The effect of combined training (theoretical-practical) of palliative care on perceived self-efficacy of nursing students

BACKGROUND

Nurses and researchers emphasize the importance of adding educational content of palliative care to nursing curricula in Iran as a means to improve the quality of care at the end of life and self-efficacy is considered as an important determinant in palliative care nursing. However, undergraduate nursing students are not sufficiently trained to achieve the qualifications required in palliative care. The aim of this study was to determine the effect of combined training (theoretical-practical) of palliative care on the perceived self-efficacy of nursing students.

METHODS

This is a semi-experimental study with a pretest-posttest design. Sampling was nonrandomized with convenience method and included 23 seventh-semester students. The intervention consisted of palliative care training for ten theoretical sessions and three practical sessions. Data were collected using demographic and the perceived self-efficacy questionnaires completed before and after the intervention. Data were then analyzed in the statistical SPSS 23 software using descriptive and analytical statistics.

RESULTS

The mean age of the samples was 22.78 (SD1.17). Most of the participants were male (56.5%) and single(91.3%). The findings showed that, perceived self-efficacy, psycho-social support and symptom management improved significantly after the intervention (p<0.05).

CONCLUSION

Palliative care training can increase the nursing students perceived self-efficacy. Since nursing students are the future nurses of the care system, therefore, managers and planners can take a step towards improving the quality of nursing care by using palliative care training programs. Since nursing students will be future nurses in health care system, therefore, managers and planners can take steps to improve the quality of nursing care by using palliative care education programs.

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.

Sense of failure in end of life care: Perspectives from physicians and nurses

Limited knowledge exists regarding sensed failure resulting provision of end-of-life (EOL) care. Among medical health professionals (MHP), a sense of failure is associated with impaired patientcare and reduced worker wellbeing, including higher rates of burnout and secondary traumatic stress. As part of a larger mixed-methods study on the effects of EOL-care provision on MHP in general hospitals, semi-structured in-depth interviews were conducted with 22 physicians and nurses at three tertiary Israeli hospitals, representing a wide range of medical specialties, training, experience, and cultural backgrounds. Qualitative thematic analysis of the interviews led to the identification of the theme 'sense of failure' with the sub-themes 'sources' and 'lived meanings' of the sensed failure. Apart from the source 'losing a patient' all other identified sources were recognized as work-related risk factors, including 'unsupportive environments' and 'shortcomings of the medical practice.' Two of the lived meaning 'sense of personal responsibility' and 'moral injury' were also recognized as work-related risk factors. Surprisingly, albeit the adverse context of EOL-care, the two remaining lived meanings 'learning from failure' and 'sense of purpose' were recognized as protective resilience factors. Changes in workplace norms by focusing on leadership and mentoring programs and implementation of evidence based interventions aimed at reducing the sense of failure and enhancing feelings of purpose are recommended. Finally, the findings described in the study would benefit from continued studies on larger scales.

Relationship between resilience and self-efficacy among Iranian nurses: a cross-sectional study during the post-Corona era

BACKGROUND

Resilience and self-efficacy play an influential role in nurses' clinical performance, which are considered resources for improving adaptability and promoting work engagement. This study aimed to determine the relationship between resilience and self-efficacy among nurses at Shahroud University of Medical Sciences hospitals during the post-Corona era.

METHODS

This cross-sectional study was conducted on 280 nurses in all clinical departments. Nurses with a bachelor of science in nursing or higher degree and at least one year of full-time work experience were included in the study using a convenience sampling method. Participants completed a three-part tool, which included the demographic information form, the Connor-Davidson Resilience Scale, and the General Self-Efficacy Scale. The data were analyzed using descriptive statistics and inferential tests (multivariate linear regression using the backward method).

RESULTS

In this study, nurses reported low levels of resilience (63.64 ± 15.66) and high levels of self-efficacy (63.01 ± 9.57). Among the five resilience subscales, the highest mean item score was associated with "spiritual influences" (2.80 out of 4), while the lowest mean item score was associated with "trust in one's instincts and tolerance of negative affect" (2.36 out of 4). Furthermore, the multivariate linear regression model results indicated that self-efficacy accounted for 33.6% of the variance in resilience (P < 0.001 and β = 0.952).

CONCLUSION

According to the results of the present study, it is suggested that nurses' psychological capabilities, such as self-efficacy, should be increased to improve resilience and address the stressful conditions of the work environment.

