNEC trainer. ELNEC is a national education program to improve end-of-life care by nurses. Today, over 13,250 nurses and other healthcare providers have attended a national train-the-trainer course. ELNEC also has been presented in 73 countries. The project, which began in February 2000, was funded by a major grant from the Robert Wood Johnson Foundation. Additional funding has been received from the National Cancer and Open Society Institutes; the Aetna, Archstone, Oncology Nursing, Bristol-Myers Squibb, and California Healthcare Foundations; and the US Department of Veterans Affairs.  ELNEC is administered through a partnership between the American Association of Colleges of Nursing (AACN) and the City of Hope (COH).
In this Edition, read about:
Check out our Facebook page that lists the latest information about ELNEC. Interact with other ELNEC trainers.
To take a glimpse and become a “friend”, click here.
Six National ELNEC Courses Remaining for 2012
Several ELNEC courses are currently accepting applications with programs offered across the US. Note that there are still seats available for Core, Pediatric Palliative Care, Geriatric, Critical Care, ELNEC-For Veterans, and the brand new ELNEC-For Veterans/Critical Care courses.
  • ELNEC-Core: March 21-22 in Lake Buena Vista - Orlando, FL (in partnership with HPNA)
  • ELNEC-For Veterans and ELNEC-For Veterans/Critical Care*: April 3-4 in Durham, NC
  • ELNEC-Core: May 10-11 in Chicago, IL (in partnership with HPNA)
  • ELNEC-For Veterans and ELNEC-For Veterans/Critical Care*: July 17-18 in Anaheim, CA
  • ELNEC-Summit**: August 23-24 in Washington, DC
  • ELNEC-Summit**: October 11-12 in Portland, OR
*These 2 courses will be held simultaneously.
**ELNEC Summit—ELNEC-Core, Pediatric Palliative Care, Geriatric, and Critical Care train-the-trainer courses are held simultaneously. 
Three ELNEC- International Courses are scheduled for Armenia, Malaysia, and South Korea later this year.
For more information and/or to register, go to www.aacn.nche.edu/ELNEC
2011 ELNEC Award Winners Announced
Each year, several outstanding trainers are chosen as ELNEC Award Winners for their commitment in providing excellent palliative care, educating staff, improving systems of care, promoting interdisciplinary care, and working in their communities.  This year, the slate of winners is certainly impressive.  You will not want to miss reading about their exemplary work.  For more information, go to http://www.aacn.nche.edu/elnec/award-winners.
Congratulations to all!  This year’s winners are:             
  • Diane C. Parker, MSN, RN, NE-BC, CHPN,  Hospice Care of South Carolina (SC)
  • Vanessa Battista, MS, RN, CPNP, CCRC, Boston College William F. Connell School of Nursing and Department of Neurology at Children’s Hospital Boston (MA)
  • Kelly Fischer, BSN, CHPN, and Kris Simon, BSN, LPC, CT, co-founder of Bear Courage (WI)
  • Elissa DeWolfe, MN, RNC, CNS, ACHPN, Kaiser Permanente, Oakland (CA) 
  • Patricia Trotta, MSN, RN, CHPN, VNA Healthcare’s Hospice/HOPE team (CT) 
  • Benito Garcia, MSN, RN, George Whalen VA , Salt Lake City (UT)         
  • Marcia LaHaie, BSN, RN, APRN-BC VA Ann Arbor Healthcare System, Ann Arbor (MI)
  • Linda Seck, MSN, RN, VA Ann Arbor Healthcare System, Ann Arbor (MI) 
  • Sheila Lozier, BSN, RN, Bay Pines VAHCS, St. Petersburg (FL) 
  • Juli McGowan, MSN, RN, FNP, Kimbilio Hospice, Kipkaren, Kenya      
  • The Team at Hospice Casa Sperantei, Brasov, Romania
Photos below are from right to left.
