Online Palliative and End-of-Life Care Education for Undergraduate Nurses

Preparing nurses for palliative care in long term care: An integrative review

BACKGROUND

With the aging population, there is an increased need for nurses with competence in chronic illness and palliative care management particularly in long-term care settings. The incorporation of palliative care education in nursing curricula has been explored previously.

PURPOSE

This review aimed to appraise the current literature on the state of palliative care education in academia and how it impacts the preparedness of nurses to enter long-term care post-graduation. There has not been an integrative review exploring curriculum-based palliative care education for long-term care.

METHOD

This review was guided by the method of Whittemore and Knafl using critical appraisal tools. The CINAHL, Cochrane, EBSCO, ERIC, Journals@Ovid, Medline, PsycINFO, and ScienceDirect databases were searched for peer-reviewed literature from 2017 to 2022.

RESULTS

Sixteen items met the search criteria for appraisal, and 11 items were retained for discussion.

CONCLUSION

There is a gap in nursing curricula in preparing nurses for the situations faced by long-term care nurses. Long-term care nurses develop strong bonds with residents and families and often lack time, space, and resources to cultivate the confidence and competence as palliative situations arise. More research is needed to determine the best placement in nursing programs for palliative-based long-term care education.

Palliative Care Knowledge Following an Interdisciplinary Palliative Care Seminar

BACKGROUND

The COVID-19 pandemic created a unique opportunity to evolve an interdisciplinary palliative care seminar (IPC) into a virtual platform. This seminar provides foundational palliative and hospice concepts, introductions into palliative care disciplines, integration of teamwork, and incorporates interdisciplinary student led patient encounters. Traditionally, this experience had been in person, however during the COVID-19 pandemic, healthcare restrictions transitioned the educational delivery to a virtual platform.

METHODS

To assess the knowledge gained from this novel experience, the Palliative Care Knowledge Test (PCKT) was administered before and after the IPC Seminar. A 1-year follow up survey was also administered to evaluate how the IPC Seminar was applicable to the students' clinical experiences and practice.

RESULTS

The virtual didactics and virtual student led patient encounters significantly improved learners understanding of palliative and hospice care. This gain of knowledge was noted across undergraduate and graduate programs, which highlights the need for and benefit from foundational concepts. Furthermore, a 1-year follow up survey noted the IPC seminar was applicable to their practices and suggests that this experience will impact future patients.

DISCUSSION

Many of the students practice in rural areas where access to palliative care services is limited or non-existent. This experience exponentially impacts the growth of palliative and hospice care understanding and access to care across the region.

CONCLUSION

Evolving our IPC Seminar has shown to significantly improve knowledge, foster collaboration of student led interdisciplinary teams, and increases capacity to meet the needs of more learners.

Exploring Perceptions and Practices of Interprofessional Shared Decision-Making Education in Palliative Care Settings

Background

Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care.

Aim

This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings.

Methods

We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted.

Findings

The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants.

Conclusion

The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.

The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study

BACKGROUND

With the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development.

OBJECTIVES

To understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences.

DESIGN

This study used a mixed-methods design.

SETTING

A University of Chinese Medicine in mainland China.

PARTICIPANTS

The first-year undergraduate nursing students (n = 65).

METHODS

A mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews.

RESULTS

The quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of "Gain from learning" included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of "Course feedback" included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization).

CONCLUSIONS

Hospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.

Student nurse education and preparation for palliative care: A scoping review

BACKGROUND

The World Health Organisation and palliative care stakeholders recommend that healthcare workers are educated in palliative care. Provision of high-quality palliative care is fundamental to nursing practice. However, caring for palliative care patients and meeting family needs is challenging without appropriate knowledge and experience. Palliative care education and clinical skill development for undergraduate student nurses is a priority to ensure graduate nurses are equipped with the knowledge and skill to deliver safe and competent care.

METHODS

A scoping review guided by Arksey and O'Malley's framework was used to identify undergraduate student nurses' palliative care education and preparation. A comprehensive literature search of five electronic databases and grey literature were conducted from January 2002 to December 2021. The aim was to review the empirical evidence and ascertain how undergraduate student nurses' palliative care education is organised, facilitated, delivered and evaluated. Screening was performed independently by two reviewers against eligibility criteria with meetings to discuss included papers and form a consensus. Data was extracted and related to palliative care undergraduate student nurses' education, educational model, methodology, key findings, and recommendations. Analysed and summarised data was mapped onto the four key review questions (educational models utilised, methods used to assess effectiveness, facilitators/barriers and gaps in the literature).