"Thai Nurses' and Midwives' Perceptions Regarding Barriers, Facilitators, and Competence in Neonatal Pain Management"

BACKGROUND

Effective neonatal pain management is reliant upon the expert care of nurses and midwives working in neonatal intensive care units (NICUs). Previous research has explored barriers, facilitators, and some aspects of nurse competence in managing neonatal pain; however, this research has been predominantly performed in Western countries. To date, little is known about the barriers, facilitators, and perceived competence of Thai nurses and midwives in relation to neonatal pain management in NICUs. Exploring Thai nurses' and midwives' perceptions in these areas is crucial for understanding the contextual nuances of neonatal pain management, which can guide the provision of care for these high-risk neonates.

PURPOSE

To investigate nurses' and midwives' perceptions of barriers, facilitators, and competence regarding effective neonatal pain management in Thai NICUs.

METHODS

Data were collected using virtual one-to-one, semistructured interviews with 12 neonatal nurses and midwives between July and August 2021 in 3 units of 2 tertiary hospitals in Southern Thailand. Inductive thematic analysis was used to examine interview data.

RESULTS

These data revealed following 3 major themes: ( a ) barriers to effective neonatal pain management, ( b ) facilitators of effective neonatal pain management, and ( c ) perceptions of competence.

IMPLICATIONS FOR PRACTICE

Assisting nurses and midwives in overcoming barriers and strengthening facilitators while enhancing their competence may result in better neonatal pain management.

IMPLICATIONS FOR RESEARCH

This study adds to our understanding that further research is needed to develop the interventions designed to change at individual, unit, and organizational levels, particularly implementing parent-friendly visitation and ongoing professional development in neonatal pain management.

Towards a set of competencies in palliative care nursing in Spain: what's getting in the way of consensus?

BACKGROUND

Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36.

METHODS

Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories.

RESULTS

Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death.

CONCLUSIONS

Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential ​​to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.

Validation of the Simplified Chinese Palliative Care Nursing Self-Competence Scale: Two Cross-sectional Studies

BACKGROUND

Due to the increasing burden of life-limiting illnesses, the need for palliative care has increased. Nurses' palliative care competence is a vital factor in improving its accessibility. A reliable instrument is needed to measure nurses' competence in providing palliative care.

OBJECTIVE

Our aim was to translate and culturally adapt the Palliative Care Nursing Self-Competence Scale (PCNSC) into the Palliative Care Nursing Self-Competence Scale-Simplified Chinese (PCNSC-SC).

METHODS

Two cross-sectional studies were conducted after content validity had been confirmed during the instrument's translation and adaption. The convergent validity, construct validity, internal consistency, and homogeneity were evaluated in both the first and second studies. Test-retest reliability was assessed only in the first study. Clinical nurses who had a registered nurse qualification certificate and at least 12 months of work experience from a tertiary hospital in Hubei, China participated in the 2 studies.

RESULTS

The PCNSC-SC contains 8 dimensions and 34 items, based on goodness-of-fit indices and confirmatory factor analysis. The Cronbach's alpha of the PCNSC-SC was .984 and .990 in the 2 studies, respectively. The test-retest reliability of the PCNSC-SC after 2 weeks was .717.

CONCLUSION

The PCNSC-SC can be used to evaluate perceived self-competence in palliative care of Chinese nurses with good reliability and validity.

Arabic version of the Palliative Care Self-Efficacy Scale: Translation, adaptation, and validation

OBJECTIVES

A lack of confidence among oncology nurses might be problematic when providing palliative care. No valid and reliable tool is currently available in Saudi Arabia to assess oncology nurses' confidence in providing palliative care. This study aims to explain the process of translation, adaptation, and validation of the Palliative Care Self-Efficacy Scale (PCSS) to support its use in the Saudi context.

METHODS

This was a methodological study of translation, cultural adaptation, and content validation of PCSS. The process of translation and adaptation was conducted according to the World Health Organization guidelines, including forward and backward translations, an expert panel review, and pretesting and cognitive interviewing, resulting in a final version. Two independent bilingual oncology nurses familiar with palliative care terminology translated the PCSS from English to Modern Standard Arabic. Next, the concise PCSS translation developed from the 2 translations was back-translated to English by 2 English-speaking translators and then compared to the original PCSS. The Arabic version PCSS was evaluated by Saudi professionals (N = 5) in oncology and palliative care nursing using a Likert scale for essentiality, relevance, clarity, and appropriateness. The content validity was examined using the calculation of the content validity ratio, item-level content validity index (I-CVI), and modified kappa statistics. The thinking aloud method was also used to interview Saudi oncology nurses (N = 8) who had palliative care experience.

