Effect of an End-of-Life Care Education Program Among Korean Nurses:

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.

Effectiveness of end-of-life educational interventions at improving nurses and nursing students' attitude toward death and care of dying patients: A systematic review and meta-analysis

OBJECTIVES

To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients.

DESIGN

A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials.

DATA SOURCES

English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020.

REVIEW METHODS

A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I² statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level.

RESULTS

Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement.

CONCLUSIONS

Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices.

Hospital Nurses' Perception of Death and Self-Reported Performance of End-of-Life Care: Mediating Role of Attitude towards End-of-Life Care

Few studies have explored how nurses in acute care hospitals perceive and perform end-of-life care in Korea. Therefore, this study aimed to evaluate the influence of nurses' perceptions of death on end-of-life care performance and analyze the mediating role of attitude towards end-of-life care among hospital nurses. This cross-sectional study included a total of 250 nurses who have had experience with end-of-life care from four general hospitals in Korea. We used the Korean validated tools with the View of Life and Death Scale, the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, and the performance of end-of-life care. Hierarchical linear regression and mediation analysis, applying the bootstrapping method. The results of hierarchical linear regression showed that nurses' positive perceptions of death and attitude towards end-of-life care were significantly associated with their performance of end-of-life care. A mediation analysis further revealed that nurses' attitude towards end-of-life care mediates the relationship between the perceptions of death and performance of end-of-life care. Our findings suggest that supportive and practical death educational programs should be designed, based on nurses' professional experience and work environment, which will enable them to provide better end-of-life care.

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

The curricula of undergraduate nursing programs lack education in palliative and end-of-life care. If the topic is covered, it is generally within isolated lectures and rarely as a full course. With the growing demand for nursing competence in palliative care, curricula must adapt to also place emphasis on this important topic. The release in 2016 of the American Association of College of Nursing (AACN) Palliative Competencies and Recommendations for Educating Undergraduate Nursing Students (CARES) drew attention to the need for expanded undergraduate education on this topic. This paper describes the development and delivery of an undergraduate-level online nursing elective course in palliative and end-of-life care offered through a large public university. Innovative elements of the course include practicing difficult conversations using technology to enable active student engagement in an online environment, a serious game involving individual role play for treatment decision making, and special topic weeks allowing a deeper dive into seldom discussed populations such as the homeless, which the students described as playing an important role in contributing to their learning.

Teaching Palliative Care to Health Professional Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background:

End-of-life care is challenging on health professionals’ mental and emotional state. Palliative care education can support health professional students’ transition, helping them to cope with the challenges of working in this complex setting. Students feel that they need more preparation in this area.

Purpose:

To collate the relevant information regarding how to teach health professional students about palliative care.

Method:

The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC, and EMBASE via Elsevier were searched until April 7, 2019. Inclusion criteria were randomized controlled trials of group interventions that aimed to increase health professional students’ knowledge, skills, or attitudes in palliative care. Studies were appraised using the PEDro scale. Data were synthesized using meta-analysis.

Results:

The results favored the intervention and were statistically significant for knowledge and attitudes but not for skills. A 2-hour seminar accompanied by readings seems sufficient to improve both knowledge and attitudes. Quality assessment scores ranged from 1/10 to 7/10 (mean 5, standard deviation 1.73). When studies at high risk of bias were excluded, then only knowledge improved significantly. Key areas where rigor was lacking were in concealing the randomization, omitting intention-to-treat analysis and not blinding of participants, therapists, or assessors.

Conclusions:

Palliative care education is effective in improving health professional students’ knowledge and attitudes toward palliative care. More research is required into skill development. This review highlights the need for more high-quality trials in both the short and long-term to determine the most effective mode of palliative care education.

Attitudes of Nurses in Turkey Toward Care of Dying Individual and the Associated Religious and Cultural Factors

The aim of this study was to determine the attitudes of nurses working in two university hospitals located in the west and east of Turkey toward care of dying individual as well as religious and cultural factors that influence their attitudes. The descriptive and comparative study was conducted with a total of 189 nurses who were working in adult inpatient clinics of two university hospitals in western (101 nurses) and eastern (88 nurses) Turkey between July and November 2016. The data were obtained by using the questionnaire and Frommelt Attitudes Toward Care of the Dying Scale. As a result of this study, it was determined that in terms of the status of receiving training the end-of-life care the majority of nurses received this training; however, this rate was higher (51.0%) in nurses working in the eastern hospital (p = 0.025). The nurses working in the east (51.6%) were determined to have more problems during caregiving due to their religious and cultural beliefs, the most frequent problem they experienced was "being uncomfortable due to privacy when giving care to patients from opposite gender" (57.1%). The emotions felt mostly by nurses during the care of dying patient were grief (nurses in the east = 48.5%, nurses in the west = 51.5%) and despair (nurses in the east = 40.4%, nurses in the west = 59.6%). Nurses working both in the east (98.27 ± 7.71) and in the west (97.19 ± 8.99) were determined to have positive attitude toward death, and there was no statistically significant difference between both groups in terms of the mean scores of the Attitudes Toward Care of the Dying Scale (p = 0.373). In accordance with these results, it is recommended to focus on death issues in end-of-life care during the nursing education and to support nurses with in-service trainings regularly after the graduation.

