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Lamminmäki A, Hökkä M, Hirvonen O, Rahko E, Saarto T, T Lehto J. Post-graduate Course in Palliative Medicine: Experiences from an E-Learning-Based Pilot Program, a Mixed Methods Study. J Palliat Care 2024; 39:209-216. [PMID: 37133388 PMCID: PMC11097605 DOI: 10.1177/08258597231171823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Objective: To study whether E-learning methods are feasible in the post-graduate education of palliative medicine. Methods: A mixed-methods study. Evaluations from pilot course attendees were analyzed numerically and answers to open-ended questions about E-learning were analyzed using inductive content analysis. A national pilot E-learning-based post-graduate course in palliative medicine with 24 participating physicians in Finland. The evaluation of teaching modules and different aspects of the course was achieved from the participants through numerical statements and open-ended questions. Results: The feedback on most aspects of the course was good. For example, issues of pain and symptom control, lectures, pre-exams, and group discussions were deemed suitable for E-learning, while studying communication and existential issues through E-learning was considered more challenging. The benefits of E-learning included efficacy, better accessibility, and the possibility to go back to the teaching material. Reduced networking and face-to-face interactions were stated as challenges of E-learning. Conclusions: E-learning is feasible in the post-graduate education of palliative medicine and can be 'surprisingly rewarding'. It allows easy access to learn many important topics, while social networking may fall short. Further studies are needed to assess the increase in competence by different learning methods.
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Affiliation(s)
- Annamarja Lamminmäki
- Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Cancer Center, KYS, Kuopio University Hospital, Kuopio, Finland
| | - Minna Hökkä
- Kajaani University of Applied Sciences, Kajaani, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Outi Hirvonen
- Department of Clinical Oncology, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | - Eeva Rahko
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - Tiina Saarto
- Faculty of Medicine, Palliative Care Unit and University of Helsinki, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Oncology, Palliative Care Centre, Tampere University Hospital, Tampere, Finland
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Sánchez-Cárdenas MA, Tibaquirá CAN, Mantilla-Manosalva N, Fonseca DA, Morales AM, Delgado MXL. Palliative care education in undergraduate medical and nursing programs in Colombia: a cross-sectional analysis. BMC Palliat Care 2024; 23:149. [PMID: 38872162 PMCID: PMC11170879 DOI: 10.1186/s12904-024-01477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science programs is necessary to improve primary PC based on international recommendations and available scientific evidence. METHODS A descriptive cross-sectional study was conducted. Active undergraduate medical and nursing programs that were approved by the Colombian Ministry of Education and integrated PC teaching into their curricula were included in the study. The total sample consisted of 48 programs: 31 nursing and 17 medical programs. RESULTS PC competencies are distributed throughout the curriculum in 41.67% of programs, in elective courses in 31.25%, and in mandatory courses in 27.08% of the programs. The average PC teaching hours is 81 for nursing and 57.6 for medicine. PC clinical rotations are not offered in 75% of the programs. For undergraduate nursing programs, the most frequent competencies taught are the definition and history of PC and identifying common symptoms associated with advanced disease. In undergraduate medicine, the most common competencies are pharmacological and non-pharmacological pain management and identification of PC needs. CONCLUSIONS PC teaching in undergraduate health science programs mainly addresses the conceptual and theoretical aspects of PC, which are part of the competencies present throughout the programs' curricula. Low availability of PC clinical rotations was identified. Future studies should assess whether the low availability of clinical rotations in PC limits the ability of students to develop the practical competencies necessary to provide quality PC. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | | | | | - David Andrade Fonseca
- School of Nursing, Universidad El Bosque. Bogotá D.C. Colombia, Bogotá, D.C, Colombia
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van Klinken M, Hafkamp E, Gualtherie van Weezel A, Hales S, Lanceley A, Rodin G, Schulz-Quach C, de Vries F. Teaching Oncology Nurses a Psychosocial Intervention for Advanced Cancer: A Mixed-Methods Feasibility Study. Semin Oncol Nurs 2023; 39:151507. [PMID: 37758582 DOI: 10.1016/j.soncn.2023.151507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Psychological interventions for advanced cancer patients are effective in decreasing distress but are not well integrated into cancer care. Oncology nurses are well positioned to deliver such interventions, and their participation may enhance professional satisfaction and wellbeing. Managing Cancer and Living Meaningfully (CALM) is an evidence-based psychotherapy supporting advanced cancer patients. A CALM-Nurses (CALM-N) training program was developed to teach oncology nurses the basics of CALM for use in daily practice. Feasibility and acceptability of CALM-N and its impact on professional wellbeing were assessed in this pilot study. DATA SOURCES Fifty-five nurses attended CALM-N in three groups. Thirty-five nurses completed the first e-learning, 29 nurses (83%) attended the first group session, and 22 (63%) attended all sessions. At baseline, 35 questionnaires were collected. Response rate at follow-up was 63% for Jefferson Scale of Empathy (n=22), 66% for self-efficacy scale (n=23), and for subscales of Professional Quality of Life Scale burnout; 51% (n=18), secondary traumatic stress; 49% (n=17), compassion satisfaction; 57% (n=20). A statistically significant increase in self-efficacy was found, but there were no significant changes in PROQOL and empathy. Focus groups suggested CALM-N helped nurses' understanding of patients and nurse-patient communication and increased reflection and perspective taking. CONCLUSION CALM-N is a feasible and acceptable intervention for oncology nurses, with the potential to improve nurse-patient communication and the nurses' reflective capacities. IMPLICATIONS FOR NURSING PRACTICE CALM-N has the potential to improve the capacity of oncology nurses to provide psychosocial care for advanced cancer patients and its application to nursing practice merits further investigation.
