Analysis of Spanish nursing students' knowledge in palliative care. An online survey in five colleges

Self-Perceived Competencies and Attitudes on Palliative Care in Undergraduate Nursing Students: A Multicenter Descriptive Study

Introduction: Caring for the dying can generate anxiety and emotional distress, particularly in nursing students, and perceived competence could play a crucial role in enabling nurses to perform their duties with greater confidence. Unfortunately, few studies describe the relationship between students' nursing attitudes and perceived self-efficacy in palliative care (PC). To overcome this gap, this survey aimed to assess the attitudes towards dying patients and the perceived competence of nursing students in palliative care at different universities in the south of Italy. Methods: A cross-sectional study was conducted from September 2022 to March 2023 involving nursing students from the three major Sicilian universities (Italy). The study included a survey investigating socio-demographic characteristics, palliative care training, knowledge about pain management, and previous experience with dying. Moreover, the Professional Competence of the Core Curriculum in Palliative Care Nursing (CCPCN) questionnaire and the Frommelt Attitudes Toward Care of the Dying-B Italian version (FATCOD-B-I) assessed competencies and emotional attitudes. Results: A total of 1913 nursing students were recruited, of which 71.3% were females, and 53.9% were in the age range of 18 to 21 years. In the multivariable analysis, practical PC training was a substantial factor in enhancing competencies (Adj-OR 2.78 [95% CI = 2.12-3.65]). Male students had higher competence odds (Adj-OR 1.38 [95% CI = 1.14-1.66]), and perceived knowledge strongly correlated with self-assessed competence. Advancement in academic years also positively influenced competence self-assessment (Adj-OR 1.98 [95% CI = 1.75-2.24]). Regarding emotional attitudes, a per-quartile increase in competence score was found to improve the attitude score (Adj-OR 1.24 [95% CI = 1.13-1.35]). Conclusions: Nursing students gain valuable experience during clinical experience. PC training and perceived knowledge of PC significantly increase nurses' competencies, and the latter seem to be strongly associated with attitudes. Thus, introducing palliative care education into nurses' core curricula could be a way to reduce anxiety and emotional distress in young students.

Knowledge and training among nursing students regarding the conspiracy of silence in palliative care: A participatory action research

AIM

To develop and implement specific training based on the knowledge and management of conspiracy of silence among nursing students.

BACKGROUND

Conspiracy of silence refers to the concealment of information from a patient on the family's request, under the influence of a paternalistic culture that seeks to protect the patient.

DESIGN

Participatory action research.

METHODS

Was conducted in the following stages: reconnaissance (focus groups); planning, action and observation (theoretical sessions); and reflection (analysis of care plans). The focus group consisted of six fourth year and eight second-year students. The intervention was conducted with 42 s-year students and a total of 93 s-year students participated in the resolution of the clinical case. The study was conducted between October 2022 and June 2023 at the Faculty of Nursing, University of Valencia. For data analysis, the process described by Carrillo et al. (2011) was followed, involving coding and the creation of categories and subcategories.

RESULTS

The focus group deficiencies were detected in the students' learning of palliative care competence, breaking bad news and the conspiracy of silence (reconnaissance stage). Therefore, an intervention was conducted to reinforce these knowledge areas, specifically addressing the conspiracy of silence (planning, action and observation stages). The resolution of the case showed how students with training approached the situation more comprehensively, including the family and proposed activities that were consistent with managing the situation (reflection stage).

CONCLUSIONS

An active feedback process was successfully established, where the students' feedback helped create specific training on oncological palliative care and provided the students with tools to manage the conspiracy of silence. The results underscore the importance of providing students with training in palliative care and managing conspiracy of silence, through therapeutic communication training, active training or enhancing emotional intelligence. This training is essential for cultivating the attitudes and skills required to deliver high-quality palliative care.

