ELNEC Fact Sheet
Updated October 2016
The End-of-Life Nursing Education Consortium (ELNEC) project is a national education initiative to improve palliative care. The project provides undergraduate and graduate nursing faculty, CE providers, staff development educators, specialty nurses in pediatrics, oncology, critical care and geriatrics, and other nurses with training in palliative care so they can teach this essential information to nursing students and practicing nurses. The project, which began in February 2000, was initially funded by a major grant from The Robert Wood Johnson Foundation (RWJF). Additional funding has been received from the National Cancer (NCI) and Open Society Institutes, US Cancer Pain Relief Committee, the Aetna, Archstone, Oncology Nursing, California HealthCare, Milbank, and Cambia Health Foundations, and the Department of Veterans Affairs (VA).
To date, over 21,400 nurses and other healthcare professionals, representing all 50 US states, plus 90 countries have received ELNEC training through these national courses and are sharing this new expertise in educational and clinical settings. ELNEC Trainers are hosting professional development seminars for practicing nurses, incorporating ELNEC content into nursing curriculum, hosting regional training sessions to expand ELNEC’s reach into rural and underserved communities, presenting ELNEC at national and international conferences, coordinating community partnerships, and improving the quality of nursing care in other innovative ways. It is estimated that since its inception, that ELNEC trainers have returned to their institutions and communities and have trained over 642,000 nurses and other healthcare providers.
The ELNEC project is administered by the American Association of Colleges of Nursing (AACN), Washington, DC and the City of Hope, Los Angeles, CA, and the esteemed faculty includes a national cadre of nursing leaders in palliative care.
KEY ELNEC FACTS
People in our country deny death, believing that medical science can cure any patient. Death often is seen as a failure of the health care system rather than a natural aspect of life. This belief affects all health professionals, including nurses. Despite their undisputed technical and interpersonal skills, professional nurses may not be completely comfortable with the specialized knowledge and skills needed to provide quality palliative care to patients. The ELNEC project gives nurses the knowledge and skills required to provide this specialized care and to positively impact the lives of patients and families facing serious illness or the end of life.
The curriculum was developed through the work of nationally recognized palliative care experts with extensive input from an advisory board and reviewers. The curriculum is revised regularly based on participant recommendations and new advances in the field, and is modified for each distinct audience. The curriculum focuses on core areas in end-of-life care reflecting AACN's 1998 publication Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care. This document outlines specific aspects of professional nursing care considered requisite for each graduate. Other landmark documents used in the development of the ELNEC curricula include the 2013 National Consensus Project’s (NCP) Clinical Practice Guidelines for Quality Palliative Care, the 2013 Institute of Medicine (IOM) Report entitled Delivering High Quality Cancer Care: Charting a New Course for System in Crisis and the 2014 IOM Report entitled Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.
ELNEC-Core content is divided into eight modules: Nursing Care at the End of Life; Pain Management; Symptom Management; Ethical/Legal Issues; Cultural Considerations in End-of-Life Care; Communication; Loss, Grief, Bereavement; and Preparation for and Care at the Time of Death. Cultural Consideration and Ethical/Legal Issues modules have been embedded in the other 6 modules if trainers only have 1 day to present ELNEC-Core. ELNEC-Pediatric Palliative Care, ELNEC-Critical Care, and ELNEC-Geriatric have similar modules (see information below about these curricula and others).
Participants receive a comprehensive 1,000+ page syllabus, palliative care textbook, and a wealth of resources and strategies to teach this content to others. Teaching materials are furnished in hard copy as well as on a CD so nurse educators can use them efficiently for their own instructional purposes.
- ELNEC-CORE: The initial RWJF grant provided eight ELNEC-Core train-the-trainer courses, held between 2001-2004. The courses were designed to meet the unique needs of several specific groups of nursing educators with 900 baccalaureate and associate degree nursing faculty attending these early courses, representing 65% of baccalaureate nursing programs nationally.
Based on post course surveys, the ELNEC team estimates that each of the 900 faculty originally trained in ELNEC, reached an estimated 50 students in the first year post-ELNEC training (total of 45,000 students). This estimate is from the 12-month post-course surveys. Approximately 14,000 nurses who provide education at various levels within the organization and in diverse clinical settings (i.e. advanced practice nurses [APN’s], continuing education providers, professional nursing organization educators, institution-wide staff development educators, unit-specific educators, community educators, etc) have been trained to date. ELNEC-Core is used to train staff nurses, advanced practice nurses, undergraduate and graduate nursing faculty, administrators, and researchers who work in acute care settings (i.e. medical-surgical and oncology units), clinics, homecare, hospice and palliative care settings. Several national ELNEC-Core courses are held each year.
