Palliative Care Education in Undergraduate Nursing Curriculum in Italy

A multicentre survey on the perception of palliative care among health professionals working in haematology

PURPOSE

Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services.

METHODS

This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed.

RESULTS

A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals.

CONCLUSION

These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.

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 effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design

Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service.

OBJECTIVES

To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death.

DESIGN

This study was designed using a mixed-methods design.

SETTING

Two campuses of a university school of nursing in China.

PARTICIPANTS

First grade Bachelor of Nursing Science students (n = 191).

METHODS

Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis.

RESULTS

The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing.

CONCLUSION

Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.

Evidence informed generalist palliative care content for undergraduate nursing curriculum: An integrative review

BACKGROUND

Clinicians delivering palliative care require the specific knowledge, skill and understanding to meet the needs of the dying. Research shows that undergraduate nursing students report feeling inadequately prepared to provide safe and effective palliative care.

OBJECTIVES

To identify existing empirical evidence on generalist palliative care content within international undergraduate nursing curricula and to synthesize existing generalist palliative care topics.

DESIGN

An integrative systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO).

DATA SOURCES

Keywords were searched in six electronic databases CINAHL, Medline, APA PsycINFO, SCOPUS, Cochran Library and ProQuest Nursing & Allied Health Database, between January 2000 and February 2022.

REVIEW METHODS

Studies were selected as per a pre-determined inclusion and exclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Tabulation of the author, year, country, aim, participants and setting, method, generalist palliative care content topics, additional findings and limitations were compiled. A thematic analysis of the data was conducted to organise and categorise generalist palliative care topics into an additional table followed by a narrative synthesis.

RESULTS

Of the n = 1014 papers retrieved, n = 13 studies of varying methodological quality were included in the analysis (n = 8 quantitative descriptive, n = 5 mixed method). Most studies were published in high income countries with developed economies. Methods used to obtain data include survey, extraction of secondary data and expert consensus. Generalist palliative care topics were presented as a list reporting frequency taught/discussed/cited (n = 10), recommended competencies (n = 2), and teaching modules (n = 1). A large variety of topics were identified with differing levels of detail and clear differences in topics identified globally. Overall, the most frequently mentioned generalist palliative care topics were pain and symptom management (n = 12), grief loss & bereavement (n = 12) and communication (n = 11).

CONCLUSIONS

This review demonstrates for the first time that international primary research evidence on generalist palliative care content in undergraduate nursing curriculum is minimal, of varying methodological quality, with visible inconsistencies among studies designed to inform curriculum verses studies reporting what is taught to students. More research is required to create evidence informed generalist palliative care content for undergraduate nursing curriculum.

RECOMMENDATIONS

It is recommended for future research to use international consensus-based methods to inform and develop internationally agreed educational topics to optimise patient care at the point of nurse registration.

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.

Predictors of nurses' attitudes and knowledge towards pain management in Italy. A cross-sectional study in the hospital settings

INTRODUCTION

Pain is multidimensional, and as such it is the chief reason patients require urgent health care services. If inadequately assessed and untreated, pain may negatively impact on the quality of life of the patient. Pain management is an essential part of Nursing. The aim to this study is to examine the level of knowledge and attitudes with regard to pain among Italian nurses who work in clinical settings.

METHODS

The Ferrell and McCaffery's Knowledge and Attitudes Survey Regarding Pain was distributed to 266 nurses employed in one specialized hospital in Rome, Italy. The staff in the survey work in three different settings: the intensive care unit, the sub-intensive care unit, and an ordinary ward. Descriptive statistics were employed and a logistic regression model was performed to evaluate the factors that may influence the attitude and knowledge of care providers.

RESULTS

49.6% of the sample correctly answered items about attitudes, 47.4% about knowledge, and 36.5% about assessment. The results show that the odds ratio of developing positive attitudes towards pain was 1.76 times higher in nurses employed in the sub-intensive care unit than in other settings. There are no statistically significant associations of knowledge between setting, sex or education.

CONCLUSIONS

Our survey revealed a limited overall level of knowledge and attitudes with regards to pain management among nurses. Implementing specific training for health professionals, starting with academic education, is therefore a priority. Further research is needed on a larger sample of Italian nurses.

Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study

BACKGROUND

International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory.

OBJECTIVES

To explore Italian nursing students' attitudes towards caring for dying patients.

DESIGN

A multicenter cross-sectional study was conducted.

SETTINGS

The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region.

PARTICIPANTS

The sample included 1193 students.

METHODS

Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression.

RESULTS

The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care.

CONCLUSIONS

Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering.

A Scoping Review of End-of-Life Communication in International Palliative Care Guidelines for Acute Care Settings

CONTEXT

End-of-life communication in acute care settings can be challenging and many patients and families have reported low satisfaction with those conversations.

OBJECTIVE

To explore existing guidelines around palliative care to increase current understanding of end-of-life communication processes applicable to the acute care setting.

METHODS

A scoping review following the method of Arksey and O'Malley was undertaken to identify eligible documents and thematically summarize findings. Web sites of government authorities, departments, and ministries of health as well as palliative care organizations were searched as were MEDLINE, CINAHL (EBSCOhost), EMBASE, Cochrane Library, Joanna Briggs Institute, and PsycINFO databases. Searches were limited to documents published between January 2009 and August 2019 that were nondisease specific and applicable to the acute care setting.

RESULTS

Thirteen guidelines from nine different countries were identified. Thematic analysis produced eight themes: 1) The purpose and process of end-of-life communications, 2) cognitive understanding and language in end-of-life communication, 3) legal aspects of end-of-life communication, 4) conflicts and barriers related to end-of-life care, 5) end-of-life communication related to medical record documentation, 6) healthcare professionals' responsibilities and collaboration, 7) education and training, and 8) policies, guidelines, and tools for end-of-life communications.

CONCLUSIONS

Palliative and end-of-life guidelines applicable to acute care settings outline the purpose of end-of-life communication and address how, when, and by whom such conversations are best initiated and facilitated. How guidelines are developed and what aspects of communications are included and emphasized may differ across countries related to role differences of physicians and nurses and national laws and regulations.

Initial exploration of training for palliative care specialist nurses in mainland China

This paper describes the initial exploration of training program for palliative care specialist nurses in mainland China. The training program included one month of theoretical learning and one month of clinical practice. The theoretical training contents were mainly set up around four modules such as clinical practice, teaching, scientific research and management. After the theoretical training, the trainees needed to practice in specific clinical practice hospitals. In total, 192 trainees from 27 provinces (municipalities) in mainland China participated in the training program. All trainees passed theoretical and clinical practice examinations. Their knowledge, attitude and behavior concerning palliative care were significantly improved after training (p < 0.001). The overall satisfaction rate of the trainees towards the theoretical courses was 95.6%, and the overall satisfaction rate of the trainees towards the clinical teaching base was 94.2%. The training program for palliative care specialist nurses can ensure the trainees to acquire basic professional knowledge and skills and improve their knowledge, attitudes and behaviors concerning palliative care. However, it is needed to explore training programs that are in part-time model, delivered online or suitable for different levels of nursing staff to improve the accessibility.

Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study

Background and aim of the work:

Nursing education plays a key role in preparing future nurses to deal with dying patients, which represents one of the most emotionally involving aspect of nursing. The aims of the study were to explore nursing students’ attitudes towards care of dying patients in three different European contexts and to analyze the variables that can influence them.

Methods:

We conducted an international multicenter cross-sectional study. We administered the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD-B) and a demographic form to 569 students, enrolled in three Nursing Programmes in different countries (Italy, Spain and United Kingdom), who accepted to participate in the study. The data were analyzed using SPSS software version 26.0.

Results:

Median total FATCOD-B scores indicated intermediate levels of students’ attitudes towards care for dying patients, with a statistically significant difference among the three student groups. The median total FATCOD-B scores did not statistically significantly change in students with different age, gender, year of study, religious beliefs, nursing education on palliative care, previous experiences of dying patient care and personal grieving.