Core Palliative Care Competencies for Undergraduate Nursing Education: International Multisite Research Using Online Nominal Group Technique

Background: Nurses should have appropriate education and required competencies to provide high-quality palliative care. The aim of this international multisite study was to list and evaluate core palliative care competencies that European nurses need to achieve in their education to provide palliative care. Methods: The Nominal Group Technique (NGT) was used as a data collection method. NGT meetings were organized in four European countries. Targeted groups of palliative care professionals with diverse contextual and professional backgrounds participated in the NGTs. The research question was: "What are the core competencies in palliative care that need to be achieved during undergraduate nursing education?" Data analysis was done in two stages: grouping the top 10 answers based on similarities and thematic synthesis based on all the ideas produced during the NGTs. Results: Palliative care core competencies based on the research were (1) competence in the characteristics of palliative care; (2) competence in decision-making and enabling palliative care; (3) symptom management competence in palliative care; (4) competence in holistic support in palliative care; (5) active person- and family-centered communication competence in palliative care; (6) competence in empathy in palliative care; (7) spiritual competence in palliative care; (8) competence in ethical and legal issues in palliative care; (9) teamwork competence in palliative care; and (10) self-awareness and self-reflection competence in palliative care. Conclusions: It was possible to find differences and similarities in the top 10 palliative care core competencies from different countries. Thematic synthesis of all the data showed that there were various competencies needed for nursing students to provide quality palliative care.

Nurses knowledge of palliative care: systematic review and meta-analysis

Lack of knowledge about palliative care is one of the most common reasons for hindering the delivery of high-quality palliative care. Nurses play a major role in providing palliative care, and the degree of their mastery of this knowledge is crucial to whether they can effectively deliver the ideal palliative care. Therefore, it is necessary to understand the level of palliative care knowledge in this population. As of 8 November 8, 2022, we performed systematic searches in 10 databases. Meta-analysis of quantitative data that measuring the level of palliative care knowledge of nurses using the Palliative Care Quiz for Nursing (PCQN) was conducted using Stata software (version: V.15). A pooled mean score <10 indicated a low/insufficient knowledge level. The funnel plot and Egger's regression test were used to detect publication bias, and finally, the robustness of the results was evaluated through sensitivity analysis. The pooled mean score for the level of nurses' knowledge of palliative care was 9.68 (95% CI: 9.40 to 9.96). Among the three dimensions of the PCQN scale, the pooled mean score for the '"Philosophy and Principles of Palliative Care'" section was 1.73 (95% CI: 1.38 to 2.08); the '"Pain and Other Symptom Control'" section was 6.73 (95% CI: 6.41 to 7.05); and the '"Psychological, Spiritual and Social Care'" section was 1.21 (95% CI: 0.72 to 1.69). It can be seen that nurses' mastery of palliative care knowledge is not sufficient. It is recommended that relevant departments formulate and promote the implementation of targeted measures to improve the knowledge level of this population.

Attitudes and knowledge of palliative care of Chinese undergraduate nursing students: A multicenter cross-sectional study

BACKGROUND

Helping patients and families to relieve severe pain and manage grief are issues that palliative care is designed to address, but integrating these topics in nursing education and practice requires increased attention. It is necessary to understand the knowledge and attitudes of nursing students to develop a targeted approach toward integrating palliative care in practice settings.

OBJECTIVES

To investigate attitudes and knowledge toward palliative care among undergraduate nursing students in China and to explore correlations and associated factors.

DESIGN

A cross-sectional study.

SETTINGS

Seven comprehensive universities in China.

PARTICIPANTS

A total of 582 undergraduate nursing students participated.

METHODS

Online questionnaires were available from December 2020 to February 2021. The Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Quiz for Nursing were used to measure students' attitude and knowledge of palliative care. Descriptive and correlational methods were used to analyse the associated factors and their correlation with knowledge and attitudes.

RESULTS

Attitude scores showed significant differences in gender, education level, religious preference, previous education in palliative care, experience in caring for dying patients and previous experience with bereavement. Knowledge of palliative care was influenced by gender, religious preference, prior education in palliative care, experience in caring for dying patients, and previous experience with bereavement. A positive correlation exists between knowledge and attitudes toward palliative care among undergraduate nursing students.