RESULTS

The relevance, clarity, and appropriateness of the first Arabic version PCSS were validated. It had a level of content validity index of 1.00 for all items after improvements were made based on the recommendations of experts and oncology nurses.

SIGNIFICANCE OF RESULTS

The PCSS demonstrated face and content validity in the assessment of oncology nurses' confidence in providing palliative care. The PCSS is suitable for use in palliative cancer care units in Saudi Arabia to identify the educational needs of nurses to promote their confidence and improve the quality of care. Additional reliable and valid language versions of the PCSS allow for international and national comparisons, which may be useful for oncology nursing administrators or managers who are accountable for the quality of palliative care during the strategic health-care planning process in cancer services.

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.

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.

Instruments to measure skills and knowledge of physicians and medical students in palliative care: A systematic review of psychometric properties

PURPOSE

Palliative care is constantly increasing around the world. The knowledge and skills of future physicians in this area are crucial. This study evaluates the psychometric properties of knowledge and skills questionnaires used in palliative care, validated by physicians or medical students based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

METHODS

A systematic review was carried out in Cosmin Databases, Cochrane Library, PsycINFO, SciELO, Cinahl, and Medline up to September 2020 (updated June 2021), based on the COSMIN methodology and PRISMA recommendations. The psychometric properties of each included questionnaire were identified. Methodological quality, quality of results, and quality of evidence were evaluated.

RESULTS

The search strategy yielded 12 questionnaires assessing the knowledge and skills of physicians or medical students. The Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) and Palliative Care Knowledge Test (PCKT) were the instruments with the highest scores for methodological quality, quality of results, and quality of evidence-based on the COSMIN methodology.

CONCLUSIONS

PEACE-Q and PCKT should be the preferred choice to assess palliative care knowledge and skills in physicians. In-depth studies following COSMIN validation criteria are recommended to improve the psychometric properties and cross-cultural validation of the questionnaires.

Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings

Background

One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context.

Methods

This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method.

Results

Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant.

Conclusions

The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.

Neonatal Nurse and Midwife Competence Regarding Pain Management in Neonates: A Systematic Review

BACKGROUND

Neonates in need of intensive care are often subjected to numerous painful procedures. Despite the growing scientific research, hospitalized neonates continue to experience unrelieved pain. Enhancing the competence of neonatal intensive care nurses is an integral component of effective pain management.

PURPOSE

The purpose of this article is to identify and synthesize the existing evidence on nurses' and midwives' competence regarding neonatal pain management internationally.

METHODS/SEARCH STRATEGY

The review was guided by Whittemore and Knafl's 5-stage framework, with 8 databases searched in June 2020 including PubMed, CINAHL Complete (via EBSCOhost), MEDLINE (via EBSCOhost), PsycINFO (via Ovid), EMBASE, Scopus, Cochrane Library, and Google Scholar. Reference lists of selected articles were also hand-searched. Studies were reviewed independently for methodology and inclusion and exclusion criteria. The initial search yielded 3037 articles; 19 met the inclusion criteria and were included for analysis: qualitative (n = 5) and quantitative (n = 14).

FINDINGS/RESULTS

Nurses' and midwives' competence regarding neonatal pain management in the neonatal intensive care unit is discussed in relation to knowledge, attitudes, behaviors, and perceptions of competence by most studies. The barriers to effective neonatal pain management were found to relate to nurses' and midwives' factors, underutilized pain assessment tools, and organizational factors. Potential facilitators to effective neonatal pain management included clear evidence-based guidelines/protocols, adequate training, and the use of appropriate and accurate pain assessment tools. Parent involvement and a team approach to neonatal pain management were also identified.

IMPLICATIONS FOR PRACTICE AND RESEARCH

These findings suggest that further research is necessary to address the barriers and promote facilitators to improve neonatal pain management.

Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study

BACKGROUND

The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses.

OBJECTIVE

To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views.

METHODS

A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland.

