End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
NLMS Users
E-learning for End of Life Care (ELCA)
Suggested full learning pathway
Mapped to NHS core competencies**:
Community based staff (Primary Care)
Nurse Practitioner
ADVANCED
79 Sessions
** Where applicable
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
INDEX
INTRODUCTION ......................................................................................................... 3
000 e-ELCA 0.0 Introduction ........................................................................................................ 3
000 e-ELCA 1.1 Advance Care Planning: Context ......................................................................... 3
000 e-ELCA 1.2 Advance Care Planning: Process .......................................................................... 4
000 e-ELCA 1.2 Advance Care Planning: Process .......................................................................... 4
000 e-ELCA 2.2 Assessment: Context .......................................................................................... 5
000 e-ELCA 3.3 Communicating: Specific contexts ........................................................................ 5
000 e-ELCA 3.4 Communication: Challenging scenarios ................................................................ 6
000 e-ELCA 4.1 Symptom management: Pain ............................................................................... 7
000 e-ELCA 4.2 Symptom management: Breathlessness............................................................... 7
000 e-ELCA 4.3 Symptom management: Nausea and Vomiting..................................................... 7
000 e-ELCA 4.6 Symptom management: General issues ............................................................... 7
000 e-ELCA 4.8 Symptom management: Advanced Illness ............................................................ 7
000 e-ELCA 4.4 Symptom management: Emergencies ................................................................. 8
000 e-ELCA 4.5 Symptom management: Last days of life ............................................................. 8
000 e-ELCA 4.5 Symptom management: Last days of life ............................................................. 9
000 e-ELCA 4.6 Symptom management: General issues ............................................................... 9
000 e-ELCA 4.7 Symptom management: Mood ......................................................................... 10
000 e-ELCA 5.0 Initiating conversations about End of Life Care (EoLC) ........................................ 10
000 e-ELCA 5.2 Critical situations ............................................................................................... 11
000 e-ELCA 5.3 Scenarios around dying...................................................................................... 11
000 e-ELCA 5.5 Frameworks and tools ....................................................................................... 11
000 e-ELCA 7.0 Bereavement .................................................................................................... 11
QUIZZES ................................................................................................................... 11
USER SUPPORT ........................................................................................................ 12
NOTES...................................................................................................................... 12
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
INTRODUCTION
This document contains the suggested Learning Pathway for established nurse practitioners who
working with End of Life Care patients.
There are shortened pathways available for those who feel they would like to build on their learning
over a longer period. Those sessions within the shortened pathways are clearly identified with an M
and or S alongside them in brackets in this document.
If you have not used the End of Life Care e-Learning resources before, then we strongly recommend
that you follow the first introductory session,

Introduction to e-learning for End of Life Care (EoLC)
This session will give you a better understanding of the benefits of using the learning environment
and how to maximise the benefits derived from the learning.
NB:
Don't forget when you finish a session to print out your personalised certificate for any
sessions you complete
000 e-ELCA 0.0 Introduction

Relationship between palliative care and EoLC (S) 1
000 e-ELCA 1.1 Advance Care Planning: Context

ACP and different trajectories (01_10)
Contributes to core competency:
 Demonstrate awareness and understanding of Advance Care Planning, and the times at which it
would be appropriate.
Additional sessions required to complete competency
(01_01)
(01_09)
(01_10)
(01_17)
(01_18)
The following sessions are included in the Nurse Practitioner Induction pathways:
(01_01)
1
Only need to be followed by those staff who have not completed the Induction pathway
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 1.2 Advance Care Planning: Process

Introduction to conducting conversations about ACP (01_11)

How to get started and get the timing right (01_12)

How to handle patients’ questions and concerns (01_13)

How to negotiate decisions which may be difficult to implement (01_15)
Contribute to the core competencies:
 Show understanding of Informed Consent and demonstrate the ability to give sufficient
information in an appropriate manner.
 Use effective communication skills when having Advance Care Planning discussions as part of
ongoing assessment and intervention.
 Work sensitively with families and friends to support them as the individual decides upon their
preferences and wishes during the Advance Care Planning process.
Additional sessions required to complete competency
(01_02)
The following sessions are included in the Nurse Practitioner Induction pathways:
(01_02)
000 e-ELCA 1.2 Advance Care Planning: Process