RESULTS

34 papers met the criteria for this review. The review highlights that undergraduate nursing palliative care education is more evident in high income countries. Limited and diverse published research existing in low- and middle-income countries. Educational models utilised were theoretical and experiential learning and educational process, early integration and multiple learning methods which were highlighted as facilitating factors. However, crowded curricula, lack of palliative care clinical placement expertise, difficulty providing clinical placement, timing and delivery of palliative care and difficulty responding to simulated environments (manikins) were perceived barriers. Nevertheless, palliative care education can increase knowledge, positive attitude, self-confidence and adequate preparation of undergraduate student nurses.

CONCLUSION

This review highlights that there is limited research regarding the timing and delivery of palliative care principles and practice in undergraduate student nurse education. Early integration of palliative care education impacts upon students perceived preparedness for practice and positively influences their attitudes to palliative care provision.

The use of games by nurses in palliative care: a scoping review

Background: Nursing is at the forefront of palliative care. Games are an innovative strategy in palliative care training. Aims: This study aimed to examine the usefulness of games for nurses in palliative care. Methods: A scoping review was conducted using the following databases: CINAHL and PUBMED (which includes MEDLINE, PsycINFO, SCOPUS and SciELO). The steps outlined by the Joanna Briggs Institute were followed. Findings: Of the 685 articles initially identified, 17 were included for analysis. Games used were role-play (n=12), card games (n=1), digital games (n=1), board games (n=1), reflection games (n=1) and experimental games (n=1). Games were aimed at nurses (n=6) and nursing students (n= 1 1). Game advantages included: improved palliative care knowledge, increased communication skills, reduced negative emotions and increased multidisciplinary team skills. Conclusions: Effective and innovative pedagogical techniques are required training techniques for nurses and nursing students who provide palliative care, as they can reduce negative emotions such as fear, anguish and guilt.

Exploring the use of games in palliative care: A scoping review

OBJECTIVE

There has been increasing recognition of the potential of games in health; however, knowledge of their application in palliative care is lacking. Therefore, this study aimed to identify and map the available evidence on the use of games in palliative care, analyzing how research has been conducted on this topic and identifying gaps in knowledge.

METHOD

A scoping review was carried out. The literature search was conducted using the respective descriptors and search syntax appropriate to each of the databases searched. The review included all study types with no time limits.

RESULTS

Of the 685 articles initially identified, 53 were included for final analysis. Several different game types were identified, with the majority of studies using role-play (n = 29) and card games (n = 17). The games analyzed were essentially aimed at empowering patients (n = 14), and in some cases, extended to families or caregivers, as well as to medical and nursing students. The analysis of the articles in this review resulted in two major themes: Role-playing for training in palliative care and card games to discuss end-of-life care.

SIGNIFICANCE OF RESULTS

Games allow space for the expression of emotions and promote creativity. They can be applied both in a training context, to enable health professionals to develop essential skills in palliative care, and for patients, families, and caregivers, allowing them to talk about serious things while playing.

Improving Critical Care Nurses Perceived Self-Efficacy in Providing Palliative Care: A Quasi-Experimental Study

BACKGROUND

Palliative care is a service that focuses on quality of life and symptom management. It is particularly important for patients with chronic disease. Palliative care in general is an underutilized service for various reasons. Many nurses have only learned about palliative care from experience and express a need for more education.

PURPOSE

This study focused on educating critical care nurses on palliative care through online training videos. This quasi-experimental study aims to determine if an online palliative care educational program improves critical care nurses' self-efficacy in providing palliative care.

PROCEDURES

The study was conducted using a pre-survey and post-survey that was created with a validated tool called the Palliative Care Self-Efficacy Scale. In between the surveys, the respondents were directed to online education.

MAIN FINDINGS

The overall Palliative Care Self-Efficacy Scale showed a median score of the Palliative Care Self-Efficacy Scale increased from pre education (Md=38) to post-education (Md = 43.5), z = -4.868, p <.001, with a large effect size (r = -.76).

PRINCIPAL CONCLUSIONS

The majority of critical care nurses have received some form of palliative care education. Online resources similar to the VitalTalk videos and handouts provide added education and improve perceived self-efficacy in providing palliative care in both psychosocial and symptom management aspects of care. The data suggests that improvements to access to education can be done by employers. Further studies can be done to assess current access to palliative care education in undergraduate nursing programs.