Conclusions:

In our study, nursing students feel partially prepared in caring for dying patients and their attitudes do not change as the course of study progresses. No selected variables had an impact on students’ attitudes towards palliative care. Since nurses play a vital role in ensuring the quality of care, education on end-of-life care should be offered as a core part of undergraduate nursing programs. (www.actabiomedica.it)

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports

BACKGROUND

Nurses are the largest regulated group of healthcare professionals involved in palliative care. In 2004, a taskforce of the European Association for Palliative Care (EAPC) launched the 'Guide for development of palliative nurse education in Europe' (hereinafter, the EAPC 2004 Guide). No systematic evaluation of its impact in the development of palliative care education was undertaken.

AIMS

To describe current undergraduate and postgraduate nursing education across Europe; to identify the roles that nurses with different palliative care educational levels have in palliative care; and to assess the uptake of the EAPC 2004 Guide in the development of palliative care nursing in Europe.

DESIGN

Descriptive research involving an online survey among nursing experts, and the consultation of national representatives.

SETTING/PARTICIPANTS

A total of 135 nurses (52% response rate) from 25 countries completed the online survey; representatives from 16 countries were consulted.

RESULTS

In 14 (56%) countries, palliative care was not identified as a mandatory subject within undergraduate nursing education. The EAPC 2004 Guide is widely known and was/is being used in many countries to promote palliative care nursing education. Large variations were found across and within country responses.

CONCLUSIONS

Palliative care nursing education varies largely in Europe. The wide awareness and use of the EAPC 2004 Guide show how policy measures can influence the development of palliative care education. Recommendations are built and focus on both fostering the use of this guide and implementing policy measures to ensure that palliative care nursing is recognised and certified as a specialty in all European countries.

Palliative care undergraduate education: Do medical and nursing students need more skills in ethical and legal issues?

This study aimed to analyze the schools that teach ethical and legal aspects within the subject of palliative care in the degrees of medicine and nursing in Spain.

MATERIAL AND METHODS

Descriptive Analysis of the palliative care subject and their ethical and legal curricular competencies in the Spanish Nursing and Physicians undergraduate. The training received in legal ethical aspects related to palliative care was compared with the criteria established by the European Association for Palliative Care (EAPC).

DATA SOURCES

The National Conference of Nursing Deans, The National Conference of Spanish Medical Faculty Deans and The Ministry of Science, Innovation, and Universities databases were searched.

RESULTS

Twenty-one universities have an undergraduate in medicine with palliative care in their curricular training explicitly. The degree in nursing is present in fifty-six universities, palliative care is present in 62.5% of the cases. The degrees of nursing and medicine receive approximately the same level of training in ethical and legal aspects of palliative care.

CONCLUSION

The specific training received in ethical and legal issues of palliative care must be improved in medical and nursing to meet the EAPC levels.

Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis

BACKGROUND

Palliative care exists in diverse healthcare settings. Nurses play a crucial role in its provision. Different levels of palliative care provision and education have been recognized in the literature. Therefore, nurses need a set of various competencies to provide high-quality palliative care.

AIMS

To systematically synthesize the empirical evidence of (1) nursing competencies needed in palliative care and (2) whether these competencies differ across the level of palliative care.

DESIGN

Systematic integrative review with thematic synthesis. Prospero: CRD42018114869.

DATA SOURCES

CINAHL, PubMed, Academic Search Premier, Scopus and Medic databases. Studies on nursing competencies linked to palliative care reported in English, Swedish, Finnish, Spanish, Portuguese or German were considered. Search terms: 'palliative care or hospice care or end-of-life care', 'competency or professional competence or skills' and 'nursing'. Articles were independently screened and reviewed by two researchers. Quality appraisal was conducted following Hawker's criteria.

RESULTS

A total of 7454 articles were retrieved, 21 articles were included in the analysis. Six diverse nursing competencies dimensions, namely leadership, communication, collaboration, clinical, ethico-legal and psycho-social and spiritual were identified. The reports rarely defined the level of palliative care and covered a wide array of healthcare settings.

CONCLUSION

Nurses need a wide range of competencies to provide quality palliative care. Few studies focused on which competencies are relevant to a specific level of palliative care. Further research is needed to systematize the nursing competencies and define which nursing competencies are central for different levels of palliative care to enhance palliative care development, education and practice.