Updated palliative care competencies for entry-to-practice and advanced-level nursing students: New resources for nursing faculty

End-of-Life Education in a Prelicensure Nursing Program

The demand for palliative and end-of-life nursing is increasing with the aging US population. The American Association of Colleges of Nursing published recommendations for incorporating palliative and end-of-life care across nursing curriculum to prepare the future workforce. However, recommendations regarding teaching end-of-life content are limited. This project aimed to integrate and evaluate the outcomes of end-of-life education introduced in a prelicensure nursing program. Using a documentary created by the American Nurses Foundation, students had the opportunity to discuss common themes in end-of-life care, practice morgue care in the simulation laboratory, and practice reflective journaling. The students' preevaluations and postevaluations indicated that the educational program significantly increased their confidence in providing end-of-life care and support to patients and families, demonstrating the importance of end-of-life curricula in nursing school.

Instruments for Evaluating Student Learning Outcomes in Palliative Care: A Literature Review

Primary palliative care is a core component of nursing practice for which all students must receive formal education. Through competency-based education, nursing students develop the knowledge, attitudes, and skills to deliver quality primary palliative care before they transition to practice. Nurse educators in academic and practice settings should use reliable and valid means to evaluate student learning across cognitive, affective, and psychomotor domains. Expert faculty conducted a literature review to identify published instruments that evaluate primary palliative care student learning outcomes. Selected articles were required to include instrument reliability, validity, or both. The literature search yielded 20 articles that report on the development and testing of 21 instruments. Findings are organized into 3 learning domains that encompass 5 outcomes. Four instruments assess knowledge within the cognitive domain. In the affective domain, 3 instruments assess attitudes about caring for seriously ill or dying patients, 7 assess attitudes about death, and 5 assess self-efficacy. Competence and competency are evaluated in the psychomotor domain with 4 tools. Instrument implementation considerations within each domain are discussed. Faculty are encouraged to use robust evaluation measures such as those identified in the literature review to measure primary palliative care learning outcomes within a competency-based education framework.

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.

Palliative Care in the Intensive Care Unit: The Standard of Care

Intensive care unit-based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. Although all critically ill patients inherently have palliative care needs, the path was not linear but rather filled with the challenges of blending the intensive care unit goals of aggressive treatment and cure with the palliative care goals of symptom management and quality of life. Today, palliative care is considered an essential component of high-quality critical care and a core competency of all critical care nurses, advanced practice nurses, and other intensive care unit clinicians. This article provides an overview of the current state of intensive care unit-based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes.

Postgraduate nursing students' experiences with simulation-based learning in palliative care education: A qualitative study

AIM

The aim of this study was to explore postgraduate palliative care nursing students' experiences with simulation-based learning focusing on communication skills, as a learning method in palliative care education.

BACKGROUND

Communication is one of several important competencies in palliative care and found to be challenging. Developing appropriate communication skills in palliative care requires education and practice. To provide postgraduate palliative care nursing students with the required knowledge and experience, practical and active learning approaches, such as simulation-based learning, can be applied. Several studies have explored undergraduate nursing students' experiences with simulation-based learning in palliative care. However, to our knowledge no studies have explored postgraduate palliative care nursing students` experiences with simulation-based learning focusing on communication skills in palliative care education.

DESIGN

An exploratory descriptive design.

METHODS

A qualitative method was employed. Three focus group interviews were conducted in May 2022 using videoconferencing (Zoom) with 11 postgraduate palliative care nursing students, eight of whom wrote reflective notes. Data were analysed using systematic text condensation.

RESULTS

Three categories were identified in the data analysis: 1) from uncertain expectations to the real experience of simulation-based learning; 2) being a skilled professional in everyday life versus being observed in the scenarios; and 3) the balance between self-confidence and challenges in experiencing professional development and mastery.