RESULTS

The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P < .001), and more often felt that these competencies are relevant to their profession (72.2% vs. 57.6%, P < .001).

CONCLUSION

PC was considered as a useful subject, still only about half of the students reported the received PC education and their competence on PC as sufficient. Previous education or experience may enhance PC competence highlighting the need for divergent teaching. The results identify development needs for the contents of PC education in undergraduate nursing studies.

Emergent care nurses' perceived self-competence in palliative care and its predictors: A cross-sectional study

AIM

To describe the prevalence of perceived self-competence in palliative care among emergent care nurses, and explore its predictors.

BACKGROUND

Emergent care nurses have a responsibility to develop palliative care competence to enhance the quality of life of dying patients and their families in the emergency department.

METHODS

With a convenience sample, a cross-sectional study was conducted among 415 emergent care nurses from 22 hospitals in China. Descriptive analysis, Spearman correlation analysis, and multivariate linear stepwise regression were performed.

RESULTS

Variables including marital status (single), emergency department not implementing palliative care, no palliative care training, and true cooperation dimension were selected as independent predictors and explained 19.9% of variation in the regression model.

CONCLUSIONS

Interventions to improve healthy work environments, offering palliative care training, advocating for policies in palliative care, and offering support to unmarried nurses can advance nurses' palliative care competence.

IMPLICATIONS FOR NURSING MANAGEMENT

This is the first study of emergent care nurses in China aimed at identifying predictors associated with palliative care self-competence. It is significant in that palliative care training and a cooperative work environment are required to encourage the development of palliative care.

Use of Theoretical Frameworks in the Development and Testing of Palliative Care Interventions

CONTEXT

Palliative care (PC) research has grown over the last 20 years. Yet, the causal components and pathways of PC interventions remain unclear.

OBJECTIVES

To document the prevalence and application of theoretical frameworks in developing and testing PC interventions.

METHODS

We conducted a secondary analysis of previously published systematic reviews of PC randomized clinical trials. Trials were evaluated for explicit mention of a theoretical framework, process or delivery model, or clinical practice guideline that supported the development of the intervention. We used a structured data extraction form to document study population, outcomes, and whether and how authors used a theoretical framework, process/delivery model, or clinical practice guideline. We applied an adapted coding scheme to evaluate use of theoretical frameworks.

RESULTS

We reviewed 85 PC trials conducted between 1984 and 2021. Thirty-eight percent (n = 32) of trials explicitly mentioned a theoretical framework, process or delivery model, or clinical practice guideline as a foundation for the intervention design. Only nine trials included a theoretical framework, while the remaining 23 cited a process/delivery model or clinical practice guideline.

CONCLUSION

Most PC trials do not cite a theoretical foundation for their intervention design. Future work should focus on developing and validating new theoretical frameworks and modifying existing theories and models to better explain the mechanisms of the variety of PC interventions.

Nurses' competency in Saudi Arabian healthcare context: A cross-sectional correlational study

AIM

To measure the competence and characteristics of nurses in Saudi Arabia delivering health care with significant correlations.

DESIGN

A cross-sectional correlational study.

METHODS

Data were collected in 2019 using a standardized questionnaire, Competency Inventory for Registered Nurses (CIRN), that included a purposive sample of 621 nurses working in Saudi Arabia.

RESULTS

A positive evaluation of nurses' overall core competency components is recognizably measured with greater competency levels in their workplace, scoring highest in "legal/ethical practice" while "critical thinking and research aptitude" represented the lowest dimension. Nurses' marital status, years of graduation, length of service, duty hours and nurse-patient ratio affect their competency level. Nurses' competence and their sociodemographic characteristics are significantly correlated attributes. Medical ward nurses are likely to have the greatest competence in delivering safe nursing care within training's legal borders.

Undergraduate nursing students' knowledge, attitudes and self-efficacy regarding palliative care in China: A descriptive correlational study

Aim

To describe nursing students' knowledge, attitudes and self-efficacy about palliative care and to examine the associations between these variables in China.

Design

A descriptive correlational study.

Methods

Undergraduate nursing students (N = 187) at the end of third year of education from a university were surveyed. Measurements included the Chinese versions of the Palliative Care Quiz for Nursing, the Death Attitude Profile-Revised, the Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Self-Efficacy Scale. Descriptive and correlational analyses were performed.