Palliative care management of head and neck cancer patients among otolaryngology surgeons: a novel national survey assessing knowledge, decision making, perceived confidence and training in the UK

Objective

Management of head and neck cancer patients provides unique challenges. Palliation serves to optimise quality-of-life by alleviating suffering and maintaining dignity. Prompt recognition and management of suffering is paramount to achieving this. This study aimed to assess perceived confidence, knowledge and adequacy of palliative training among UK-based otolaryngologists.

Method

Eight multiple-choice questions developed by five palliative care consultants via the Delphi method were distributed over five weeks. Knowledge, perceived confidence and palliative exposure among middle-grade and consultant otolaryngologists were assessed, alongside training deficits.

Results

Overall, 145 responses were collated from middle-grade (n = 88, 60.7 per cent) and consultant (n = 57, 39.3 per cent) otolaryngologists. The mean knowledge score was 5 out of 10, with 22.1 per cent (n = 32) stating confidence in palliative management. The overwhelming majority (n = 129, 88.9 per cent) advocated further training.

Conclusion

A broad understanding of palliative care, alongside appropriate specialist involvement, is key in meeting the clinical needs of palliative patients. Curriculum integration of educational modalities such as simulation and online training may optimise palliative care.

Knowledge of Critical Care Nurses about End-of-Life Care towards Terminal Illnesses: Levels and Correlating Factors

Introduction

The preparedness of nurses in relation to providing palliative care is not always adequate, indeed, it is sometimes unsatisfactory; this may be caused by lack of knowledge and limited experience in end-of-life care (EOLC). Thus, this study purposed to assess the levels of registered nurses' knowledge about EOLC, examine the relationships between EOLC knowledge and some demographic variables, and explore predictors of EOLC knowledge.

Methods

A cross-sectional design survey was conducted with Jordanian registered nurses in critical care units (N = 175) in different heath sectors in Jordan. The End-of Life Professional Caregiver Survey (EPCS) was used.

Results

Findings showed that nurses had moderate/quite a lot of knowledge (M (SD) = 2.58 (.48)) about EOLC. The cultural and ethical values was the highest subscale of knowledge about EOLC (M (SD) = 2.74 (.52)), while effective care delivery subscale was the lowest one ((M (SD) = 2.33 (.66). Knowledge about EOLC was correlated with age (r = .145, P < .05), work experience (r = .173, P < .05), and training course in palliative or EOLC (r = .217, P < .01). The main predictor of EPCS was training courses in palliative or EOLC (B = .190, P < .05).

Conclusion

The nurses need to enhance their knowledge about EOLC and correlating factors should be taken into consideration when developing any intervention program. Nurses need palliative care training courses; also more attention is required in palliative care education particularly in clinical skills in effective care delivery.

The neuropalliative multidisciplinary team-Members and their roles

Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.

Practice Improvement Projects in an Interdisciplinary Palliative Care Training Program

CONTEXT

Demand for palliative care (PC) continues to increase with an insufficient number of specialists to meet the need. This requires implementation of training curricula to expand the workforce of interdisciplinary clinicians who care for persons with serious illness.

OBJECTIVES

To evaluate the impact of utilizing individual practice improvement projects (PIP) as part of a longitudinal PC curriculum, the Coleman Palliative Medicine Training Program (CPMTP-2).

METHODS

Participants developed their PIPs based on their institutional needs and through a mentor, and participated in monthly meetings and bi-annual conferences, thereby allowing for continued process improvement and feedback.

RESULTS

Thirty-seven interdisciplinary participants implemented 30 PIPs encompassing 7 themes: (1) staff education; (2) care quality and processes; (3) access to care; (4) documentation of care delivered; (5) new program development; (6) assessing gaps in care/patient needs; and (7) patient/family education. The majority of projects did achieve completion, with 16 of 30 projects reportedly being sustained several months after conclusion of the required training period. Qualitative feedback regarding mentors' expertise and availability was uniformly positive.

CONCLUSION

The CPMTP-2 demonstrates the positive impact of PIPs in the development of skills for interdisciplinary learners as part of a longitudinal training program in primary PC. Participation in a PIP with administrative support may lead to operational improvement within PC teams.

Baccalaureate nursing students' engagement with end-of-life curriculum: A grounded theory study

BACKGROUND

The art of being prepared to support patients and their families during end of life experiences is not always emphasized in nurse education. Despite the efforts from the American Association of Colleges of Nursing and End of Life Nursing Education Consortium (ELNEC), only 25% of nursing schools across the United States are using their modules.

OBJECTIVE

The purpose of this study was to explore how student nurses engage with end of life education.