How to document conversations about advance care planning (01_14)

How to review previous ACP decisions (01_16)
Complete the core competency:
 Where appropriate, ensure that the wishes of the individual, as described in an Advance Care
Planning statement, are shared (with permission) with other workers.
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 2.2 Assessment: Context

Assessing those with fluctuating mental capacity (02_12)

Assessing urgent situations with limited information (02_13)
Contributes to the core competency:

Regularly review assessments to take account of changing needs, priorities and wishes and ensure
information about changes is properly communicated.
Additional sessions required to complete competency
(02_18)
The following sessions are included in the Nurse Practitioner Induction pathways:
(02_18)
000 e-ELCA 3.3 Communicating: Specific contexts

Communicating with people with speech and hearing difficulties (03_16)

Communication with children and young people (03_17)

Communicating with children and young people (03_18)

Discussing “do not attempt CPR” decisions (03_30)

Discussing food and fluids (03_31)
Contribute to the core competency:
 Work with individuals, their families and friends in a sensitive and flexible manner, demonstrating
awareness of the impact of death, dying and bereavement, and recognising that their priorities
and ability to communicate may vary over time.
Additional sessions required to complete competency :
(03_07)
(03_10)
(03_21)
The following sessions are included in the Nurse Practitioner Induction pathways:
(03_07)
(03_10)
(03_21)
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 3.3 Communicating: Specific contexts

Request for organ and tissue donation (03_19)

Request for euthanasia (03_20)
000 e-ELCA 3.4 Communication: Challenging scenarios

“Am I dying?” “How long have I got?” – handling challenging questions (03_22)

“Please don’t tell my husband….” – Managing collusion (03_23)

“How dare you do this to me!” – Managing anger (03_24)

“I don’t believe you; I’m not ready to die!” – Managing denial (03_25)

“What will it be like?” – talking about the dying process (03_26)

“Why can’t I stay here” “I don’t want to stay here” – when preferred place of care cannot be
met (03_27)

“I’m not loveable anymore…” discussing intimacy in end of life care (03_28)

“Why me?” – discussing spiritual distress (03_29)

Discussing ‘do not attempt CPR’ decisions (03_30)

Discussing food and fluids (03_31)

Silence: the withdrawn patient (03_32)

Distress: the crying patient (03_33)

Dealing with challenging relatives (03_34)

Challenging communication with colleagues (03_35)
Complete the core competency:
 Develop and maintain communication with people about difficult and complex matters or
situations related to EoLC.
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 4.1 Symptom management: Pain

Assessment of pain (04_07)

Principles of pain management (04_08)

Drug management of pain – core knowledge (04_09)

Opioids in pain management – advanced knowledge (04_10)

Managing different types of pain (04_11)
000 e-ELCA 4.2 Symptom management: Breathlessness

Assessment of breathlessness (04_12)

Drug management of breathlessness (04_13)

Non-drug management of breathlessness (04_14)
000 e-ELCA 4.3 Symptom management: Nausea and Vomiting

Causes of nausea and vomiting (04_15)

Assessment of nausea and vomiting (04_16)

Management of nausea and vomiting (04_17)

Assessment of constipation (04_18)

Management of constipation (04_19)
000 e-ELCA 4.6 Symptom management: General issues

Use of syringe drivers (04_27)

Non-drug interventions in symptom management (04_28)

Management of symptoms associated with wounds (04_31)
000 e-ELCA 4.8 Symptom management: Advanced Illness

Recognising and managing fatigue (04_36)

Assessment & management of weight loss & loss of appetite (04_37)

Management of sore mouth and other oral problems (04_38)

Assessment of physical & cognitive deterioration in function (04_39)
Complete the core competencies:
 Understand that the underlying causes of a symptom will have an impact upon how care should
be delivered.
 Understand the range of therapeutic options available, including drugs, hormone therapy, physical
therapist, counselling or other psychological interventions, complementary therapies, surgery,
community or practical support.
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 4.4 Symptom management: Emergencies

Management of bleeding (04_20)

Management of seizures (04_21)

Recognising and managing malignant spinal cord compression (04_22)
000 e-ELCA 4.5 Symptom management: Last days of life