Although the initial RWJF grant ended in 2004, a grant from the National Cancer Institute (NCI) began in 2002 to meet the special needs of faculty teaching in graduate nursing education programs. Between 2003-2006, four NCI-funded ELNEC-Graduate train-the-trainer courses were held. A total of 400 graduate nursing faculty attended, representing every state in the United States and 285 out of 438 (65%) graduate nursing programs.
The NCI began funding the ELNEC-Oncology training program in August 2003. This program trained oncology nurses, who were members of the Oncology Nursing Society (ONS), to disseminate palliative care education through their local ONS chapter to improve care of cancer patients and their families. At the conclusion of the four-year grant, 264 oncology nurses, representing 141 out of 222 (64%) ONS chapters attended a national ELNEC-Oncology course.
NOTE: While the ELNEC-Oncology and ELNEC-Graduate courses have concluded, oncology and graduate nursing educators now attend ELNEC-Core or ELNEC-APRN courses and the Oncology and Graduate content have been integrated in the ELNEC-Core and APRN curricula.
- ELNEC-PEDIATRIC PALLIATIVE CARE: Adapted from the ELNEC-Core curriculum, a pediatric-specific course, ELNEC-Pediatric Palliative Care was developed by 20 pediatric palliative care experts and piloted in 2003. Each year, at least three national train-the-trainer courses are offered across the US. Six other courses, in collaboration with the Association for Pediatric Hematology/Oncology Nurses (APHON) have been provided. The Aetna Foundation partially-funded the August 2005 and 2006 courses. In 2009, the curriculum was up-dated to include enhanced perinatal and neonatal content.
- ELNEC-CRITICAL CARE: Also adapted from the ELNEC-Core curriculum, a critical care-specific course has been developed for nurses who work in intensive care, coronary care, burn and dialysis units, emergency departments and other clinical areas encompassing critical care. This course debuted in 2006. In January 2007, April 2008, January 2009, and October 2010 a national ELNEC-Critical Care course was offered to California nurses and funded by the Archstone Foundation. At least two national train-the-trainer courses are offered around the country annually.
- ELNEC-GERIATRIC: With life expectancy increasing and the numbers of aging adults growing each day, the healthcare system in the U.S. and abroad requires nurses to be educated in meeting the palliative care needs of older adults. The ELNEC-Geriatric curriculum addresses the specific educational needs of nurses who provide care to people who reside at home or are being cared for in community-based settings, such as assisted living, nursing communities, skilled nursing settings, hospices, or ambulatory care clinics. Based on the National Consensus Project (2013), each module captures essential elements of geriatric palliative care that is easy to teach or implement across the continuum of community care settings. Unique features of the course include a focused module on geriatric palliative care that elaborates on physiologic changes in older adults, medications, and chronic conditions using a person-centered approach. Geriatric syndromes are integrated across all 9 modules. A plethora of patient and family education materials and evidence-based assessment tools are provided to augment pain and symptom management. Undergraduate and graduate nursing faculty find its supplemental teaching materials and case studies invaluable to their current lectures. In addition, the curriculum includes supplemental teaching strategies for educating unlicensed personnel that work with geriatric patients and their families. ELNEC is grateful to the California HealthCare Foundation (CHCF), which provided funding for the development of the ELNEC-Geriatric curriculum in 2005-2006 and funded two train-the-trainer courses and the Archstone Foundation, who funded three ELNEC-Geriatric courses from 2008-2010.