End-of-Life Nursing Education Consortium (ELNEC) Marks 100 Courses
On January 26-27, 2012, over 200 nurses, physicians, social workers, and chaplains attended the 100th national/international ELNEC course in Glendale, CA. These participants came from 28 states and 4 countries--Canada, Mexico, South Korea, and Taiwan. Four ELNEC courses (Core, Pediatric Palliative Care, Geriatric, and Critical Care) were held simultaneously, to meet the unique needs of those working in acute care hospitals, hospices, homecare agencies, long-term care/skilled nursing facilities, clinics, and schools of nursing. Betty Ferrell, PhD, RN, FAAN, FPCN, Research Scientist at City of Hope and Principal Investigator of ELNEC, provided the opening address. Betty was honored for her great vision and ability to secure funds to promote ELNEC courses over the past eleven years.  
 Betty Ferrell, PhD, RN, FAAN, FPCN, Research Scientist at City of Hope and Principal Investigator of ELNEC
A presentation of flowers and a box full of letters from trainers around the world, thanking her for the contribution she has made to palliative care, were presented to Betty. Many who wrote letters to Betty shared examples of how they had used ELNEC to improve palliative care in their institution. “It has been so encouraging to see nurses and other healthcare professionals attend an ELNEC course and envision better care and have the tools in hand to promote palliative care in their institution,” said Betty. “Education is the key to promoting this care, as no one can practice what they do not know.”
ELNEC Curriculum Developed for Those Who Work in Public Hospitals
In the spring of 2011, the California HealthCare Foundation (CHCF) contacted the ELNEC Project Team, asking for assistance in training nurses who work with the underserved in 16 public hospitals throughout the state of California. Each of these public hospitals are extremely busy healthcare systems, and they serve a variety of underserved/multicultural populations. In addition, these hospitals have a large Medicare/Medi-Cal population and receive limited reimbursements for their services, as well as provide significant unreimbursed care. On November 28-30, 2011, thanks to a grant from the CHCF, a total of 58 nurses, representing these 16 public hospitals attended ELNEC-For Public Hospitals. A curriculum was developed to meet the unique needs that these nurses face daily. Many of these nurses have returned to their institutions and have begun using ELNEC in orientation, developing palliative care order sets, identifying palliative care champions on each unit of the hospital, etc. In addition, two other activities will occur over the next 2 years to support these nurses as they continue to promote palliative care
1) For the next 12 months, those who attended the November 2011 ELNEC-for Public Hospitals course will participate in monthly mentoring calls with the national ELNEC Project Team. 
2) To support their efforts in educating their staff, each hospital will have a 2-year subscription to ELNEC-For Public Hospitals through the Hospice Education Network (HEN).   
Besides ELNEC-For Public Hospitals, the ELNEC project has partnered with HEN to provide ELNEC-Core, Pediatric Palliative Care, Geriatric, and ELNEC-For Veterans training courses via video streaming. For more information about HEN, click here.
If you currently work in a public hospital and would like to purchase a copy of the ELNEC-For Public Hospitals CD, please notify Karen Contreras at kacontreras@coh.org.
ELNEC-For Veterans: Final Two Courses Funded by VA to Occur in 2012
To date, over 500 nurses, physicians, social workers, chaplains, pharmacists, and other providers have attended one of four national ELNEC-For Veterans training courses. Though funding is provided to those working in VA facilities, over 70 participants have attended from community hospices, military hospitals, non-VA acute care facilities, and schools of nursing. Only 4% of veterans die in VA facilities, so the other 96% die in non-VA facilities—most in community hospices and hospitals. With these statistics, it is vital that this training also be provided to those not working in VA facilities. Recently, the VA has requested that the final two courses, to be held in 2012, be aimed at educating nurses in the critical care arena. A new curriculum, ELNEC-For Veterans/Critical Care has been developed to meet this request. In addition, the original ELNEC-For Veterans curriculum will be taught, simultaneously, for those nurses who do not work in critical care arenas. Dates of these courses are:  April 3-4 in Raleigh-Durham, NC and July 17-18 in Anaheim, CA.
If you work in a VA facility, contact your palliative care program manager for further details.  For those not working in VA facilities, you may obtain more information and a registration form  at www.aacn.nche.edu/ELNEC.