CONCLUSIONS

Postgraduate palliative care nursing students seemed to experience anxiety towards simulation-based learning in palliative care education, as well as variable expectations for the approach. This could be due to their unfamiliarity with the learning method. The need for repetition was underlined and the students indicated that they would like to be able to participate in several simulation sessions to familiarise themselves with the approach. The contrast between being a skilled professional in everyday life and the pressure of being observed and judged in the scenarios was an important finding. Students outlined the desire to feel safe, but also highlighted the importance of being challenged to experience professional development and enhanced mastery. Generally, the findings indicate that academic and psychological safety should be a focus during simulation-based learning and instructors should understand that students may have varied learning strategies, divergent learning experiences and shifting beliefs in their own competencies.

Professional Standards and the Role of the Advanced Practice Registered Nurse in Hospice and Palliative Care

Palliative care aims to optimize quality of life and reduce physical, psychological, social, and spiritual suffering for people living with serious and life-threatening illness throughout the life span. There are different educational pathways to becoming an advanced practice registered nurse (APRN) and a range of areas in which APRNs may specialize, including hospice and palliative care. National guidelines and professional standards have been developed to guide the delivery of high-quality palliative care and to demonstrate the need for all nurses to be competent in providing primary palliative care. Advanced practice registered nurses are well poised to integrate palliative care standards into their practice in a variety of settings and in myriad ways including clinical care, program development, leadership, education, and advocacy. This article is the first in a series that will highlight the different roles of the hospice and palliative care APRN, including the doctor of nursing practice, clinical nurse specialist, pediatric APRN, adult/gerontology APRN, and community-based APRN in a variety of settings throughout the country.

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.

Perception of Nurses' Knowledge about Palliative Care in West Bank/ Palestine: Levels and Influencing Factors

Objective: Healthcare professionals particularly nurses should be professionally prepared with knowledge about the standards of palliative care and their roles in providing palliative care. Nurses' knowledge about palliative care and influencing factors has not been examined adequately in Arab countries including Palestine. Thus, this study aimed to assess the adequacy of knowledge level and influencing factors (socio-demographic) about palliative care among nurses in West Bank/ Palestine. Methods: A descriptive-correlational design was utilized. A cluster random sampling method was applied to select 12 hospitals from the three regions in West Bank. Then, four hospitals were selected from each region using a simple random method. All registered nurses working in critical care units and medical and surgical wards in the selected hospitals were recruited. The sample consists of 424 registered nurses and data were collected using Palliative Care Quiz for Nursing (PCQN). Results: The Findings revealed that nurses' level of knowledge about palliative care was low/inadequate (M = 7.75, SD = 2.96). Knowledge about palliative care was influenced by age (B = -.106; p < 0.05), gender (B = -.223; p < 0.001), and hospital ward (B = -.597; p < 0.001), in which younger nurses, females, and those who work in critical care units reported higher levels of knowledge about palliative care. Conclusions: Findings of this study emphasized the need for developing educational and training courses, seminars, and workshops on palliative care to increase nurses' knowledge in order to enhance the quality of patient care. Also, policymakers should develop national strategic plans and policies regarding palliative care and apply these plans in all hospitals in West Bank/ Palestine.

Hospice and Palliative Care for Undergraduate Nursing Education: Results from a Delphi Study

There is an urgent need to strengthen the nursing workforce through hospice and palliative care education to support patients living with serious illness. The aim of this study was to identify skills/topics in hospice and palliative care for undergraduate nursing education. We conducted a two-round online Delphi Survey of hospice and palliative care leaders and clinicians in New York State between June and August 2022. Participants were asked to list and rate the importance of clinical skills and topics in hospice and palliative care for undergraduate nursing education. Twenty-eight participants completed Round One and 21 participants completed Round Two. Topics ranked as extremely important were goals of care, patient/family education, communication skills, advance directives, medication management, pain management, and symptom management. Our findings highlight the importance of including the perspective of healthcare systems leaders and clinicians in discussions about training of future nurses to meet the needs of patients with serious illness and their families.

Palliative Care Education and Serious Illness Communication Training for Baccalaureate Nursing Students

BACKGROUND

Palliative care is an essential component of community health for a growing population of seriously ill older adults residing in the community. Yet, nursing students are often challenged in initiating and engaging in serious illness conversations.

PURPOSE

This study implemented and evaluated an educational activity designed to increase nursing students' skills and self-efficacy to initiate and conduct conversations with patients/clients experiencing serious illness.