Comparison of Attitudes Toward Death Between University Students Who Receive Nursing Education and Who Receive Religious Education

This study aims to compare attitudes toward death between university students who receive nursing education and who receive religious education. This study is cross-sectional in nature. It was conducted with the participation of 197 university students in a university located in the Eastern part of Turkey between June and August, 2017. Data were collected using the socio-demographic form and Turkish form of Death Attitudes Profile-Revised. Of all the students participating in the study, 52.8% received nursing education and 47.2% received religious education. It was found that majority of both groups had no education about death, or found the education they received insufficient. Besides, no significant differences were found between the students who received nursing education and who received religious education in terms of their attitudes toward death (p > 0.05). Results showed that students who received nursing education and who received religious education had similar attitudes toward death. In conclusion, the education given to students about the religious or health aspects of death in accordance with the curriculum seemed to have no effects on students' developing positive attitudes toward death.

Nurses attitudes towards death, dying patients and euthanasia: A descriptive study

Background:

Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses’ views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care.

Objectives:

The purpose of this study was to determine nurses’ views and attitudes about death, dying patient, euthanasia and the relationships between nurses’ characteristics.

Methods:

Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey. ‘Nurse Information Form’ and ‘Attitude Scale about Euthanasia, Death and Dying Patients (DAS)’ were used as data collection tool.

Ethical consideration:

Written permissions were received from the ‘Noninterventional Clinical Researches Ethics Board’ of authors’ university and education councils of each hospital. Informed consent was obtained from participants.

Findings:

It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses’ attitudes about euthanasia, death and dying patient (p < 0.05).

Conclusion:

The results indicate that nurses are negatively affected to face the concepts of death, euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required.

Nursing interventions to promote dignified dying in South Korea

PURPOSE

This descriptive study aimed to assess the appropriateness of the International Classification for Nursing Practice (ICNP) catalogue Palliative Care for Dignified Dying for palliative care nursing interventions in South Korea.

METHODS

The study surveyed 213 South Korean nurses who might regularly care for dying patients. Nurses were recruited to complete a survey that included interventions from the ICNP catalogue listed with Likert response sets.

FINDINGS

All of the interventions were scored as being at least 'slightly important' on average. The following three nursing interventions were ranked as most important when caring for dying patients: establish trust, establish rapport, and administer pain medication.

CONCLUSIONS

The study provides new insights into the palliative care provided in South Korea by documenting nurses' views of what are the most important palliative care nursing interventions. It also suggests that the palliative care interventions listed in the ICNP catalogue Palliative Care for Dignified Dying are in congruence with the interventions that nurses in South Korea use.

End of life care education, past and present: a review of the literature

BACKGROUND

Research on end of life care education suggests that undergraduate nursing students are largely unprepared to provide end of life care to dying patients and their families. Although there have been attempts to address the issue of lack of preparedness, little is known on how to improve this.

LITERATURE REVIEW AIMS

To examine how end of life care education has been delivered to undergraduate nursing students and to critically discuss the research on modes of delivery and teaching strategies.

REVIEW METHODS

An extensive literature search on end of life care education in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 18 research papers published between 1984 and 2012 that met the selection criteria are included in the review.

FINDINGS

Findings of these 18 articles are reported under two main themes: Modes of End of Life Education Delivery and End of Life Care Education Initiatives.

CONCLUSION

This review highlights issues with end of life care education and suggests that end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care.

Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: a systematic review

BACKGROUND

Staff from a range of health and social care professions report deficits in their knowledge and skills when providing end-of-life and palliative care, and education and training has been advocated at a range of levels.

AIMS

To review the literature related to classroom-based and distance learning education and training initiatives for health and social care staff in end-of-life and palliative care, in terms of their target audience, extent, modes of delivery, content and teaching and learning strategies, and to identify the most effective educational strategies for enhancing care.

DESIGN

A systematic review of the literature evaluating classroom-based and distance learning education and training courses for health and social care staff in end-of-life and palliative care.

DATA SOURCES

Online databases CINAHL, MEDLINE, EMBASE and PSYCHINFO between January 2000 and July 2010. Studies were selected that discussed specific education and training initiatives and included pre-and post-test evaluation of participants' learning.

RESULTS

30 studies met eligibility criteria. The majority reported successful outcomes, though there were some exceptions. Level of prior experience and availability of practice reinforcement influenced learning. Participative and interactive learning strategies were predominantly used along with discussion of case scenarios. Multi-professional learning was infrequently reported and service user and carer input to curriculum development and delivery was reported in only one study.

CONCLUSIONS

Classroom-based education and training is useful for enhancing professionals' skills and perceived preparedness for delivering end-of-life care but should be reinforced by actual practice experience.