Results

Although most nursing students had favourable attitudes towards death and caring for the dying, students had low level of knowledge and self-efficacy regarding palliative care, suggesting the need for integrating palliative care education into nursing curriculum in China. Moreover, special attention should be paid to psychosocial and spiritual care teaching and preparing students to psychologically deal with the challenges in the process of patient's dying.

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.

Nurses' self-efficacy, rather than their knowledge, is associated with their engagement in advance care planning in nursing homes: A survey study

BACKGROUND

Considering social cognitive theory and current literature about successful advance care planning in nursing homes, sufficient knowledge and self-efficacy are important preconditions for staff to be able to carry out advance care planning in practice.

AIM

Exploring to what extent nurses' knowledge about and self-efficacy is associated with their engagement in advance care planning in nursing homes.

DESIGN

Survey study as part of a baseline measurement of a randomised controlled cluster trial (NCT03521206).

SETTING/PARTICIPANTS

Nurses in a purposive sample of 14 nursing homes in Belgium.

METHODS

A survey was distributed among nurses, evaluating knowledge (11 true/false items), self-efficacy (12 roles and tasks on 10-point Likert-type scale) and six advance care planning practices (yes/no), ranging from performing advance care planning conversations to completing advance directives.

RESULTS

A total of 196 nurses participated (66% response rate). While knowledge was not significantly associated with advance care planning practices, self-efficacy was. One unit's increase in self-efficacy was statistically associated with an estimated 32% increase in the number of practices having carried out.

CONCLUSIONS

Nurses' engagement in advance care planning practices is mainly associated with their self-efficacy rather than their knowledge. Further research is necessary to improve the evidence regarding the causal relationship between constructs. However, these results suggest that educational programmes that focus solely on knowledge might not lead to increasing uptake of advance care planning in nurses.

Effect of palliative care training on perceived self-efficacy of the nurses

Background

Nurses are involved in providing end-of-life care for end stage individuals and their self-efficacy is one of the key factors bearing on such care. The purpose of this study was to determine the effect of palliative care on perceived self-efficacy of the nurses.

Methods

This is a quasi-experimental study with pretest-posttest design. Sampling was randomized and included 40 individuals. The intervention consisted of palliative care training for four sessions, each lasting 45 min. Data were collected using demographic and perceived self-efficacy questionnaires completed before and after the intervention. Data were then analyzed by SPSS 16 software using descriptive and inferential statistics.

Results

The mean age of the participants was 38.6 and their work experience was 14.25 years. The majority of the participants were female (85%) and had a bachelor level of education (92.5%). The findings showed that “perceived self-efficacy”, “psychosocial support” and “symptom management” improved significantly after intervention (p < 0.05).

Conclusion

Based on the results, palliative care education has the potential to increase nurses’ perceived self-efficacy. Since all members of the health care team Including nurses play an important role in providing palliative care, nursing managers can take an effective step to maximize the capacity of nurses by planning and supporting training in this regard.

Palliative care knowledge and self-awareness in active and observing undergraduate nursing students after end-of-life simulation

AIM

The purpose of this quasi-experimental one-group repeated measure (pre-test/post-test) study was to determine the effect of an end-of-life (EoL) simulation-based experience (SBE) on active and observer nursing students' palliative care knowledge and self-awareness.

BACKGROUND

Baccalaureate nursing (BSN) graduates must demonstrate competence in EoL care; however, gaining EoL experience is challenging given constraints on nursing faculty and clinical sites. Research also is needed to determine whether similar outcomes are achieved by active and observer participants after EoL SBE.

METHOD

Senior-level BSN students' palliative care knowledge and self-awareness of active and observer participants were measured before and after an EoL SBE.

RESULTS

Knowledge and self-awareness increased (P<0.001) post-SBE in all participants, with equivalent post-test scores (P≥0.248) for active (M_attitude=130.1; M_knowledge=80.5) and observer (M_attitude=128.3; M_knowledge=77.9) participants.

CONCLUSION

EoL SBE is an effective method for increasing student palliative care competence. Student observers benefit as much as active participants on knowledge and self-awareness outcomes.