CONCLUSIONS

The findings highlight the need to offer palliative care courses in nursing education and practice settings in Chinese health care settings. Nurse educators need to integrate the concept of palliative care into the curriculum of nursing education programs. Healthcare administrators and nurse leaders should promote investment and training in the education of nurses in practice settings to deliver high-quality palliative care services.

An evaluation of undergraduate student nurses' gameful experience whilst playing a digital escape room as part of a FIRST year module: A cross-sectional study

BACKGROUND

The circumstances arising from the COVID-19 pandemic have accelerated the use of digital teaching and learning in health professions education. Digital gamification-based teaching and learning activities are innovative and versatile tools for the acquisition of professional competencies in higher education, which can be used on a range of topics and can be supplemental to other teaching methods.

OBJECTIVES

This study aimed to investigate nursing students' gameful experience whilst playing a digital escape room. In addition, we aimed to analyze the students' motivation, learning experience and outcome of the activity, and the students' perception of the degree of achievement of the intended learning outcomes.

DESIGN

Cross-sectional descriptive study.

PARTICIPANTS

A total of 136 undergraduate first year student nurses enrolled in a "Fundamentals of Nursing" course.

METHOD

The digital escape room game took place online during the academic year 2020-2021. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the outcome of the scape room game and the degree of achievement of the intended learning outcomes.

RESULTS

More than 80 % of the participants were moderately to very motivated to play the game. Three GAMEX dimensions achieved a mean score of 3 or above 3, namely Enjoyment, Creative Thinking and Absence of Negative effects. The mean score for each of the outcome variables was over 3. However, the degree of achievement of the learning outcomes after exiting the digital escape room was uneven.

CONCLUSION

Gamification-based teaching and learning activities, such as digital escape rooms, can be effective in fostering specific skills, including teamwork, communication and critical thinking. However, they should be designed carefully, and used as a complement, rather than a substitute, of other educational activities.

Nursing undergraduates’ experiences of a simulation-centred educational program in hospice care in Macao: A qualitative research

Objectives

The study aimed to explore the experiences of nursing undergraduates participating in a simulation-centred educational program in hospice care in Macao, China.

Methods

This descriptive qualitative study was based on the data collected through semi-structured individual interviews. Seventeen nursing undergraduates in Macao, China who attended the simulation-centred program in hospice care participated in this qualitative from November to December 2020. This program included three parts: introduction to hospice care (2 h), management of terminal symptoms (10 h), and hospice situation simulations (6 h). The interview data were analyzed using qualitative content analysis.

Results

This study revealed two themes and six sub-themes. Theme 1 was developing competencies in caring for dying patients and their families, which included four subcategories of sensitivity to patients’ needs, knowledge of hospice care, skills of symptom control and comfort supply, and communication skills. Theme 2 was improving the ability to self-care and support colleagues, which included two subcategories of reflection on life and death and sharing and supporting among colleagues.

Conclusion

This program improved the competency of nursing undergraduates in hospice care and participants’ learning experience was good.

Finnish nursing students' perceptions of the development needs in palliative care education and factors influencing learning in undergraduate nursing studies - a qualitative study

BACKGROUND

Nurses have an essential role in providing high-quality palliative care to patients and their families. Hence, they require adequate palliative care education. However, there is only limited insight into how final-year nursing students perceive palliative care education in undergraduate nursing programs. This study aimed to describe nursing students' perspectives of the development needs of palliative care education. An additional two aims emerged based on the collected data, namely, to describe the preferred education for palliative care and the factors which promote or hinder palliative care learning during undergraduate nursing studies.

METHODS

The research was guided by a descriptive qualitative approach and applied inductive content analysis. The frequencies (f) of identified codes (reduced expressions) were counted to show the noteworthiness of each category in relation to the entirety. The participants were final-year nursing students (n = 766) who had participated in a national survey.

