Perceptions about training and education Among the greatest

challenges that nurses perceived to be associated with ACP were their own and colleagues’ knowledge and skills about communication practice, recording and follow up: …we’ve still got – when you look at teams – a lot of nurses that aren’t confident to have those conversations. They say: ‘ well you like palliative care, you’re good at it’, and they back off …That’s my worry – the confidence of the staff, teaching them to do it and then following it Cyclosporin A nmr through (Macmillan Nurse). I’ve been in the post three years, so for me it’s the uncertainty or where you do document all this information Inhibitors,research,lifescience,medical and actually how you can get it through to other people so the patients’ wishes are respected – the documentation is a big thing for me (Community Matron). Nurses recommended that training and education should occur in Inhibitors,research,lifescience,medical several ways. Alongside formal training and education, whether by face-to-face teaching or distance learning, some saw the use of

mentorship and apprenticeship styles of training as crucial, so that less experienced staff could learn from their more experienced colleagues: I think there is so much to learn about communication skills and dealing with patients which you can emulate from a role model. And I feel very passionately that Inhibitors,research,lifescience,medical junior nurses need to work with senior nurses much more at the bedside, not in the classroom because I think there’s a theory and practice divide (Macmillan Nurse). Those who were involved in care homes perceived a need to provide ongoing support and mentorship of

this type to care home staff, particularly to care home managers, so that ACP could Inhibitors,research,lifescience,medical gradually become embedded in practice there and so that care staff could gain confidence in dealing with GPs and visiting clinical staff. Drawing on their experiences of receiving training which had largely focused on the implementation of the Mental Capacity Act, nurses recommended that the following should be included in any Inhibitors,research,lifescience,medical education programme to ensure familiarity with the broader aspects of ACP: • Design of ‘real’ scenarios for training, which reflected the reality of daily practice and reflected the variety of patients and people encountered during community nursing • Design of a flow chart to inform nurses and others about the various stages of ACP • Practical advice about communication and documentation. Those nurses who were already Adenylyl cyclase involved in ACP practice, perceived the importance of ongoing support/clinical supervision as a means of building confidence and safe practice. This was perceived to be just as crucial as knowledge and skills training. Discussion This paper reports one aspect of a larger study, which recruited a relatively small number of community nurses working with patients with palliative care needs in two cancer networks in England.