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Affiliation(s)
- Merel van Klinken
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Emma Hafkamp
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Sarah Hales
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Anne Lanceley
- EGA Institute for Women's Health, Dept of Women's Cancer, University College London, London
| | - Gary Rodin
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Christian Schulz-Quach
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Froukje de Vries
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada; and Department of Psychiatry, Netherlands Cancer Institute, Amsterdam, the Netherlands
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van Klinken M. Palliative and End-of-Life Care: Challenges for Patients and Nurses. Semin Oncol Nurs 2023; 39:151527. [PMID: 37953089 DOI: 10.1016/j.soncn.2023.151527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023]
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The Acknowledge-Normalize-Partner (ANP) Framework: A novel empathic communication tool for oncology nurses. Palliat Support Care 2023; 21:12-19. [PMID: 35236541 DOI: 10.1017/s1478951522000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the development and implementation of a novel tool designed to enhance nurse-patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience. METHOD An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires. RESULTS Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001). SIGNIFICANCE OF RESULTS Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.
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Kirkpatrick AJ, Donesky D, Kitko LA. A Systematic Review of Interprofessional Palliative Care Education Programs. J Pain Symptom Manage 2023; 65:e439-e466. [PMID: 36736863 DOI: 10.1016/j.jpainsymman.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/08/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
CONTEXT Interprofessional education (IPE) involving palliative and end-of-life content benefits learners by addressing interprofessional and palliative care (PC) competency needs. OBJECTIVES A synthesis of educational approaches promoting interprofessional PC in academic and clinical settings would address research gaps and promote effective teaching. METHODS A systematic review of interprofessional PC educational studies was conducted to summarize current approaches in PC IPE and to appraise teaching and research methods. Characteristics of excellence in interprofessional PC education established by Donesky et al. served as a framework for evaluating studies in this systematic review. RESULTS A total of 39 articles met inclusion criteria for this review. Learners from medicine and nursing were the most included professions. University programs represented most studies, and evaluation methods demonstrated achievement of mostly self-reported outcomes like learner attitude and self-efficacy. While the effect of interprofessional collaboration on patient outcomes is well-documented, the effect of IPE on PC delivery is not. Although content spanned all interprofessional and PC domains, few studies addressed cultural aspects and fewer addressed well-being for the care provider. CONCLUSION In light of the current healthcare landscape, there is an imminent need to address culture and provider well-being more directly through interprofessional PC education. Education and research must also move beyond university programs into health systems to support the professional development of clinicians for systems integration, sustainability, and impact on patient outcomes. Future evaluation of interprofessional PC education would be strengthened by multisite studies, randomized controlled trials, and repeated measures looking at outcomes over time.
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Affiliation(s)
| | - DorAnne Donesky
- Clinical Nursing-Emeritus (D.D.), University of California, San Francisco, California, USA
| | - Lisa A Kitko
- School of Nursing (L.A.K.), University of Rochester, University of Rochester Medical Center, Rochester, New York, USA
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Seow H, Bainbridge D, Winemaker S, Stajduhar K, Pond G, Kortes-Miller K, Marshall D, Kilbertus F, Myers J, Steinberg L, Incardona N, Levine O, Pereira J. Increasing palliative care capacity in primary care: study protocol of a cluster randomized controlled trial of the CAPACITI training program. BMC Palliat Care 2023; 22:2. [PMID: 36604714 PMCID: PMC9813458 DOI: 10.1186/s12904-022-01124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Primary care providers play a critical role in providing early palliative care to their patients. Despite the availability of clinical education on best practices in palliative care, primary care providers often lack practical guidance to help them operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to provide an early palliative approach to care. The entire program consists of 12 sessions (1 h each), divided evenly across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Coordinate for Ongoing Care. We report the protocol for our planned evaluation of CAPACITI on its effectiveness in helping primary care providers increase their identification of patients requiring a palliative approach to care and to strengthen other core competencies. METHODS A cluster randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning, consisting of online access to program materials; and 2) facilitated learning, which also includes live webinars where the online materials are presented and discussed. The primary outcomes are 1) percent of patients identified as requiring palliative care (PC), 2) timing of first initiation of PC, and self-reported PC competency (EPCS tool). Secondary outcomes include self-reported confidence in PC, practice change, and team collaboration (AITCS-II tool), as well as qualitative interviews. Covariates that will be examined are readiness for change (ORCA tool), learning preference, and team size. Primary care teams representing interdisciplinary providers, including physicians, nurse practitioners, registered nurses, care coordinators, and allied health professionals will be recruited from across Canada. The completion of all three modules is expected to take participating teams a total of six months. DISCUSSION CAPACITI is a national trial aimed at behavior change in primary care providers. This research will help inform future palliative care educational initiatives for generalist health care providers. Specifically, our findings will examine the effectiveness of the two models of education delivery and the participant experience associated with each modality. TRIAL REGISTRATION ClinicalTrials.gov NCT05120154.
