In 2024, we adopted the Entrustable Professional Activities (EPA) framework as the foundation for onboarding and developing Home Care nurses. Originally designed for medical education, this framework has been adapted to suit the complexities of community-based palliative care. It offers a structured, work-based approach to training and assessment, focusing on real-world clinical responsibilities.
All new Home Care nurses joining Assisi from 2024 onwards are trained using this model. EPAs define key activities that nurses must competently perform, allowing educators and clinical leads to make informed, real-time decisions about the level of supervision or autonomy each nurse requires in patient care.
This approach supports a smoother transition from theory to practice, especially in the unpredictable and emotionally demanding environment of home hospice care. The EPA framework ensures consistency in skill development, enhances clinical judgment, and supports nurses in managing symptoms, responding to emergencies, and coordinating care with families and the broader healthcare team. Ultimately, the goal is to equip nurses with the confidence and competence to be fully entrusted with patient care, while maintaining the high standards required for safe, compassionate, and responsive palliative service delivery in the home setting.
Senior Staff Nurse Rain Lim joined Assisi Hospice as a Home Care nurse in Oct 2024, and was among the new team members trained under the EPA framework.
She found the EPA framework useful as the goals and skill sets required at specific milestones are clearly stated, and she could prepare herself and work towards the goals. It also gave her confidence that she was competent and ready for specific levels of autonomy for the range of complexity in patient care, when she had been assessed to have the necessary skill sets; for example, seeing patients in a stable condition with on-demand supervision by her preceptor at the 6 week timeline.
For Rain’s preceptor, Senior Staff Nurse Yumi Teo, she joined the Home Care team a year ago before the implementation of the EPA framework. She said, “Previously, we learned mainly by shadowing our preceptor and consulting them when in doubt.” She found the EPA useful in communicating expectations for a new nurse, and to make sure that the nurse was on track in her training.
