Prelicensure Nursing Students' Attitudes and Perceptions of End-of-Life Care

Insights into the experiences of nurse educators in end-of-life care: A qualitative study

AIM

This study elucidated the experience of nurse educators instructing practicums for nursing students assigned to the care of end-of-life patients in fundamental nursing education.

BACKGROUND

With the growing population of older adults and increased mortality, nurses providing care for people at the end-of-life stage and their families (referred to as end-of-life nursing) will be increasingly important in Japanese healthcare settings. Acquiring knowledge and action-level methods can be insufficient for nursing students to approach the illness experiences of people at the end of their life and their families, increasing the importance of practicum in end-of-life nursing to enable learning from experience. This situation raised the need to study how nurse educators for nursing care for end-of-life patients experience the situation and what they practice as observed through the educator's standpoint to devise better teaching methods for end-of-life nursing practica.

DESIGN

Interpretative phenomenology was used.

METHODS

Semi-structured interviews were conducted with six nurse educators. Participants were interviewed about their experiences in teaching nursing students who care for people in the final stages of life. Data were analyzed using Benner's Interpretive phenomenological approach.

RESULTS

Nurse educators teaching students assigned to end-of-life patients experienced the [sudden appearance of patients themselves] and were involved in the nursing care for these end-of-life patients. They [seized the opportune "moments" for teaching] while [placing the value of practicum in end-of-life nursing in the "fragments" that students find] and then acknowledged that students were becoming aware of the core values of end-of-life nursing, even though they could not perform the techniques of care. Nurse educators also [recognized students as learners at the "borderline stage"] who are still distinct from nurses and valued students in their current state of development with hopes and expectations for further growth.

CONCLUSIONS

This study highlighted the importance of nurse educators leveraging their practical knowledge to provide direct guidance to nursing students in clinical settings. The educators approached patient care with intentionality, prioritizing the well-being of patients while engaging in co-existent care alongside the students. Simultaneously, they respected the nursing students in their transition to becoming nurses, harboring hopes and expectations for continued growth. Concurrently, they were curious about the patient and student. They sought to balance the interests of the two parties representing dissimilar temporality, thereby applying their intuitive embodied intelligence into practice. Such experiences were also interpreted from the temporality of nursing students in a transitional stage of becoming nurses.

Development of a Primary Palliative Nursing Care Competence Model and Assessment Tool: A Mixed-Methods Study

AIM

The purpose of this study was to develop a new primary palliative nursing care (PPNC) competence model and assessment tool.

BACKGROUND

Consensus guidelines, a national position statement, and new nursing program accreditation standards require nurses to be educated in providing PPNC. A means to assess PPNC competence for prelicensure nursing students and entry-level nurses is needed.

METHOD

The mixed-methods study utilized a three-phase design encompassing in-depth document analysis and expert workgroups; focus groups with palliative care educators, practitioners, and administrators; and stakeholder focus groups.

RESULTS

Findings across all phases resulted in development of a PPNC competence model and assessment tool, each composed of nine domains and associated competency statements.

CONCLUSION

There is a global imperative for nurses to provide high-quality PPNC. Both the model and assessment tool are vital to develop a nursing workforce with the skills to care for persons with serious illness and their families.

A meta-analysis of nursing students' knowledge and attitudes about end-of-life care

OBJECTIVES

To synthesize nursing students' knowledge and attitudes about end-of-life care and to identify strategic directions for optimizing end-of-life care education.

DESIGN

A meta-analysis of observational studies.

DATA SOURCES

PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, MEDLINE, CNKI, and WANFANG 8 electronic databases in English and Chinese were systematically searched from inception until 10 April 2022.

REVIEW METHODS

Two reviewers independently screened literature and extracted data using structured tables. The Agency for Healthcare Research and Quality (AHRQ) was used to appraise the methodological quality of included studies. The study outcomes were synthesized using a meta-analysis.

RESULTS

26 cross-sectional studies of medium or high quality from 13 countries met the eligibility criteria, involving 9749 nursing students. In our review, nursing students demonstrated insufficient knowledge about end-of-life care, with a pooled mean score of 7.50 (95 % CI: 6.55-8.45); of these, knowledge about philosophy and principles, psychosocial and spiritual care, and pain and symptom management were all deficient, with pooled mean scores of 1.49 (95 % CI: 0.78-2.21), 1.00 (95 % CI: 0.35-1.65), and 3.44 (95 % CI: 2.25-4.63), respectively. Conversely, nursing students showed positive attitudes toward end-of-life care, with a pooled mean score of 102.97 (95 % CI: 99.43-106.51). The subgroup analysis revealed that male nursing students had lower pooled mean scores for end-of-life care knowledge and attitudes.

CONCLUSION

There is a mismatch between nursing students' knowledge and attitudes about end-of-life care, they have a positive attitude but lack the necessary knowledge. Male nursing students seem to have a greater deficit of knowledge and a relatively conservative attitude toward end-of-life care. These findings may provide a significant reference for nursing educators to adjust educational strategies promptly.