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Affiliation(s)
- Hsien Seow
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Daryl Bainbridge
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Samantha Winemaker
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Kelli Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, BC Canada
| | - Gregory Pond
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Kathy Kortes-Miller
- grid.258900.60000 0001 0687 7127Department of Social Work, Lakehead University, Thunder Bay, ON Canada
| | - Denise Marshall
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Frances Kilbertus
- grid.436533.40000 0000 8658 0974Northern Ontario School of Medicine University, Thunder Bay, ON Canada
| | - Jeff Myers
- grid.17063.330000 0001 2157 2938Division of Palliative Care, University of Toronto, Toronto, ON Canada
| | - Leah Steinberg
- grid.17063.330000 0001 2157 2938Division of Palliative Care, University of Toronto, Toronto, ON Canada
| | - Nadia Incardona
- grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Oren Levine
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Jose Pereira
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, Hamilton, ON Canada
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Teng X, Tang M, Jing L, Xu Y, Shu Z. Healthcare Provider Knowledge, Attitudes, and Practices in Hospice Care and Their Influencing Factors: A Cross-sectional Study in Shanghai. Int J Health Policy Manag 2022; 11:3090-3100. [PMID: 35988031 PMCID: PMC10105208 DOI: 10.34172/ijhpm.2022.6525] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In 2017, the Chinese government launched a pilot project in hospice care (HC), in which Shanghai was a pioneer. Healthcare provider knowledge, attitudes, and practices in hospice care (KAPHC) may facilitate or hinder HC development. To determine how to design targeted training for healthcare providers and policies to improve their KAPHC, we conducted an original study based on an indigenized KAPHC scale to (a) comprehensively measure the KAPHC baseline of healthcare providers in Shanghai and (b) explore its influencing factors. METHODS A cross-sectional study was designed to evaluate healthcare providers' KAPHC with the indigenized KAPHC scale. Descriptive analysis, linear regression, and Pearson's (r) correlation analysis were performed to uncover providers' KAPHC, its influencing factors, and their correlations. RESULTS The KAPHC scale proved applicable to the knowledge, attitudes, and practices of the large sample of providers we surveyed. The 7027 KAPHC scaling results revealed that 42.44% of participants had HC experience and 57.49% were willing to provide HC. The mean accuracy of the responses related to knowledge was 59.30%. Scoring rates for attitudes, confidence, and self-reported practices were 74.20%, 73.96%, and 75.55%, respectively. The linear regression revealed that higher KAPHC scores were associated with experience and willingness and varied with professional specializations. The Pearson's (r) correlation evidenced that HC practices were strongly correlated with confidence (r = 0.648, P<.001) and moderately correlated with attitudes (r = 0.463, P<.001). CONCLUSION We uncovered that targeted training for enhancing healthcare provider KAPHC in Shanghai should focus on psychological and spiritual care, the management of pain and other symptoms, and traditional Chinese medicine (TCM). Additionally, training should be scaled up for providers with different characteristics. Meanwhile, policy should encourage providers to work enthusiastically in HC-universal high-quality HC requires well-trained, supported, and motivated providers.
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Affiliation(s)
- Xiaohan Teng
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maocheng Tang
- Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiqun Shu
- Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Seow H, Bainbridge D, Stajduhar K, Marshall D, Howard M, Brouwers M, Barwich D, Burge F, Kelley ML. Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program. Am J Hosp Palliat Care 2022:10499091221134709. [PMID: 36269212 DOI: 10.1177/10499091221134709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Kelli Stajduhar
- Department of School of Nursing and Institute on Aging and Lifelong Health, 8205University of Victoria, Victoria, BC, Canada
| | - Denise Marshall
- Department of Health Sciences, 62703McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, 177403University of Ottawa, Ottawa, ON, Canada
| | - Doris Barwich
- 12358The University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, 152980Dalhousie University, Halifax, NS, Canada
| | - Mary Lou Kelley
- School of Social Work, 157782Lakehead University, Thunder Bay, ON, Canada
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Parry M, Jones B, Churcher C. End-of-life simulation: a cross-field evaluation in an undergraduate nursing programme. Int J Palliat Nurs 2022; 28:388-395. [PMID: 36006791 DOI: 10.12968/ijpn.2022.28.8.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Death can cause a great deal of anxiety in nursing students for a variety of reasons. They are expected to provide a high level of care for patients, give the family the respect and patience they deserve and contend with the associated emotional attachments. This raised the question in today's educational world-can the use of technology and simulation aid students in preparing for an end-of-life scenario as part of an undergraduate nursing programme? AIM To explore the efficacy of the use of simulations in end-of-life care. METHOD A small study focusing upon the evaluation of an end-of-life simulated scenario for undergraduate second year cross-field Bachelor of Nursing students in a university setting. The simulated scenario consisted of a young patient who was dying and her mother. This project used a mixed approach to address varied students' learning styles and combined the need for visualisation and more structured base-sessions on the topic of death and end-of-life care. One student from the cohort group was randomly assigned as the nurse in charge, while other students were allocated to a scenario (out of a potential four) and provided care in real time. Subsequently, the impact of the scenario was assessed and students were immediately debriefed. Students' response to the scenario was important and needed to be considered, as it directly influenced the debriefing. There were some significant differences between how the students approached the scenario and their reaction to it. RESULTS Of the students who took part in the end-of-life simulated scenario, the majority strongly agreed that the simulation increased their clinical reasoning and learning. CONCLUSION The end-of-life scenario was deemed beneficial, despite the emotional impact on the learners involved.