METHODS

A mixed-methods approach was used to study how statement cards and prompts facilitated students' readiness to engage in such conversations. A quantitative pre- and posttest survey was used to evaluate self-efficacy and students' perception of their ability to engage in challenging conversations.

RESULTS

The results indicated a significant increase in student confidence in conducting serious illness conversations.

CONCLUSION

Students reported an improved perception of their ability to conduct serious illness conversations and emphasized the need to practice these conversations in clinical practice.

Evaluating the Construct Validity of Competencies: A Retrospective Analysis

Background

A competency-based framework focuses on alignment between professional standards and assessment design. This alignment implies improved measurement validity, yet it has not been established that competence in one context predicts performance in another context. High-stakes competence assessments offer insights into the relationship between assessment design and competencies.

Methods/Analyses

The internationally educated nurses competency assessment program (IENCAP) was developed at Touchstone Institute in collaboration with the College of Nurses of Ontario (CNO) and includes a 12-station OSCE. Each station evaluated the same 10 competencies. We submitted competency scores to a multi-trait multi-method matrix analysis to evaluate the convergent and discriminant validity of competencies.

Results/Observations

All correlations were significant and positive; however, we did not find evidence of convergent or discriminant validity. Correlations were higher between different competencies evaluated within the same station (mean correlation = 0.60) compared to identical competencies evaluated across different stations (mean correlation = 0.19).

Discussion

The results do not provide evidence of construct validity for competencies. While competency-based approaches emphasize various generalized knowledge, skills, and attitudes, these findings indicate that the clinical context is a major determinant of performance.

Conclusion

The context-dependent nature of competencies requires multiple assessments in varied contexts. Performance on a single competency cannot be determined in a single occasion.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01794-z.

Enhancing Care of Older Adults Through Standardizing Palliative Care Education

Nursing skill in caring for persons with serious chronic illness is increasingly in demand as the proportion of older adults in the United States increases. There is robust evidence that palliative care education among health care providers influences the reduction of death anxiety and avoidance behavior, while positively impacting self-efficacy and comfort, when caring for persons with serious illness or those nearing death. The international recognition of access to palliative care as a universal human right drives the need for education to adequately prepare nurses who have not been properly prepared for this work. The development of national competencies in palliative care education for nurses is an important step in synthesizing and disseminating available evidence in support of palliative care nursing education. These recently published competencies can lead to policy innovations at local, state, and national levels. Identifying competencies that lead to more clearly defined curricula will ultimately improve standardizing education and improve nursing practice in caring for older adults with serious chronic illness and their families. [Journal of Gerontological Nursing, 49(6), 6-12.].

Interprofessional primary palliative care: Do the AACN Essentials prepare nurses for collaborative practice?

BACKGROUND

Palliative care specialists alone cannot meet the rising needs for palliative care. Primary palliative care, delivered interprofessionally by generalist health professionals, is essential to ensure equitable access. Educational competencies and clinical practice guidelines prepare these clinicians to integrate palliative care principles into practice.

PURPOSE

The purpose of this project was to evaluate how the AACN Essentials prepares entry-level professional nursing students to function as members of the interdisciplinary primary palliative care team, as described in the National Consensus Project (NCP) for Quality Palliative Care Clinical Practice Guidelines.

METHOD

A team of nurse educators utilized a crosswalk mapping process with the Essentials domains, the Competencies and Recommendations for Educating Undergraduate Nursing Students (CARES) statements, and the NCP Guidelines.

RESULTS

All eight of the NCP domains align with the Essentials. There were clear areas of overlap between the documents and unique areas of emphasis.

CONCLUSION

This project identifies how educational competencies and clinical guidelines can guide competent palliative care practice. It also describes how nurses are prepared to collaborate in the delivery of palliative care.

Simulation-based learning in palliative care in postgraduate nursing education: a scoping review

BACKGROUND

Nurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education.

METHODS

The aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Meth 8(1):19-32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework.

RESULTS

This review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one's ability to communicate during emotionally challenging situations; and impact and relevance to one's own clinical practice.

CONCLUSIONS

The use of SBL in palliative care in postgraduate nursing education seems to enhance students' understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students' confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students' experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.