Metodologías para la enseñanza de cuidados paliativos en estudiantes de áreas de la salud

Introducción: la necesidad de la enseñanza de los cuidados paliativos a los profesionales de la salud es cada vez más imperante en el mundo y en Latinoamérica. Los educadores deben reconocer los avances para la enseñanza de los cuidados paliativos a través de nuevas formas de aprendizaje. Objetivo: caracterizar las metodologías, contenidos y efectos de la enseñanza del cuidado paliativo en estudiantes del área de la salud en literatura publicada entre los años 2016 y 2020. Métodos: se realizó una revisión de literatura tipo scoping review.Se revisaron artículos publicados en revistas indexadas en las bases de datos Medline, Cuiden, Lilacs, CINAHL durante el periodo 2016-2020 en inglés, español y portugués. Se seleccionaron 25 investigaciones luego de realizar el proceso de crítica de la evidencia. Resultados: los estudios incluidos fueron en su mayoría realizados con metodologías cuantitativas, en Estados Unidos y con poblaciones de estudiantes de enfermería. La información extraída de los artículos se organizó en cuatro temas: 1) cursos educativos en cuidado paliativo, 2) estrategias de simulación, 3) conocimientos en cuidados paliativos de los estudiantes, y 4) actitudes y emociones de los estudiantes ante los cuidados paliativos. Conclusiones: las estrategias encontradas para enseñar los cuidados paliativos incluyen cursos completamente virtuales o en multimodalidad y simulación clínica o en laboratorios. En general, la evidencia muestra el interés que existe por parte de los estudiantes para recibir este tipo de curso y la importancia que tienen en su desarrollo profesional.

Frommelt Attitude Toward Care of the Dying Scale Form B: Validation for Spanish health professionals

Objective

The aim of this study is to culturally adapt and validate the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B) in Spanish health professionals.

Method

A cultural adaptation and scale validation was carried out to evaluate the validity of appearance, content and construct, reliability and feasibility. The psychometric validation of the FATCOD-B was carried out on a sample of 2,446 Spanish physicians, nurses, psychologists, and social workers and students of these disciplines, between January 2017 and December 2018. This sample was selected by intentional sampling. Descriptive statistics were used to characterize the sample. An exploratory multi-group factor analysis was performed, internal consistency was evaluated by calculating Cronbach's α and stability by test–retest.

Results

A total of 2,446 people participated in the study, 1,134 students and 1,312 professionals. The exploratory multi-group factor analysis revealed a two-dimensional factor structure, with a total of 17 items retained in the model from the 30 of the original scale. The results showed that this version has adequate reliability (α = 0.79) and for each subscale, and stability (ICC = 0.843, p < 0.001).

Significance of results

FATCOD has been used with physicians and nurses from different countries. However, no reports have been found in the literature of its use with psychologists and social workers. It is important to have an instrument that allows us to know the attitudes of these professionals since they are all directly involved in the care of patients at the end of their lives and their families. The Spanish version of FATCOD-B has proven to be a reliable and valid instrument for its use in Spanish health professionals while allowing comparisons between disciplines.

Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results

Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence-based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end-of-life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1-5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.

A Phenomenological Study: Student Nurses' Perceptions of Care of the Dying in a Hospice-Based Facility

Despite emerging evidence of increased death education in nursing curricula, research suggests the graduate nurse is unprepared to effectively communicate and manage the array of symptoms experienced by the dying patient. This qualitative phenomenological research study's intent was to explore the impact of clinical experience in a community-based free-standing hospice facility as an effective pedagogical strategy for preparing student nurses to care for patients and families at the end of life (EOL). The researchers used descriptive phenomenology rooted in Husserl's philosophy. The qualitative data source included semistructured individual interviews. Convenience sampling yielded 10 senior-level nursing students in a community health nursing course. The analysis yielded 6 major themes: (1) fear of witnessing death, (2) contrasting care priorities in a hospice-dedicated versus acute care setting, (3) value of storytelling from hospice team members, (4) unprepared for EOL conversations, (5) guidance and support, and (6) benefit of hospice-dedicated experiential learning. The findings of this study support the use of expert hospice team members to guide and mentor students. Didactic and video-enhanced education, storytelling, preparation in EOL conversations, and experiential learning seem essential to familiarize students with EOL care and improve perceptions about caring for patients and their families.

Undergraduate nursing students' palliative care knowledge and attitudes towards end-of-life care: a cross-sectional descriptive study

BACKGROUND

It is crucial that future nurses be prepared with the knowledge and skills to provide palliative care (PC).

AIMS

This study aimed to investigate Mongolian nursing students' PC knowledge and attitudes towards end-of-life (EOL) care, as well as identify related predictors.

METHODS

Participants were 141 students who enrolled in nursing program in Mongolia.

RESULTS

Mean Palliative Care Quiz for Nursing (PCQN) score was 7.15 out of 20. The mean Frommelt Attitudes Toward Care of the Dying (FATCOD) score was 64.2 out of 100. Older age, male gender, and higher satisfaction with nursing school were significant predictors of higher levels of palliative care knowledge. Living in traditional Mongolian housing (Ger) and having clinical EOL experience were significant predictors of positive attitudes towards EOL care.

CONCLUSIONS

Mongolian senior nursing students were inadequately prepared to provide PC. PC nursing education in Mongolia needs to be improved to meet an appropriate global standard.

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.