Cultural Adaptation, Validation, and Analysis of the Self-Efficacy in Palliative Care Scale for Use with Spanish Nurses

The aim of the present study is to validate the Self-Efficacy in Palliative Care Scale (SEPC) in Spanish nursing professionals and students, to describe their levels of self-efficacy, and to determine the influencing factors. A validation study and a cross-sectional descriptive study were carried out, with the data analysed using contrast tests and multiple linear regression; 552 nurses and 440 nursing students participated. The Spanish version consists of 23 items and has a high degree of reliability (α = 0.944). Confirmatory factor analysis revealed one additional factor (i.e., management of psychosocial and spiritual aspects) in comparison to the original scale. Contrast tests revealed that the mean SEPC score was higher in professionals than in students (p < 0.001) and that the professionals who had higher levels of self-efficacy were older (p < 0.001), had more previous training (p < 0.001), and had more experience in end-of-life care (p = 0.001). The linear analysis results confirm a significant association between age and previous training in end-of-life care. The Spanish version of the SEPC is a reliable tool for both nursing professionals and students. The level of self-efficacy of both groups is moderate and is influenced by age, experience, and training in end-of-life care.

Evolution and Conceptual Foundations of Nonhospice Palliative Care

The term nonhospice palliative care was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and clarify this concept using Rodgers’s evolutionary concept analysis method. Attributes of nonhospice palliative care include (a) patient- and family-centered care, (b) holistic care, (c) interdisciplinary team, (d) early intervention, (e) quality of life-enhancing, (f) advanced care planning, (g) any age of the patient, (h) at any stage in illness, (i) care coordination, (j) concurrent curative treatment options, and (k) provided by primary and specialist providers. Nonhospice palliative care antecedents are serious illness, education, and access to services; consequences include benefits for the patient, family, provider, and health care system. Offering a clearly defined concept may allow for changes in health care to improve access to these services.

Development of a New Measure to Assess Primary Palliative Care Perceived Competence

BACKGROUND

Many nursing schools have begun to address the gap in palliative care education. Recently released entry-to-practice competencies in palliative care can guide educators as they incorporate such material into their curriculum. In an effort to evaluate learning, educators need a reliable instrument that aligns with the updated competencies.

PURPOSE

This article describes the development of a new instrument to evaluate perceived competence to provide primary palliative care.

METHODS

The psychometric properties and performance of the new instrument in evaluating perceived competence were tested via an interprofessional palliative care simulation with medical, nursing, and social work students. Perceived competence was measured before and after the simulation.

RESULTS

The new instrument demonstrates strong reliability and validity, represents a unidimensional construct, and captures changes in perceived competence across time and disciplines.

CONCLUSIONS

The new instrument is acceptable for assessing perceived competence to provide palliative care, particularly for nursing students.

Factors Associated with Nurses’ Self-Efficacy in Applying Palliative Care in Intensive Care Unit

Introduction: The increasing need for palliative care (PC) in the intensive care unit (ICU) is characterised by an increasing number of patients with critical and terminals conditions. It requires comprehensive treatment of nurses, through PC. Self-efficacy is a major predictor that affects the application of PC in ICU. Therefore, nurses need to have high self-efficacy to provide quality PC for patients and their families. This study aimed to analyse the factors that dominant relates to nurses' self-efficacy in implementing of providing PC in ICU.Methods: This research was correlational research with cross-sectional survey design. The sampling technique used was total sampling, which involved 127 critical nurses who were actively working at a general hospital in Bandung, Indonesia. Data were collected using questionnaires. Bivariate analysis using Pearson correlation and Rank-Spearman test and multivariate analysis using linear regression.Results: The results showed that the majority of respondents had high self-efficacy, working experience >15 years, enough interest to the nursing profession had less knowledge and negative perception related to the PC in ICU. There was a significant relationship between self-efficacy with work experience, nurses' interest in the nursing profession, knowledge and perception variables. The most dominant factors related to self-efficacy, namely knowledge and perceptions of nurses related to PC.Conclusion: This study indicates that majority of the respondents lacked knowledge and had negative perceptions related to PC in ICU, it is necessary to socialise and training related to it by focusing on self-belief or self-efficacy of nurses on their ability.

Relationships among nursing student palliative care knowledge, experience, self-awareness, and performance: An end-of-life simulation study

BACKGROUND

Palliative care education and experience are needed for student competence in delivering high-quality palliative nursing care. Simulation has been linked to acquired clinical competency among pre-licensure students. A known literature gap is measurement of students' performance during end-of-life simulations.

