AACN Advanced Critical Care
Volume 24, Number 2, pp. 121-129
© 2013 AACN
121
Copyright © 2013 American Association of Critical-Care Nurses. Unauthorized reproduction of this article is prohibited.
DOI: 10.1097/NCI.0b013e3182832a94
End-of-Life Care Education in Acute
and Critical Care
The California ELNEC Project
Marian Grant, RN, DNP, CRNP, ACHPN
Clareen Wiencek, RN, PhD, CRNP, ACHPN
Rose Virani, RNC, MHA, OCN, FPCN
Gwen Uman, RN, PhD
Carla Munevar, MD
Pam Malloy, RN, MN, FPCN
Betty Ferrell, PhD, MA, FPCN
Marian Grant is Assistant Professor, University of Maryland,
655 West Lombard St, Baltimore, MD 21201 (grant@son
.umaryland.edu).
Clareen Wiencek is Nurse Manager/Clinician, Thomas Pallia-
tive Care Unit, VCUHS, Richmond, Virginia.
Rose Virani is Senior Research Specialist, City of Hope, Divi-
sion of Nursing Research & Education, Duarte, California.
Gwen Uman is Partner Vital Research, LLC, Los Angeles,
California.
Carla Munevar is Clinical Research Assistant, City of Hope,
Division of Nursing Research & Education, Duarte, California.
Pam Malloy is ELNEC Project Director, American Association
of Colleges of Nursing, Washington, District of Columbia.
Betty Ferrell is Professor, Nursing Research and Education,
City of Hope, Division of Nursing Research & Education,
Duarte, California.
The authors declare no conflicts of interest.
T
he mission of critical care practitioners is
the concentrated care of patients with life-
threatening illnesses or crises who are most
likely to benefit from resource-intensive care.
1,2
Although this mission generally has not
changed over the past 50 years, contextual fac-
tors have. The population is aging, and con-
comitant with this fact, the number of patients
with multiple chronic illnesses is increasing.
Persons aged 65 years and older will make up
20% of the American population by 2030,
3
and those older than 85 years are currently the
fastest-growing segment.
4
The chronic illnesses
of aging, such as heart failure, cancer, and
dementia, are increasing as a result of these
demographic shifts. The prevalence of patients
with a history of cancer in the intensive care
ABSTRACT
Acute and critical care nurses care for an
increasingly aging population in the last stages
of life. Unfortunately, many of these nurses do
not have adequate education to care for this
population. The End-of-Life Nursing Education
Consortium (ELNEC) developed a critical care
course, and in 2007 the Archstone Foundation
provided a grant to educate critical care nurses
in California. From 2007 to 2010, 388 participants
completed the course and rated it very effective
at improving end-of-life care education in their
institution. After completing the national ELNEC-
Critical Care train-the-trainer course, these par-
ticipants taught more than 2900 classes in the
ELNEC modules to their colleagues. Participants
also revised policies and made system changes
in their workplaces to provide better care to
dying critical care patients and their families.
The ELNEC/Archstone program improved acute
and critical care nurses’ end-of-life care educa-
tion and, ultimately, practice and serves as a
model for future educational efforts.
Keywords: critical care, education, end-of-life
care, nursing, palliative care