"White Wreath Protocol" Promotes Respect for Dying Patients and Their Families
The process of sharing the final moments in our patients’ lives is often as emotional for caregivers as it is for families. With that in mind, the Medical Intensive Care Unit (MICU) team at Buffalo General Hospital (BGH)is taking steps to improve the human elements of that experience for everyone by introducing the “White Wreath” protocol. One in five deaths in the U. S. occur in an Intensive Care Unit (ICU), which tends to be a brightly lit area with multiple monitor alarms regularly going off and an unfortunate lack of privacy—hardly anyone’s idea of the most peaceful or healing ways to say our final goodbyes to someone we care about.  The “White Wreath” protocol creates a cultural awareness and respect for an individual's ethnicity, age, religion, and spirituality; allows for the appropriate  
Pictured above, standing left to right are the following nurses who work on this project:  Cathy Papia, Rose St. Pierre, Kimberly Dale, Cynthia Hamm.  Seated is Heidi Lowitzer.
modification of the critical care environment for an actively dying patient, and supports the nurse providing end-of-life care. Upon recognizing a patient is in the final hours of life, the following “White Wreath” protocol is now being implemented at BGH:
  • A white wreath will be placed on the glass outside of the patient’s room as a signal to those present in the MICU to modify noise and conversation levels.
  • A vase of white silk flowers will be placed on the secretary’s desk as a signal to all staff entering the MICU to modify noise and conversation levels.
  • Pastoral Care Services will be offered to the patient and their family/significant others.
  • A specially prepared basket will be made available with the following contents (e.g. LED candle, CD player with assorted music, scented lotion for family members to apply to their loved one’s hands/feet, Bible or Koran, Kleenex, blanket that can be used on the patient and then family can take it home after the death, an angel/dove pin for the patient to wear, which would then be offered to the family/significant others that are present to take home.
Once the nurse caring for the dying patient has completed their responsibility for the patient’s care, they will be encouraged to leave the MICU for a short break. The MICU charge nurse will then collaborate with the remaining staff to provide coverage of that nurse’s assignment to allow for this very personal, stress-reducing period of time. Although the tasks and processes of medicine have their place at the end-of-life stage, the softer touches that show respect and care for the father, mother, brother, sister, friend, son, daughter, patient, etc. being lost must play an equal—if not greater—role at this time. “This is an incredible tribute to our patients and families from caring clinicians who recognize the human need for compassion and consideration at the end-of-life,” said Pat Holtz, manager, MICU. “It is truly my pleasure to work with such talented caregivers and caring people.” Start-up funds for the program were provided by Lucy Campbell, MD, MICU medical director, and Pat Holtz. If you would like to learn more about this project, contact Cathy Papia at CPapia@KaleidaHealth.Org
Utah Rural Hospice Nurses Participate in Advanced Communication Workshops: Pilot Research Project Tests Telepresence
Rocky Mountain Hospice nurses Tracy Ridley (Tooele, UT) and Sandra Jensen (Price, UT) are rural hospice registered nurse case managers who give researchers at the University of Utah a glimpse of what it’s like to serve hospice patients in frontier and rural areas in the west. They are working with Lee Ellington, Patricia Berry and Maija Reblin, nurse researchers to develop advanced communication workshops delivered to rural hospice nurses through telepresence, or video conferencing. As part of this research project development, Tracy and Sandy recorded visits with consenting hospice patients and their family caregivers, and researchers analyzed tapes to determine communication processes used in their visits. During two workshop sessions, researchers provided nurses with a framework to organize their communication, and nurses provided feedback on issues specific to rural areas. This development work will serve as a basis for future workshop development. For further information on this project, contact Maija Anne Reblin at Maija.Reblin@nurs.utah.edu.
It Takes One Person With an Idea:
Oncology Nurse Raises Money for Kenyan Hospice
In April 2011, Mary Kate Eanniello, an oncology/palliative medicine nurse educator at the Helen and Harry Gray Cancer Center at Hartford Hospital in Hartford, CT, was attending the Oncology Nursing Society (ONS) Congress, listening to the impact of ELNEC trainers who work every day with patients who have cancer and their families. “One of the highlights during the 2011 ONS Congress for me was the lectureship given by Dr. Betty Ferrell, as she shared a story about a nurse, Joyce Marete, in Kenya whose goal was to become trained as a hospice nurse so that she could bring quality end-of-life care to the people of the Laikipia Region in Kenya,” stated Mary Kate. This story touched Mary Kate and it impressed upon her that Joyce shared the same professional goals as herself and the nursing staff that she works with each day. “I committed myself that day to do something to help Joyce achieve her goal of bringing quality end-of-life care to her community,” stated Mary Kate. Since the Congress, Mary Kate has been in communication with Joyce and has just finished a fundraiser to help raise money to support the Kenya hospice/palliative care center. She was able to sell tote bags by Mixed Bag Designs and raised approximately $800 for the Laikipia Palliative Care Center. “ It is my hope that I can continue to share a friendship and ‘sisterhood’ with this amazing nurse so many miles away from me.” Mary Kate can be contacted at meannie@harthosp.org.