- ELNEC-FOR VETERANS: In 2010, The Department of Veterans Affairs (VA) awarded the City of Hope a three-year contract to educate nurses on how to provide better palliative care for Veterans with life-threatening illnesses. A new curriculum has been developed, ELNEC-For Veterans, to meet the unique needs of nurses caring for Veterans with life-limiting illness. More than 54,000 American Veterans – mostly from World War II and Korea -- die each month, and the Department of Veterans Affairs Hospice and Palliative Care Initiative (VAHPC) is trying to improve hospice and palliative care for them. Given that the number of Vietnam-era Veterans over 65 years of age will continue to grow through 2034, so too will the need for hospice and palliative care in the VA system. The expertise gained at these courses promises to improve the quality of palliative care for thousands of Veterans in 153 Department of Veterans’ Affairs Medical Centers across the U.S. To date, six national train-the-trainer courses have been held across the US with 745 nurses and other members of the interdisciplinary team in attendance, representing over 200 VA facilities (i.e. medical centers, clinics, CLC’s, etc). Community partners with VA (i.e. homecare, hospice, etc) have attended these courses, too, as they care for many Veterans in various community settings. A new curriculum, ELNEC-For Veterans/Critical Care, was developed at the end of 2011, to assist nurses working in critical care settings, as they care for Veteran’s unique needs. Additional funding was received by the Milbank Foundation for Rehabilitation to train 60 nursing faculty at the AACN Baccalaureate Conference in November, 2012 in San Antonio, TX, with the intent of infusing the Veterans content into nursing curricula. For a list of ELNEC-For Veterans trainers, go to https://www.aacn.nche.edu/elnec/trainers.
- ELNEC-FOR PUBLIC HOSPITALS: In the spring of 2011, the national ELNEC Project Team conducted site visits to 16 public hospitals throughout the state of California. The 16 facilities were being supported by the California HealthCare Foundation (CHCF) to assist in establishing palliative care programs throughout their organizations. These hospitals are extremely active healthcare systems that serve a variety of underserved/multicultural populations. They also serve a large Medicare/MediCal population and receive limited reimbursement for the services they deliver. Through a grant from CHCF, the ELNEC Project Team developed a curriculum specifically for nurses who work in public hospitals and a 2.5 day train-the-trainer course to develop leadership and mentoring. In November 2011, 58 nurses from the 16 public hospitals throughout California attended the ELNEC-For Public Hospitals train-the-trainer course. These trainers have returned to their hospital to promote palliative care education with the purpose of improving end-of-life care to the most vulnerable citizens of California. In addition, a generous grant from the Archstone Foundation has provided each of the hospitals with two years of access to the ELNEC-For Public Hospitals curriculum via the Hospice Education Network (HEN), an opportunity that will allow greater distribution of the training. For a list of ELNEC-For Public Hospitals trainers, go to https://www.aacn.nche.edu/elnec/trainers.
- ELNEC-ADVANCED PRACTICE REGISTERED NURSES (APRN): This first course, supported by Cambia Health Foundation, debuted April 4 & 5, 2013 in Anaheim, CA with 115 APRNs, representing 26 states. There are many palliative care teams across the US being led by APRNs and they are key team members who exemplify commitment to their varied roles in not only leadership, but practice, education, and research. Participants receive advanced education in pain and symptom assessment/management and communication. Additional education in palliative care-related finances, budgets, quality improvement, education, and leadership are also provided. Participants can choose to attend one of 2 tracks—adult-or pediatric-focused care. In 2015, additional funding from the Milbank Foundation and the US Cancer Pain Relief Committee provided scholarships for APRNs working in underserved areas of the US and with older adults. This funding will allow 90+ APRNs to attend this course in 2015 & 2016. For further information about future national courses, go to https://www.aacn.nche.edu/ELNEC.
- INTEGRATING PALLIATIVE ONCOLOGY CARE INTO DOCTOR OF NURSING PRACTICE (DNP)EDUCATION AND CLINICAL PRACTICE: On April 1, 2013, City of Hope Medical Center, in partnership with the American Association of Colleges of Nursing (AACN) received a 5-year grant for the purpose of educating DNP faculty and clinicians in palliative care. This project, funded by the National Cancer Institute (NCI), provides education to these future nursing leaders, as care for those with cancer continues to be complex and financially burdensome. Participants receive resources to assist in integrating evidence-based palliative care content into DNP program curricula and to prepare DNP graduates in providing evidence-based palliative care in a variety of oncology settings. This program is built around the 2013 National Consensus Project’s (NCP) Clinical Practice Guidelines for Quality Palliative Care, the 2013 Institute of Medicine (IOM) Report entitled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, and the AACN Essentials of DNP Education. For more information on this project, go to https://www.aacn.nche.edu/ELNEC.