RESULTS

The inductive content analysis identified three unifying categories. The first was 'Development needs and views of palliative care education' (f = 524), which consisted of the main categories 'the need to develop palliative care education' (f = 414) and 'meaning of palliative care and its education' (f = 110). Secondly 'Preferred types of palliative care education' (f = 1379), including the main categories 'teaching contents in palliative care education' (f = 905), 'teaching methods for palliative care learning' (f = 393), and 'placement of palliative care studies' (f = 81). Thirdly 'The facilitators and barriers to palliative care learning' (f = 401), consisting of the main categories 'factors facilitating palliative care learning' (f = 66) and 'barriers to palliative care learning' (f = 335).

CONCLUSIONS

This study provides detailed information about nursing student's perspectives of palliative care education and its development needs. Hence, the results are relevant to decision-makers who want to develop undergraduate nursing curricula. This study highlights that palliative care education should be developed by ensuring that all students have equal access to palliative care education provided by highly competent teachers. Possibilities for clinical placements or visits to palliative care units during the education should also be improved. The participating students felt unprepared to provide high-quality palliative care even though they responded that palliative care is an important topic in their nursing studies.

Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study

BACKGROUND

The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses.

OBJECTIVE

To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views.

METHODS

A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland.

RESULTS

The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P < .001), and more often felt that these competencies are relevant to their profession (72.2% vs. 57.6%, P < .001).

CONCLUSION

PC was considered as a useful subject, still only about half of the students reported the received PC education and their competence on PC as sufficient. Previous education or experience may enhance PC competence highlighting the need for divergent teaching. The results identify development needs for the contents of PC education in undergraduate nursing studies.

Spanish Nurses' Knowledge about Palliative Care. A National Online Survey

(1) Background: Nurses can find people with advanced diseases or in their last days of life during their professional careers and in many different care settings. For this reason, they need to have at least a basic level of palliative care education since they are the professional cohort treating these patients in a very close way. This research aims to determine the level of knowledge in palliative care of Spanish nurses and establish any possible difference based on their experience and training in palliative care. (2) Methods: A cross-sectional design using survey methods (distributed an online questionnaire) aimed at Spanish registered nurses. A validated questionnaire (PCQN-SV) was used to determine the level of knowledge in palliative care; information on some variables to characterize the population was also collected (experience and education in palliative care, years of professional experience, academic level, and others). Uni and bivariate descriptive analyses were performed. A binary logistic regression model was also developed to identify those variables that influenced obtaining results higher than the population’s average. (3) Results: Spanish nurses have a medium–low level of knowledge in palliative care, higher in those who have previous experience or education in this area. Statistically significant differences were also found according to the area in which their caring activity was developed. (4) Conclusions: It is necessary to implement strategies for the basic training of nursing professionals in palliative care to offer quality care to people in advanced stages of illnesses or at the end of their lives.

Fear of death and its relationship to resilience in nursing students: A longitudinal study

AIM

Taking a corpus of nursing students enrolled in the 2017-2021 nursing degree, we aim to analyse how students' levels of resilience and fear of death evolve in the first three years of the degree and whether there are differences between students based on age and gender. In addition, we aim to describe the relationship between resilience and fear of death.

BACKGROUND

Throughout their training, nursing students will encounter situations of grief and death that may generate reactions of rejection, anxiety and emotional imbalance. Recognising and controlling these emotions through specialised training in end-of-life care and fostering resilience is essential.

DESIGN

Comparative, correlational and longitudinal study.

METHODS

Our corpus comprised 100 nursing students who were followed through the first three years of their training. Data were collected using a sociodemographic questionnaire, the Collet-Lester Fear of Death Scale and the Resilience Scale.

RESULTS

The corpus reported medium-high levels of fear of death overall. Patterns were similar for all academic years: fear of other people's death was invariably the highest scoring subscale; and while individual dimensions of the Collet-Lester scale correlated directly and significantly with each other they were found to be inversely related to student age. High levels of resilience were recorded and were highest in the final year.

CONCLUSIONS

In this sample of student nurses, fear of death and resilience do not appear to be related to each other. Nursing education must include training specifically targeted at increasing levels of resilience and decreasing fear of death to improve end-of-life care.

Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models

The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)^®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.