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Affiliation(s)
- Maria Parry
- Academic Manager, Undergraduate Nursing Programme, University of South Wales, Wales
| | - Bridie Jones
- Academic Subject Manager, Head of Post Registration Provision, University of South Wales, Wales
| | - Clare Churcher
- Senior Lecturer; Course Leader Post Graduate Certificate Palliative Care, University of South Wales, Wales
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Cao W, Li C, Zhang Q, Tong H. Perceptions on the current content and pedagogical approaches used in end-of-life care education among undergraduate nursing students: a qualitative, descriptive study. BMC MEDICAL EDUCATION 2022; 22:553. [PMID: 35842629 PMCID: PMC9288025 DOI: 10.1186/s12909-022-03625-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With the aging of the population, high rates of cancer and comorbidity complexity, the end-of-life care for patients will be ever more important. Nurses have always played an essential role in end-of-life care. Insufficient education and training in end-of-life care has been regarded as a major reason of inadequate symptom recognition, symptom management, and communication which results in mental trauma for both the patient's family and attending health care providers. Undergraduate nurses do end-of-life care as part of their clinical learning. However, undergraduate nurses' perceptions of the education they received about end-of-life care are not documented. OBJECTIVE This study aimed to critically explore the current state of education regarding end-of-life care from the perspectives of undergraduate nurses. METHODS We used a descriptive qualitative design. Face-to-face semi-structured interviews were conducted from May to August 2020, with a purposive sample of 15 fourth-year undergraduate nurses who finished the internship. Data were transcribed verbatim and analyzed using content analysis. FINDINGS Three main themes relating to undergraduate nurses' experiences of end-of-life care education emerged from the thematic analysis: 1) Universities provide foundational knowledge about end-of-life care, but it still needs improvement; 2) Clinical practice consolidates and drives undergraduate nurses' knowledge, skills and confidence about end-of-life care; and 3) cultural attitudes of patients' family toward disease and death sometimes impedes learning and knowledge translation about end-of-life care. CONCLUSION Undergraduate nursing students benefit from not only theoretical content delivered in the university setting but also practice happened on clinical placement. The current undergraduate curriculum, related to end-of-life care, is disjointed. Meanwhile, undergraduate nurses' learning and knowledge translation of end-of-life care are impeded by cultural attitudes toward disease and death.
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Affiliation(s)
- Wenjing Cao
- Nursing School, Xiangnan University, Chenzhou, Hunan, China
| | - Chunyan Li
- Nursing School, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Qianqian Zhang
- Nursing School, Xiangnan University, Chenzhou, Hunan, China
| | - Huiru Tong
- Foreign Language Department, Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
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Abu-Odah H, Molassiotis A, Liu J. Lessons Learned from Countries That Have Introduced Palliative Care Services into Their National Health System: A Narrative Review. J Palliat Care 2021; 37:55-66. [PMID: 33525947 DOI: 10.1177/0825859721989557] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This review aims at gaining a broad overview of national approaches about Palliative care (PC) implementation into health care systems in countries that have PC identified within their national policies and strategies. METHODS Paper searching was conducted using both peer-reviewed databases and gray literature sources covering governmental reports with PC strategies from 2000 onward. Articles published in English that cited at least 1 category of the WHO's public health PC model were included. Qualitative content analysis was used for data analysis and synthesis of findings. RESULTS Thirteen reports met the inclusion criteria. Education and appropriate policies were the most frequent strategies covered by all countries included. Under education; information about training health care providers was needed for the effective introduction of a PC program. Reviewing standards of care required to deliver PC effectively, and financial support for PC service development were considered the central policies needed. Furthermore, partnerships and collaborations across the health systems as well as providing care based on patients' needs were required for the provision of a PC program. CONCLUSION It is of the essence to learn from countries demonstrating enhanced PC practices before the implementation of a new PC program in a given country. Such practices could be used as a guide and to address barriers that may hinder the development of PC at a national level. Best practices can be achieved by focusing on educational and policy-based strategies through identifying patients' needs, assessing general public awareness, health care providers' knowledge and training as well as incorporating stakeholders' perspectives.
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Affiliation(s)
- Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Justina Liu
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Thavaraj A, Gillett K. Does post-registration palliative care education for nurses improve practice? A systematic review. Int J Palliat Nurs 2020; 25:552-564. [PMID: 31755829 DOI: 10.12968/ijpn.2019.25.11.552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS We aimed to answer the question: what is the evidence that post-registration palliative care education for nurses improves practice? BACKGROUND The 2008 End of Life Care Strategy emphasised the need for a workforce equipped to provide high-quality end-of-life care for patients and their families. As registered nurses are the healthcare professionals spending most time with patients and families at the end of life, associated policy documents stress the importance of educating nurses to equip them with the necessary knowledge and skills to provide effective care. Despite education being a consistent recommendation, the ability of education to influence nursing practice is uncertain. METHODS We undertook a systematic review of literature using Joanna Briggs Institute Methodology for Mixed Methods by searching the Medline, Embase and CINAHL databases between January 2006 and December 2018. FINDINGS Ten studies met the inclusion criteria, seven contained quantitative data. Six demonstrated improvements in outcome measures, but not all results were statistically significant. Most quantitative data related to self-reported measures of confidence. Six studies contained qualitative findings that were categorised into themes: confidence, practice change, skills and proactivity. CONCLUSION Little research exists exploring the impact of post-registration palliative care education for nurses. Existing outcome measures do not clearly demonstrate changes to end-of-life practice. Research is suggested to establish links between self-reported confidence and improvements to practice. Evaluation of the impact on practice should be an integral component of end-of-life education initiatives.