Managing death rattle (04_24)

Managing agitation and restlessness in the dying phase (04_25)

Managing distress during the dying phase (04_26)
000 e-ELCA 4.8 Symptom management: Advanced Illness

Management of physical deterioration (04_40)

Management of cognitive deterioration (04_41)
Contribute to the Core Competency:
 In partnership with others, including the individual, their family and friends, develop and EoLC
plan which balances disease-specific treatment with other interventions and support that meet
the needs of the individual.
Additional sessions required to complete the competency :
(04_03)
The following sessions are included in the Nurse Practitioner Induction pathways:
(04_03)
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 4.5 Symptom management: Last days of life

Recognising the dying phase, last days of life, verifying death (04_23)
Contribute to the Core Competency:
 In partnership with others, implement, monitor and review the EoLC plan.
Additional sessions required to complete the competency :
(04_05)
(04_06)
The following sessions are included in the Nurse Practitioner Induction pathways:
(04_05)
(04_06)
000 e-ELCA 4.6 Symptom management: General issues

Symptom management in people with learning difficulties or mental health problems (04_29)
Contribute to the Core Competency:
 Understand the significance of the individual’s own perception of their symptoms to any
intervention.
Additional sessions required to complete the competency :
(04_02)
The following sessions are included in the Nurse Practitioner Induction pathways:
(04_02)
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 4.6 Symptom management: General issues

Symptom management complicated by coexisting conditions (04_30)
000 e-ELCA 4.7 Symptom management: Mood

Assessment of mood (04_32)

Assessment and management of anxiety (04_33)

Management of depression (04_34)

Assessment and management of agitation (04_35)
Contribute to the Core Competency:
 Be aware that symptoms have many causes, including the disease itself, its treatment, a
concurrent disorder, including depression or anxiety, or other psychological or practical issues.
Additional sessions required to complete the competency :
(04_01)
The following sessions are included in the Nurse Practitioner Induction pathways:
(04_01)
000 e-ELCA 5.0 Initiating conversations about End of Life Care (EoLC)

initiating conversations about EoLC: COPD

Initiating conversations about EoLC: cancer

Initiating conversations about EoLC: dementia

Initiating conversations about EoLC: long term neurological conditions
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
000 e-ELCA 5.2 Critical situations

Scenario: ambulance called to home

Scenario: terminal agitation – patient in a care home

Scenario: patient dying in acute hospital: optimising situation
000 e-ELCA 5.3 Scenarios around dying

When the dying process is protracted or unexpectedly fast

Sudden unexpected death

Treatment and care towards the end of life: good practice decision-making
000 e-ELCA 5.5 Frameworks and tools

A unified DNACPR Policy

Using the NHS Continuing Healthcare Fast Track Pathway Tool
000 e-ELCA 7.0 Bereavement 2

Talking about death and dying (S)
QUIZZES
Where the content lends itself to summative assessment, you will find quizzes available for the
above session, the links are contained in the box below the recommended sessions.
If you encounter any queries or errors with the quiz content, please contact: sue@sweolc.co.ukplease ensure you include the actual question text in your correspondence, as the quizzes randomly
draws from a question bank, therefore the question number is insufficient to enable us to
investigate.
2
Only need to be followed by those staff who have not completed the Induction pathway
End of Life Care (ELCA) Full Pathway: Nurse Practitioner - Mapped
USER SUPPORT
If users encounter difficulties, they can find supporting documents on the NLMS website http://www.esrsupport.co.uk/nlms/documentation.html
There is also support documentation on the SWEOLC website:
http://www.sweolc.co.uk/lphome.html
Alternatively, please contact your Trust’s IT Department for assistance.
NOTES
This learning pathway document was created by the South West End of Life Care e-Learning Project
Officer and Project Manager to support staff in the South West wishing to use the ELCA e-learning
content - it is the full version of the learning pathway from the e-LfH Website. Shortened versions are
available on the SWEOLC website.
Where applicable, the sessions have been mapped to the relevant NHS Core competencies.
If you have any queries, in the first instance, please contact email Sue at sue@sweolc.co.uk
if you are based outside the South West of England, please include your location so we can direct your
query correctly.
Last Updated: 20th March 2013