Did You Know?
In 2011, 187 regional ELNEC courses were registered through the ELNEC Project Office? These courses were presented in 39 states + the District of Columbia. Three international ELNEC training courses were presented by ELNEC trainers in Saudi Arabia, Mexico, and Thailand. Approximately 3,800 people were trained throughout the US and around the world by these 190 ELNEC trainers. To date for 2012, 39 ELNEC courses have been registered with the ELNEC Project Office, in 19 states. 
Remember:  If you plan to hold an ELNEC course, be sure to complete the notification form and send it to the ELNEC Project Office. 
ELNEC-Core Has Undergone a Change
Many ELNEC trainers have reported to the national ELNEC Project Office that it is becoming more difficult to provide a 1 ½ - 2 day ELNEC training course at their facility. Many struggle to hold even a one-day course, due to poor staffing and lack of educational funds.  Yet, to hold a one-day course means rushing through each of the 8 modules in the 8-hours delegated.  With this in mind, the 2012 edition of ELNEC-Core has two modules, Culture and Ethical Considerations, embedded into the remaining six modules (Introduction to Palliative Nursing Care, Pain Management, Symptom Management, Communication, Loss/Grief/Bereavement, and Final Hours). This will allow more time for each of the 6 modules, and yet still be able to review concepts within the Culture and Ethical Considerations modules. Please note that these two modules will still be made available in hard copy and on the CD-ROM, for those who want to review eight modules. If you are an ELNEC trainer and would like to order this new version, contact Pam Malloy at pmalloy@aacn.nche.edu.
Educational Opportunities
Improving Quality of Life and Quality of Care for Oncology Family Caregivers
The primary aim of this oncology educational initiative is to implement a national education program on family caregiving in cancer. This program seeks to improve quality of life and the quality of care for family caregivers who are impacted by a loved one’s cancer across the trajectory of illness. The program aims to educate competitively chosen multidisciplinary teams (two participants per team) from cancer institutions across the nation in improving care for oncology family caregivers. Family caregivers, although profoundly impacted by a loved one’s cancer diagnosis, have received only minimal attention by most healthcare providers who are focused primarily upon the physical needs of the patient. It is estimated that two of every three American families will at some time have at least one family member diagnosed with cancer. The current trend toward earlier discharge from acute care hospitals and the expected increase in home care results in more adult children becoming involved in caring for a physically dependent parent. Furthermore, advances in cancer treatment have led to increased survivorship, which in turn has led to caregiving demands that may exist for several months to years.  For more information and/or to apply for this course, to be held July 11-13, 2012 in Anaheim, CA, click here
Oncology Social Workers: 
You are Invited to Apply to Join the Growing ExCEL in the Social Work Community!
If you are an adult or pediatric oncology social worker, plan to attend one of two ExCel in Social Work courses in 2012. Dates and locations are May 14-15 (Portland, OR—in association with APOSW) and May 28-29 (Boston, MA—in association with AOSW). This innovative education is offered free of cost (for competitively selected applicants). Accepted applicants are eligible for hotel stay, extensive materials, CEs, and meals associated with the program. ExCEL is strategically scheduled immediately preceding the 2012 AOSW and APOSW annual conferences in an effort to minimize your time away from work and out-of-pocket travel costs while maximizing educational opportunities. Additionally, two participants each year will be awarded $1,500 in recognition of their outstanding goal achievements. For further information and/or to apply, click here
Let Us Hear From You!
We are interested in your thoughts and suggestions about end-of-life nursing issues. What would you like to see in this newsletter? Do you have a story to share about how end-of-life nursing education has made a difference for your patients and their families?
Please forward your suggestions or comments to:

Pam Malloy
ELNEC Project Director
202-463-6930 X238
End-of-Life Nursing Education Consortium (ELNEC)