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Affiliation(s)
| | - Karen Gillett
- Lecturer, King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London
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14
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Abstract
Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between-subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care.
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15
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Downar J. Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care. J Palliat Med 2020; 21:S57-S62. [PMID: 29283871 DOI: 10.1089/jpm.2017.0396] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care. Fourth, two palliative care competency areas in particular can be readily taught: symptom management and communication skill (e.g., breaking bad news and advance care planning). Fifth, palliative care educational interventions are undermined by the "hidden curriculum" in medical education; interventions must be accompanied by continuing education and faculty development to create lasting change in physician behavior. Sixth, undergraduate and postgraduate medical training is shifting from a time-based training paradigm to competency-based training and evaluation. Seventh, virtually every physician in Canada should be able to provide basic palliative care; physicians in specialized areas of practice should receive palliative care education that is tailored to their area, rather than generic educational interventions. For each key message, one or more implications are provided, which can serve as recommendations for a framework to improve palliative care as a whole in Canada.
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Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Family and Community Medicine and Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto , Toronto, Ontario, Canada
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16
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Williams BR, Bailey FA, Goode PS, Kvale EA, Slay LA, Bakitas MA, Burgio KL. "Online Training Is Great but Human Interaction Is Better": Training Preferences of VA Interdisciplinary Palliative Care Consult Teams. Am J Hosp Palliat Care 2020; 37:800-808. [PMID: 32122166 DOI: 10.1177/1049909120907599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating in either a multisite webinar or a small group, in-person workshop. We interviewed participants by telephone seven to eight month post-training. In all, 75.9% preferred in-person education and training, including 78.9% of workshop participants and 73.1% of webinar participants. Respondents described in-person training as fostering learning through the following processes: (1) active engagement and focus, (2) interaction and networking, (3) meaning-making and relevance, and (4) reciprocity and commitment. Although it is not possible for Web-based palliative care education programs to replicate all aspects of the in-person learning experience, building experiential, interactive, meaningful, and reciprocal components into Web-based education may help shift preferences and make interdisciplinary team-based palliative care education accessible to a larger audience.
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Affiliation(s)
- Beverly Rosa Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Amos Bailey
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Denver Health Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Patricia S Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Kvale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Laurie A Slay
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie A Bakitas
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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17
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Rowlands G, Tabassum B, Campbell P, Harvey S, Vaittinen A, Stobbart L, Thomson R, Wardle-McLeish M, Protheroe J. The Evidence-Based Development of an Intervention to Improve Clinical Health Literacy Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1513. [PMID: 32111050 PMCID: PMC7084414 DOI: 10.3390/ijerph17051513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
Low health literacy is an issue with high prevalence in the UK and internationally. It has a social gradient with higher prevalence in lower social groups and is linked with higher rates of long-term health conditions, lower self-rated health, and greater difficulty self-managing long-term health conditions. Improved medical services and practitioner awareness of a patient's health literacy can help to address these issues. An intervention was developed to improve General Practitioner and Practice Nurse health literacy skills and practice. A feasibility study was undertaken to examine and improve the elements of the intervention. The intervention had two parts: educating primary care doctors and nurses about identifying and enhancing health literacy (patient capacity to get hold of, understand and apply information for health) to improve their health literacy practice, and implementation of on-screen 'pop-up' notifications that alerted General Practitioners (GPs) and nurses when seeing a patient at risk of low health literacy. Rapid reviews of the literature were undertaken to optimise the intervention. Four General Practices were recruited, and the intervention was then applied to doctors and nurses through training followed by alerts via the practice clinical IT system. After the intervention, focus groups were held with participating practitioners and a patient and carer group to further develop the intervention. The rapid literature reviews identified (i) key elements for effectiveness of doctors and nurse training including multi-component training, role-play, learner reflection, and identification of barriers to changing practice and (ii) key elements for effectiveness of alerts on clinical computer systems including 'stand-alone' notification, automatically generated and prominent display of advice, linkage with practitioner education, and use of notifications within a targeted environment. The findings from the post-hoc focus groups indicated that practitioner awareness and skills had improved as a result of the training and that the clinical alerts reminded them to incorporate this into their clinical practice. Suggested improvements to the training included more information on health literacy and how the clinical alerts were generated, and more practical role playing including initiating discussions on health literacy with patients. It was suggested that the wording of the clinical alert be improved to emphasise its purpose in improving practitioner skills. The feasibility study improved the intervention, increasing its potential usefulness and acceptability in clinical practice. Future studies will explore the impact on clinical care through a pilot and a randomised controlled trial.
