Implementing a Program to Improve Pediatric and Pediatric ICU Nurses’ Knowledge of and Attitudes Toward Palliative Care:

Work-related quality of life in professionals involved in pediatric palliative care: a repeated cross-sectional comparative effectiveness study

Background

Working in pediatric palliative care (PPC) impacts healthcare and allied professionals' work-related quality of life (QoL). Professionals who lack specific PPC training but who regularly provide services to the affected children have articulated their need for support from specialized PPC (SPPC) teams.

Objectives

This study had two objectives: (1) to evaluate whether the availability of a SPPC team impacted the work-related QoL of professionals not specialized in PPC; and (2) to explore the work-related QoL of professionals working in PPC without specialized training.

Design

Repeated cross-sectional comparative effectiveness design.

Methods

One hospital with an established SPPC program and affiliated institutions provided the intervention group (IG). Three hospitals and affiliated institutions where generalist PPC was offered provided the comparison group (CG). Data were collected by paper-pencil questionnaire in 2021 and 2022. The Professional Quality of Life (ProQOL 5) questionnaire was used to assess work-related QoL, yielding separate scores for burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS). A descriptive statistical analysis was performed and general estimation equations were modelled. To increase the comparability of the IG and CG, participants were matched by propensity scores.

Results

The 301 participating non-PPC-specialized professionals had overall low to moderate levels of BO and STS and moderate to high levels of CS. However, none of these scores (BO: p = 0.36; STS: p = 0.20; CS: p = 0.65) correlated significantly with support from an SPPC team. Compared to nurses, physicians showed higher levels of BO (1.70; p = 0.02) and STS (2.69; p ⩽ 0.001).

Conclusion

Although the study sample's overall work-related QoL was satisfactory, it showed a considerable proportion of moderate BO and STS, as well as moderate CS. To provide tailored support to professionals working in PPC, evidence regarding key SPPC support elements and their effectiveness is needed.

Trial registration

ClinicalTrials.gov ID, NCT04236180.

Neonatal intensive care unit nurses knowledge and attitude toward neonatal palliative care: review of the literature

Aim

To review studies regarding neonatal nurses' knowledge and attitude toward neonatal palliative care (NPC).

Method

The researchers searched internet sources such as Google Scholar for NPC, Nurses, Knowledge, Attitude, and Educational Intervention.

Results

Subheadings identified in the literature review were Nurses Knowledge toward NPC in NICU, Nurses Attitude toward NPC in NICU, correlation between Knowledge and Attitude toward NPC in NICU, The Effect of Educational program on Nurses Knowledge and Attitude toward NPC in NICU, and the Predictors of Knowledge and Attitude toward NPC among Nurses in NICU and Barriers to NPC provision and improvement.

Conclusion

There are few studies from different nations regarding NPC found nurses have an inadequate knowledge of NPC, which also reflects their attitude.

Impact of educational programs on nurses' knowledge and attitude toward pediatric palliative care

OBJECTIVE

This study aims to assess the knowledge and attitude of nurses toward pediatric palliative care (PPC) and examine the impact of an educational program on pediatric nurses' knowledge and attitude regarding PPC for children facing life-threatening illnesses or chronic diseases in Jordan.

METHOD

A quasi-experimental design was used. Exactly 120 pediatric nurses participated in the study, of which 60 were in the intervention group and 60 in the control group.

RESULTS

The results of the study showed that nurses had a low score in knowledge and attitude toward PPC. The mean knowledge score of PPC for the control group is 6.88 (SD = 2.26), while that of the intervention group was 7.92 (SD = 1.99; p = 0.052). The mean attitude for PPC score for the control group was 95.88 (SD = 7.90), while that of the intervention group was 100 (SD = 10.95; p = 0.009). Also, the educational intervention had a significant positive effect on the knowledge and attitude toward PPC among nurses.

SIGNIFICANCE OF THE RESULTS

Based on the result of this study, the authors found strong evidence of the effectiveness of the PPC educational program when it came to improving the nurses' knowledge and attitude toward PPC services and offer us an effective educational program.

Instrument development of health providers' Knowledge, Attitude and Practice of Hospice Care Scale in China

OBJECTIVE

To match the reform of hospice development in China, this study aimed to construct an indigenized health providers' Knowledge, Attitude and Practice of Hospice Care (KAPHC) Scale in China with good validity and reliability.

METHODS

We used three steps to develop the scale, establishing items-pool firstly based on literature review and expert consultation, followed by forming a draft-scale design through synthetically consideration, and finally modifying the draft by conducting a self-administrative survey in sampled institution and testing the reliability and validity by statistical analysis.

RESULTS

The KAPHC Scale was comprised of 15 knowledge items, 24 attitude items and 22 practice items. In the part of knowledge, the Cronbach's α coefficient was 0.686, the average difficulty was 0.62 and average discrimination was 0.46. The attitude items were divided into four domains (KMO = 0.770), with Cronbach's α coefficient of 0.868. The practice items included confidence of practices and self-reported behaviors (KMO = 0.732), with Cronbach's α coefficient of 0.958.

CONCLUSION

The KAPHC Scale demonstrated good validity and reliability. As an effective tool, the scale may contribute to assessing health providers' KAP status of hospice care and exploring their future education needs in mainland China.