OBJECTIVES

The aim of this study was to determine relationships among previous palliative care nursing experience, knowledge, self-awareness, and performance in nursing students during an end-of-life simulation.

DESIGN/SETTING/PARTICIPANTS

A quasi-experimental pretest/posttest design was used to assess these variables with a convenience sample of 75 senior nursing students during an end-of-life simulation at a Midwest Jesuit university.

METHODS

Self-awareness was measured with the Frommelt Attitudes Toward Care of the Dying, Form B. The Palliative Care Quiz for Nursing measured participants' knowledge. Participants' performance during the simulation was measured using a modified version of the Creighton Competency Evaluation Instrument®. Palliative care nursing self-awareness and knowledge were assessed before and after the simulation. Previous end-of-life care experience was assessed with a single demographic question at pretest only.

RESULTS

The sample was highly experienced in end-of-life care (93.3% reporting experience pre-simulation). Although pretest self-awareness (M = 124.5; ±1.3) and knowledge (M = 57.1%; ±2.2) were higher in students with two or more types of end-of-life experience (n = 42), there were no significant differences (p > .10) in these outcomes by groups pre- or post-simulation. Self-awareness (M = 130.1; ±1.2), knowledge (M = 80.5%; ±2.6), and performance (M = 94.1%; IQR 87.5 to 100) scores were high for student participants (n = 36) post-simulation, with moderate correlations found between some scores (r_pb < -0.40 or 0.40).

CONCLUSIONS

Findings support self-awareness and knowledge as antecedents of high quality palliative nursing care. Students demonstrated increased post-simulation knowledge, self-awareness, and quality performance of palliative nursing care regardless of previous end-of-life experience. End-of-life simulation is supported as an education method for increasing palliative care nursing competence and assessing student performance of palliative care nursing interventions.

Mind the gap: is the Canadian long-term care workforce ready for a palliative care mandate?

The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

Prepared for end-of-life care: a concept analysis

BACKGROUND

Recent international documents have highlighted the importance of preparing the nursing workforce for end of life care. However, these documents do not make clear what prepared in the context of end-of-life care actually means. Searching the literature failed to retrieve any papers defining prepared in this context.

AIM

A concept analysis, using Walker and Avant's model, was conducted to help address this gap in the knowledge base.

RESULTS

From this analysis many attributes and antecedents were synthesised. These include that a prepared nurse would be confident to: assess the dying patient, communicate with empathy, identify and manage symptoms, recognise and deal with death and dying, understand the holistic elements of dying, be comfortable with the effects of loss and bereavement on patients and self, and be self-competent.

CONCLUSIONS

From this analysis, a clearer idea of what is needed to prepare nurses for end-of-life care is offered and suggestions for future research are made.

A Concept Analysis of Palliative Care Nursing: Advancing Nursing Theory

The American Association of Colleges of Nursing specifies that all nurses must be prepared to deliver high-quality palliative care upon entry into practice. To achieve this aim, a clear understanding of palliative care nursing is needed. The Walker and Avant model for concept analysis was used to review and analyze relevant literature from 2000 to 2016. The authors utilized findings of this extensive review to develop a concept model and other practical resources for guiding nurses, educators, and researchers in applying and evaluating competence in the delivery of high-quality palliative nursing care.

The Development of a Nurse-Led Internet-Based Learning and Self-care Program for Cancer Patients With Symptoms of Anxiety and Depression-A Part of U-CARE

BACKGROUND

Having access to information about the disease and being encouraged to participate in self-care activities may reduce anxiety and depression symptoms in cancer patients. Internet-based interventions may be one way to support effective self-care strategies to improve emotional well-being and health-related quality of life.

OBJECTIVE

The aim of this study was to describe the development and acceptance of an Internet-based program intended to support cancer patients with anxiety and depression symptoms.

METHODS

A structured collaboration between patients, clinicians, and researchers was used to develop a theory- and evidence-based interactive health communication application (IHCA) based on Orem's self-care deficit nursing theory with influences from Bandura's social learning theory and psychoeducation.

RESULTS

The result is an IHCA described as a Nurse-led, Internet-based Learning and Self-care program that helps patients to perform self-care using different types of material in interaction with patients and healthcare staff. The acceptance of the program is consistent with the results of similar studies.