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Affiliation(s)
- Gill Rowlands
- Population Health Sciences Institute, Baddiley Clark Buildig, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (B.T.); (A.V.); (L.S.); (R.T.)
| | - Bimasal Tabassum
- Population Health Sciences Institute, Baddiley Clark Buildig, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (B.T.); (A.V.); (L.S.); (R.T.)
| | - Paul Campbell
- Faculty of Medicine and Health Sciences, Keele University, Staffordshire ST5 5BG, UK; (P.C.); (J.P.)
| | - Sandy Harvey
- Patient Research Ambassador, (North East and North Cumbria) and Voice Research Advisor, Voice, Newcastle upon Tyne NE1 4BF, UK
| | - Anu Vaittinen
- Population Health Sciences Institute, Baddiley Clark Buildig, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (B.T.); (A.V.); (L.S.); (R.T.)
| | - Lynne Stobbart
- Population Health Sciences Institute, Baddiley Clark Buildig, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (B.T.); (A.V.); (L.S.); (R.T.)
| | - Richard Thomson
- Population Health Sciences Institute, Baddiley Clark Buildig, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (B.T.); (A.V.); (L.S.); (R.T.)
| | - Mandy Wardle-McLeish
- Community Health and Learning Foundation, currently Reaching People, 15 Wellington Street, Leicester LE1 6HH, UK;
| | - Joanne Protheroe
- Faculty of Medicine and Health Sciences, Keele University, Staffordshire ST5 5BG, UK; (P.C.); (J.P.)
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18
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Early integration of palliative care in a long-term care home: A telemedicine feasibility pilot study. Palliat Support Care 2020; 18:460-467. [DOI: 10.1017/s1478951520000012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePalliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences.MethodThis was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys.ResultsFor the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021).Significance of resultsThe results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.
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19
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The Development of a Digital Dysphagia Guide with Care Homes: Co-Production and Evaluation of a Nutrition Support Tool. Geriatrics (Basel) 2019; 4:geriatrics4030048. [PMID: 31443170 PMCID: PMC6787745 DOI: 10.3390/geriatrics4030048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/25/2019] [Accepted: 08/09/2019] [Indexed: 12/03/2022] Open
Abstract
Good nutrition is a recognised outcome in the health and well-being of older care home residents and dysphagia is a known risk factor associated with under nutrition and poor outcomes. The study co-produced a digital Dysphagia Guide with Care Homes using a consensus method with interviews and focus groups to prioritise the need for information and explore acceptability of an educational tool for care home workers. Evaluation of use, acceptability of design, and content of the guide were completed via remote monitoring. The workforce prioritised the need for training as well as the knowledge and skills in relation to planning resident-centred care and advice on textured diets. The technology was a means of offering ‘bite-size’ learning to enhance planning for nutrition across the whole organisation including managers, kitchen staff, and care workers. The Guide to Dysphagia was produced on a tablet and piloted in four care homes over 12 weeks, by 57 staff. Integrated analytics allowed user activity to be monitored. Findings showed that 73% of respondents reported the guide helped them in their job. Additionally, 88% of respondents stated they would recommend the guide to other staff, with 90% reporting it was easy to use. Engagement with staff and managers in four homes resulted in a co-designed, dysphagia guide.
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20
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Pruskowski J, Patel R, Brazeau G. The Need for Palliative Care in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7410. [PMID: 31333268 PMCID: PMC6630864 DOI: 10.5688/ajpe7410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/28/2019] [Indexed: 06/10/2023]
Abstract
There is a growing need for palliative care pharmacists in the United States. There is also a gap in the education of palliative care for pharmacy students. To address both, pharmacy schools must develop and disseminate palliative care-focused experiences, including traditional didactic lectures, problem-based learning, interactive skills, laboratory- and web-based experiences. This commentary presents the need for palliative care-focused experiences in the Doctor of Pharmacy (PharmD) degree program, and how schools can take smaller steps to tackle this issue.
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Affiliation(s)
| | - Ravi Patel
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Gayle Brazeau
- Marshall University, Huntington, West Virginia
- Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
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21
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Jones B, Parry M. The rationale for making a short DVD in relation to the last offices procedure. Int J Palliat Nurs 2019; 25:91-97. [DOI: 10.12968/ijpn.2019.25.2.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: This article outlines the rationale of developing a DVD using a simulated patient to show students how to perform the last offices in the UK and what they can expect when a patient dies. Aim: This is an aspect of the curriculum that students felt was not adequately covered and they were anxious about experiencing the death of a patient for the first time. The DVD allowed a large number of students to receive extra teaching on this topic and was a time-effective way of introducing more teaching into the curriculum. Conclusion: Students felt more prepared for the death of a patient during their first clinical placement.