DESIGN

Qualitative study using a grounded theory approach.

SETTING

Baccalaureate nursing program located in the rural agricultural western United States.

PARTICIPANTS

Using purposive sampling, a single cohort of baccalaureate student nurses in two focus groups (n = 17; n = 23).

METHODS

Using a grounded theory approach, student experiences and engagement with the curriculum were explored. Using the constant comparative method, three researchers coded the data independently and then came together to reach consensus on themes and for the development of the conceptual model.

RESULTS

Three categories emerged from the data to describe the student engagement with the curriculum: Novice, Evolving, and Prepared. The central theme for the Novice students was Being Afraid. Students expressed fear over the unknown and not knowing what to say or do. Becoming Aware was the central theme for the Evolving students which included a blend of being aware of their deficiencies as well as the important aspects of end of life care. The final category was Prepared. The theme for this category was Becoming Accomplished, which included recognition of respectful care, disrespectful care, team work, and advocacy.

CONCLUSION

End of life education is essential for nursing students to provide appropriate care at end of life, as well as providing improved knowledge, attitudes, and confidence of students. The End of Life Nursing Education Consortium modules, placed strategically within the curriculum, allow nursing students to move through the process of Being Afraid, to Becoming Aware, and finally Becoming Accomplished upon graduation.

The Role Complexities in Advance Care Planning for End-of-Life Care-Nursing Students' Perception of the Nursing Profession

Nurses’ perceptions of being responsible for advance care planning (ACP) vary greatly across different studies. It could, however, affect their involvement in advance care planning and patients’ quality of death. Recent studies on this topic have mostly focused on advance directives but not ACP and nurses in the ward setting. This study aimed to assess the perception of Hong Kong nursing undergraduates of the nurse’s role in advance care planning and examine its associations with knowledge, attitude, and experience. A cross-sectional 57-item survey was delivered to nursing undergraduates between June and August 2020. The chi-squared test or Fisher’s exact test were used for univariate analysis. The multiple logistic regression model was used for multivariate analysis. A total of 469 participants were assessed for eligibility; 242 of them were included in the data analysis, with a response rate of 97.6%. The majority of respondents—77.3% (95% CI: 72.0–82.6%)—perceived having a role in ACP, but large discrepancies were found between their perception of their role regarding different aspects of ACP. Participants who had a better knowledge status (p = 0.029) or supported the use of ACP (p < 0.001) were more likely to have a positive perception of their role in ACP. A negative correlation was found between the experience of life threat and positive role perception (p < 0.001). Through strengthening training, the role clarity of nursing undergraduates could be achieved, maximizing their cooperation with and implementation of ACP in their future nursing career. The enhancement of end-of-life education could also be undertaken to fill nursing undergraduates’ knowledge gap in this area and change their attitudes.

Student responses to advance directives assignments in undergraduate courses in the United States: A qualitative examination of stress appraisals, coping, and outcomes

Guided by stress and coping theory, qualitative content analysis was used to examine student written assignment responses (N = 100) about the importance of and student preparedness for completing their own advance directive (AD). Codes represented primary and secondary appraisals, coping, and outcomes. Primary appraisals were 47% benign, 47% stressful, and 6% irrelevant. Benign primary appraisals were associated with reporting greater internal and external resources and intent to complete an AD. Exposing students to information about AD can be useful, but student completion of an AD should be reserved for classes that help students process emotions and information about their preferences for end-of-life care.

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.

An Innovative Application of End-of-Life Nursing Education Consortium Curriculum to Increase Clinical Nurses' Palliative Care Knowledge

Clinical nurses are in a crucial position to provide primary palliative care by advocating for patients and families at the end of life, collaborating with the health care team to optimize quality of life, and contributing to enhanced symptom management. Most clinical nurses, however, have not received the comprehensive palliative care education needed to provide high-quality palliative care. The End-of-Life Nursing Education Consortium curriculum can bridge this gap by providing nurses with the knowledge needed to promote palliative care. Following completion of an End-of-Life Education Consortium train-the-trainer program, 6 nurses from a large, metropolitan academic medical center designed and implemented a series of 20-minute educational sessions informed by a hospital-wide needs assessment and based on the End-of-Life Nursing Education Consortium curriculum. The educational sessions, Palliative Care Conversations, provide clinical nurses with the core palliative care knowledge and skills needed to advocate for and provide patient-/family-centered care throughout the serious illness trajectory and at end of life. This article describes the process, design, and content of the palliative care educational sessions.