Paediatric palliative care: a systematic review

OBJECTIVES

To review literature relating to evidence, context and facilitation to describe knowledge translation in paediatric palliative care. Paediatric palliative care requires competences including both paediatric specialists as well as services that are developed for this purpose, and there is a need to facilitate paediatric palliative care knowledge translation. Promoting Action on Research Implementation in the Health Services (PARiHS) is a framework for knowledge translation, which highlights the relationships between evidence, context and facilitation. PARiHS framework has been revised and updated in a new version called i-PARiHS.

METHODS

The electronic databases AgeLine, CINAHL, The Cochrane Library, PsycINFO, PubMed and Scopus were searched. Papers included were limited to English and Swedish publications and restricted to publications dated between 1993 and August 2019. All types of observational and experimental studies using any research design were included.

RESULTS AND CONCLUSIONS

Thirty-eight articles were included and there was a common vision about how and when palliative care should be offered to children. The i-PARiHS was used as a lens to describe the knowledge translation in paediatric palliative care. Symptom relief was the most commonly described evidence-based strategy, and the hospital environment was the most commonly described context. Different types of education were the most commonly used strategies to facilitate knowledge translation. The results mainly focused on increasing knowledge of palliative care in paediatric care. To sum up, the results report strategies to achieve knowledge translation of paediatric palliative care, and these can be interpreted as a guideline for how this process can be facilitated.

TRIAL REGISTRATION NUMBER

CRD42018100663.

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.

Training Pediatric Fellows in Palliative Care: A Pilot Comparison of Simulation Training and Didactic Education

BACKGROUND

Pediatric fellows receive little palliative care (PC) education and have few opportunities to practice communication skills.

OBJECTIVE

In this pilot study, we assessed (1) the relative effectiveness of simulation-based versus didactic education, (2) communication skill retention, and (3) effect on PC consultation rates.

DESIGN

Thirty-five pediatric fellows in cardiology, critical care, hematology/oncology, and neonatology at two institutions enrolled: 17 in the intervention (simulation-based) group (single institution) and 18 in the control (didactic education) group (second institution). Intervention group participants participated in a two-day program over three months (three simulations and videotaped PC panel). Control group participants received written education designed to be similar in content and time.

MEASUREMENTS

(1) Self-assessment questionnaires were completed at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) External reviewers rated simulation-group encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultations were compared in the six months pre- and post-intervention.

RESULTS

Compared to the control group, participants in the intervention group improved in self-efficacy (p = 0.003) and perceived adequacy of medical education (p < 0.001), but not knowledge (p = 0.20). Reviewers noted nonsustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04).

CONCLUSIONS

This simulation-based curriculum is an effective method for improving PC comfort, education, and consults. More frequent practice is likely needed to lead to sustained improvements in communication competence.

Exploring NICU Nurses' Affective Responses to End-of-Life Care

BACKGROUND

The survival rate for infants born with life-threatening problems has improved greatly over the last few decades. Nevertheless, infants still die in neonatal intensive care units (NICUs) every day. Despite existing standards of care, some aspects of end-of-life care (EOLC) are still not delivered consistently. Little is known about how NICU nurses' individual experiences affect EOLC.

PURPOSE

The purpose of this study was to explore, through lived and told stories, the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Coping strategies and changes in practice were also explored.

METHODS

Thirty-six members of the National Association of Neonatal Nurses submitted written narratives about an EOLC experience during which the nurse experienced strong emotions.

FINDINGS

Narrative analysis revealed many affective responses, but 3 were the most frequent: responsibility, moral distress, and identification. Coping methods included healthy and less healthy strategies, such as colleague support, informal and formal debriefing, practicing intentional gratefulness, avoidance, and compartmentalization. Changes in practice identified were universally described as professional growth through the use of reflective practice.

IMPLICATIONS FOR PRACTICE & RESEARCH

Educators should discuss the range of emotions experienced by caregivers related to EOLC and healthy coping strategies and encourage the use of reflective practice as a facilitator of professional growth. Nurse leaders should promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Future research should focus on formulating interventions to utilize debriefing with NICU nurses and perhaps the development of EOLC mentors.

What neonatal intensive care nurses need to know about neonatal palliative care

The purpose of this study was to identify and prioritize topics for a professional development program in neonatal palliative care. A total of 276 nurses and midwives who work in an Australian neonatal intensive care unit (NICU) and 26 international healthcare professionals working in NICU and palliative care served as participants. A Delphi technique was used, consisting of a series of rounds of data collection via interview and questionnaire, to identify and consolidate opinions of nurses and other healthcare professionals who work in neonatal intensive care units. The main outcome measures were: (1) Topics to be included in a professional development program for nurses working in neonatal intensive care units and (2) the preferred format of the program. Twenty-three high-priority topics were identified, which included preparing families when death is imminent, how to provide emotional support to grieving parents, advocating for a dying baby, and assessing and managing pain in a dying baby. Care of a dying infant requires the same skill set as caring for older terminally ill children internationally. A combination of face-to-face lectures and interactive workshops using case studies and audiovisual examples is the preferred format.