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Affiliation(s)
- Bridie Jones
- Academic Manager Bachelor of Nursing Course Leader, Faculty of Life Science and Education
| | - Maria Parry
- Academic Subject Manager Professional Practice and Development, Faculty of Life Science and Education
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22
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Jack BA, Kinloch K, O'Brien MR. Teaching nurses to teach: A qualitative study of nurses' perceptions of the impact of education and skills training to prepare them to teach end-of-life care. J Clin Nurs 2019; 28:1819-1828. [PMID: 30667584 PMCID: PMC7328783 DOI: 10.1111/jocn.14786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/17/2018] [Accepted: 11/03/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore nurses' perceptions of the impact of a programme designed to train them to teach end-of-life care. BACKGROUND Central to national and international policies are the need for generalist healthcare staff to have education in end-of-life care. Much end-of-life care education is provided by specialist nurses who often have no specific education development to prepare them to teach. To address this gap, an Education Development Programme (EDP) was developed and delivered to specialist nurses. We report on the evaluation of the programme. DESIGN A qualitative programme evaluation methodology was adopted. METHODS Data were collected through focus groups, at three hospice education centres in North West England, with a total of 20 participants. Nurses who had completed the EDP were purposively sampled. Data were digitally audio-recorded and subjected to thematic analysis to organise, reduce and refine the data. Ethical approval was obtained. COREQ guidelines have been adhered to in the reporting of this study. RESULTS Two main themes were identified; learning to teach and building skills to change teaching practice. Participants felt more confident and better prepared to teach. CONCLUSIONS It cannot be assumed that specialist staff, with teaching in their role, have the skills to facilitate learning. This programme offers a potential method of improving facilitation skills for nurses who have an education element to their role. RELEVANCE TO CLINICAL PRACTICE Quality end-of-life care is only possible with a skilled workforce, confident and able to apply the principles of compassionate end-of-life care to everyday practice. Appropriately trained, specialist staff are better able to teach others how to deliver good quality end-of-life care. Specialist staff with teaching responsibilities should be provided with, or engage in, continuous professional development to develop their skills and improve their efficacy when teaching.
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Affiliation(s)
- Barbara A Jack
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Lancashire, UK.,Post-Graduate Medical Institute, Edge Hill University, Lancashire, UK
| | - Karen Kinloch
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Lancashire, UK
| | - Mary R O'Brien
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Lancashire, UK.,Research and Innovation, Faculty of Health and Social Care, Edge Hill University, Lancashire, UK
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Teixeira MJC, Alvarelhão J, Souza D, Teixeira HJC, Abreu W, Costa N, Machado FAB. Healthcare professionals and volunteers education in palliative care to promote the best practice–an integrative review. Scand J Caring Sci 2019; 33:311-328. [DOI: 10.1111/scs.12651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/12/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Maria João C. Teixeira
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care Cicely Saunders Institute Kings College of London London UK
| | | | - Dayse Souza
- Centro Universitário Adventist – UNASP São Paulo Brazil
- Research Centre ‘Didactic and Technology in the Education of Educators (CIDTFF/UA) Aveiro Portugal
| | | | - Wilson Abreu
- School of Nursing & Research Centre Centre for Health Technology and Services Research/ESEP –CINTESIS Porto Portugal
| | - Nilza Costa
- University of Aveiro – Research Centre ‘Didactic and Technology in the Education of Educators/CIDTFF’ Aveiro Portugal
| | - Flávia A. B. Machado
- University of Aveiro – Research Centre ‘Didactic and Technology in the Education of Educators/CIDTFF’ Aveiro Portugal
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A Network Approach to Neonatal Palliative Care Education: Impact on Knowledge, Efficacy, and Clinical Practice. J Perinat Neonatal Nurs 2019; 33:350-360. [PMID: 31651629 DOI: 10.1097/jpn.0000000000000437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than 80 000 babies are admitted to specialist neonatal units in the United Kingdom every year, with approximately 2109 neonatal deaths a year; 98% in hospital. A common element in guidance and pathways to facilitate the provision of palliative care to infants and their families is the importance of good education and training to develop high-quality staff and services. This article presents a mixed-methods, sequential, explanatory design evaluation of 1 day palliative care education workshops delivered using a network-wide approach to multidisciplinary professionals. Workshops were delivered by healthcare professionals and bereaved parents and evaluated using questionnaires, adapted for neonatal staff from standardized measures, and follow-up interviews. The workshop content and shared learning approach resulted in significant improvements in participant's knowledge, attitude, self-beliefs and confidence in neonatal palliative care, enhanced awareness of services, and improved links between professionals. Participants cascaded their learning to their teams and provided examples of changes in their clinical practice following the workshop. Parent stories were identified as a very powerful component of the training, with lasting impact on participants. Formal, integrated palliative care education programs for perinatal and neonatal staff and longitudinal research into the impact on practice and the experience received by families are needed.
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Hutchinson C, Tieman J, Devery K. Evaluation of a toolkit resource package to support positive workplace behaviours in relation to quality end-of-life care in Australian hospitals. BMJ Open Qual 2018; 7:e000286. [PMID: 30515465 PMCID: PMC6231109 DOI: 10.1136/bmjoq-2017-000286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 11/05/2022] Open
Abstract
Background The study aimed to determine the effectiveness of an action-orientated toolkit in supporting behaviour change in relation to quality end-of-life care in acute hospital settings. The toolkit was developed to complement a programme of online end-of-life care education. Methods A toolkit was developed from an international review of peer-reviewed literature on end of life. Toolkits were distributed (n=428) to Australian healthcare professionals over a 4-week period. An online survey was sent to all recipients; 65 responses were received (16% response rate, excluding emails returned as undeliverable). Semistructured interviews (n=10) were conducted using purposeful sampling to ensure a range of views were captured. The focus of the evaluation was on investigating (1) users’ responses to the toolkit and (2) individuals’ reported behaviour change. Findings The toolkit was well received by users who reported increased confidence in communication around end-of-life matters. 59.3% of users reported making a behaviour change over the previous 4 weeks; 70.8% of those who had not made a change reported they intended to in the near future. Against expectation, the toolkit’s appeal went beyond its intended audience in acute hospital settings, for example, personal care workers in aged care settings. Conclusions Despite study limitations (self-report of a small, self-selected sample), these early findings suggest that the toolkit has potential to positively impact on end-of-life care practices. However, additional evaluation is needed to determine whether such a toolkit can positively impact on practice and on patient experience at the end of life.