CONCLUSIONS

Collaboration between patients, clinicians, and researchers seems to be a fruitful approach in the development of an IHCA aiming to support cancer patients' self-care strategies. Well-designed intervention studies are needed to evaluate the effects of the IHCA.

IMPLICATIONS FOR PRACTICE

This article suggests a theoretical foundation for an IHCA and allows researchers and healthcare providers to take part in the discussion regarding format and content of IHCAs.

Graduating nurses' self-efficacy in palliative care practice: An exploratory study

BACKGROUND

Educational institutions and the health care industry agree that graduates from professional programs need to be "work ready" and capable of delivering competent and confident nursing care. One measure of program success is the student's self-efficacy in meeting expected graduate capabilities. In this study student's self-efficacy is related to palliative care graduate capabilities.

AIM

To explore graduating Bachelor of Nursing Science (BNSc) students' self-efficacy in caring for palliative care patients.

DESIGN

A qualitative design using semi-structured face-to-face interviews.

SETTING

A regional Australian university.

PARTICIPANTS

A purposive sample of 10 students in their final semester of study in a Bachelor of Nursing Science degree program.

METHOD

Semi-structured face-to-face interviews were conducted. Interview questions were informed by published palliative care graduate capabilities. Interview data were transcribed verbatim and coded by capability. The coded data were then analysed to determine evidence of self-efficacy in caring for palliative care patients.

RESULTS

All participants had experiences in caring for palliative care patients. However, the responses did not consistently reflect high degrees of self-efficacy in four documented palliative care graduate capabilities required to care for persons with a life-limiting illness.

CONCLUSIONS

The findings support others that have identified gaps between curriculum and health care industry requirements in terms of students' beliefs about their empowerment to deliver nursing care as graduates. Education interventions and approaches to program evaluation require further development to better support students' growth of self-efficacy in undertaking their graduate roles.

A Pilot Study of Palliative Care Provider Self-competence and Priorities for Education in Kenya

This study explored palliative care provider self-competence and priorities for future education in an inpatient hospice setting in Kenya. Self-competence scores for clinical skills and patient and family communication skills were hypothesized to differ according to provider type. A descriptive, cross-sectional study design was piloted at Kimbilio Hospice, a 26-bed rural, inpatient facility in Kenya. A quantitative survey instrument entitled, "Self assessment of clinical competency and concerns in end-of-life care," was administered to participants. Survey responses were collected from 5 clinical staff, 11 caregivers, and 8 support staff. Data were analyzed using Kruskal-Wallis test to compare between mean scores. Statistically significant differences were found in 5 self-competence variables: performing a basic pain assessment, use of oral opioid analgesics, assessment and management of nausea/vomiting and constipation, and discussing an end-of-life prognosis with a patient's family member (P < .05). Sixteen participants (66%) selected pediatric palliative care as their top priority for future education. The findings support the hypothesis that palliative care providers have varying levels of self-competence. Improving education to build palliative care competencies in adult and pediatric palliative care in sub-Saharan Africa is recommended.

Characteristics of caring self-efficacy in pediatric nurses: a qualitative study

PURPOSE

The present study was conducted to clarify pediatric nurses' characteristics of caring self-efficacy.

DESIGN AND METHODS

This study was conducted using a qualitative content analysis approach. The participants included 27 pediatric nurses and clinical instructors, selected purposively. Data were collected using semi-structured interviews and were analyzed using the content analysis method.

RESULTS

Data analysis generated four main themes as attributes of a self-efficient pediatric nurse including: (a) professional communications; (b) management of care; (c) altruism; and (d) proficiency.

PRACTICE IMPLICATIONS

Nursing managers and instructors can use these results to help develop nurses' empowerment and self-efficacy, especially in pediatric care.

Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors

PURPOSE

To evaluate an end-of-life (EOL) program related to specific outcomes (i.e., number of hospitalizations and place of death) for children with brain tumors.

DESIGN AND METHODS

From 1990 to 2005, a retrospective chart review was performed related to specified outcomes for 166 children with admission for pediatric brain tumors.

RESULTS

Patients who received the EOL program were hospitalized less often (n = 114; chi-square = 5.001 with df = 1, p <.05) than patients who did not receive the program.

PRACTICE IMPLICATIONS

An EOL program may improve symptom management and decrease required hospital admissions for children with brain tumors.