- ELNEC ONLINE FOR UNDERGRADUATE NURSING STUDENTS: Cambia Health Foundation (CHF) is investing funds to develop an innovative ELNEC online curriculum to integrate palliative care in undergraduate nursing education across the nation. The online format will make the ELNEC curriculum equally available to students in rural areas and help standardize palliative care nursing education. Through the generous funding of CHF, the online ELNEC curriculum, which will be available through Relias Learning, will be introduced to 92 undergraduate nursing programs in Idaho, Utah, Oregon and Washington for free. The online curriculum will also be available to the remaining 46 states for a nominal fee. This new online curriculum will be available January, 2017.
ELNEC’s primary aim is to educate nurses to improve palliative care. While the initial efforts, launched in 2000, were focused in the United States, many ELNEC trainers have had opportunities to travel internationally and provide this education to nurses and other healthcare providers throughout the world. The National ELNEC Project has also received funding to provide international courses. Currently, ELNEC trainers and faculty have traveled to six of the seven continents, representing 88 countries. Many trainers have provided ELNEC educational courses, while others have gone as consultants to work with educators, health administrators, and community leaders to improve care of the seriously ill in their countries. It is estimated that over 10,500 nurses and other healthcare providers have received ELNEC training internationally. Some are working on translating ELNEC into other languages and adapting it to increase the relevance to other cultures. For example, ELNEC has already been translated into Russian, Romanian, and Albanian, where nursing administrators and faculty are using the curriculum in Eastern Europe. ELNEC is also translated in Spanish (Core and Pediatric Palliative Care versions) and is being widely disseminated in Mexico, Central America, and parts of South America. Lastly, ELNEC-Japanese, ELNEC-Korean, ELNEC-Chinese, and ELNEC-German are available.
In October 2006, the 1st Salzburg Medical Seminar Series for Nurses in Palliative Care took place in Salzburg, Austria. Four ELNEC faculty members taught ELNEC to 38 Eastern European nursing leaders in education and clinical practice from 14 Eastern European countries. Due to the tremendous success of the first seminar, ELNEC faculty was invited to present this training program again in April 2008, 2011, December 2014 and September 2015. Over 120 nursing faculty, administrators, and physicians attended these five courses. Each of these courses were supported by the Open Society Institute, with representation from 23 Eastern European countries.
For more examples of recent invitations to present ELNEC-International, go to http://www.aacn.nche.edu/elnec/about/elnec-international.
For more information on ELNEC trainers’ efforts to disseminate ELNEC internationally and for a listing of efforts by country, go to: https://www.aacn.nche.edu/elnec/elnec-international.
- Website: The ELNEC project is described in detail at www.aacn.nche.edu/ELNEC. ELNEC Trainers use the complete list of Trainers found on the website by state to locate colleagues with whom to consult and partner. Those outside the ELNEC network can also use this list to contact experts as consultants and instructors.
- Newsletter: The quarterly newsletter, ELNEC Connections is sent to ELNEC Trainers, various palliative care organizations and projects, governmental agencies, and media representatives. ELNEC Connections provides information on palliative care and offers a forum through which the network of ELNEC Trainers can stay in contact and share successful education strategies. The newsletter is available online at https://www.aacn.nche.edu/elnec/publications/elnec-connections.
- Publications: Many articles have been written about the ELNEC Project since its inception in 2000. Numerous articles have been published regarding outcomes of various ELNEC courses/curricula. In addition, the ELNEC Project has been featured in various national and international journals and in electronic publications. For listings of these articles, go to https://www.aacn.nche.edu/elnec/elnec-publications.
- Awards: Excellence in ELNEC Education Awards are presented annually to ELNEC Trainers who have made particularly noteworthy contributions to palliative care education. https://www.aacn.nche.edu/elnec/elnec-award-winners
- ELNEC Online: Since 2007, ELNEC modules have been placed on-line through the Hospice Education Network (HEN). These modules have been presented by national nursing leaders in palliative care. In 2014, Relias Learning, the leader in online learning content and learning management systems for the senior care industry, acquired HEN. In 2014, communication vignettes were videotaped and are now available through Relias, as well as various ELNEC curricula. The vignettes and ELNEC modules (ELNEC-for Veterans, Core, Critical Care, Geriatric, and Pediatric Palliative Care ) are useful teaching tools in schools of nursing, acute care facilities, clinics, hospice, homecare, long-term care and skilled nursing facilities. Obtain more information about these modules.