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Affiliation(s)
- Claire Hutchinson
- Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia
| | - Jennifer Tieman
- Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia
| | - Kim Devery
- Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia
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Abstract
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.
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Affiliation(s)
- Sue Griffith
- Education Co-ordinator, Farleigh Hospice, Chelmsford, UK
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27
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Miller-Lewis L, Tieman J, Rawlings D, Parker D, Sanderson C. Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:242-271. [DOI: 10.1177/0030222818765813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A Massive Open Online Course, Dying2Learn, was designed to foster community death conversations and strengthen community awareness of palliative care and death as a normal process. This exploratory study used a pre–post prospective design to determine if participation in Dying2Learn and exposure to online conversations about death and dying resulted in any significant influence on death competence in 134 participants who completed the Coping-with-Death-Scale both at the beginning and end of the course in 2016. Death competence refers to a range of attitudes and capabilities people have for dealing with death. Results at the end of the course indicated that engagement in Dying2Learn led to significant improvements in death competence scores over time (medium-to-large effect size). The positive impact was greater for those who completed more of the course, and effectiveness did not depend on sociodemographic characteristics. In conclusion, this study found that an online learning platform in the form of a Massive Open Online Course could engage community members in meaningful social discussion about death and dying, and that exposure to these conversations was beneficial for all participants regardless of previous exposure to death. Further exploration is required to determine whether this change in death competence will have an impact on participant’s behavior in the community regarding death conversations and preparedness.
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Affiliation(s)
- Lauren Miller-Lewis
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Jennifer Tieman
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deb Rawlings
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Christine Sanderson
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Palliative Medicine, Calvary Health Care Kogarah, NSW, Australia
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Riotte CO, Kukora SK, Keefer PM, Firn JI. Identifying the Types of Support Needed by Interprofessional Teams Providing Pediatric End-of-Life Care: A Thematic Analysis. J Palliat Med 2017; 21:422-427. [PMID: 29027835 DOI: 10.1089/jpm.2017.0331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the number of interprofessional team members caring for children at the end of life, little evidence exists on how institutions can support their staff in providing care in these situations. OBJECTIVE We sought to evaluate which aspects of the hospital work environment were most helpful for multidisciplinary team members who care for patients at the end of life and identify areas for improvement to better address staff needs. DESIGN Qualitative thematic analysis was completed of free-text comments from a survey distributed to interprofessional staff members involved in the care of a recently deceased pediatric patient. A total of 2701 surveys were sent; 890 completed. Free-text responses were provided by 306 interprofessional team members. SETTING/SUBJECTS Interprofessional team members involved in the care of a child who died at a 348 bed academic children's hospital in the Midwestern United States. MEASUREMENTS Realist thematic analysis of free-text responses was completed in Dedoose using a deductive and inductive approach with line-by-line coding. Descriptive statistics of demographic information was completed using Excel. RESULTS Thematic analysis of the 306 free-text responses identified three main support-related themes. Interprofessional team members desire to have (1) support through educational efforts such as workshops, (2) support from colleagues, and (3) support through institutional practices. CONCLUSIONS Providers who participate in end-of-life work benefit from ongoing support through education, interpersonal relationships, and institutional practices. Addressing these areas from an interprofessional perspective enables staff to provide the optimal care for patients, patients' families, and themselves.
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Affiliation(s)
- Clare O Riotte
- 1 Pain and Palliative Medicine, Connecticut Children's Medical Center , Hartford, Connecticut
| | - Stephanie K Kukora
- 2 Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital and Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan.,3 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan
| | - Patricia M Keefer
- 4 Pediatric Palliative Care Program, C.S. Mott Children's Hospital and Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
| | - Janice I Firn
- 3 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan.,5 Division of Geriatric and Palliative Medicine, Department of Internal Medicine , Michigan Medicine, Ann Arbor, Michigan
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Surr CA, Gates C, Irving D, Oyebode J, Smith SJ, Parveen S, Drury M, Dennison A. Effective Dementia Education and Training for the Health and Social Care Workforce: A Systematic Review of the Literature. REVIEW OF EDUCATIONAL RESEARCH 2017; 87:966-1002. [PMID: 28989194 PMCID: PMC5613811 DOI: 10.3102/0034654317723305] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ensuring an informed and effective dementia workforce is of international concern; however, there remains limited understanding of how this can be achieved. This review aimed to identify features of effective dementia educational programs. Critical interpretive synthesis underpinned by Kirkpatrick's return on investment model was applied. One hundred and fifty-two papers of variable quality were included. Common features of more efficacious educational programs included the need for educational programs to be relevant to participants' role and experience, involve active face-to-face participation, underpin practice-based learning with theory, be delivered by an experienced facilitator, have a total duration of at least 8 hours with individual sessions of 90 minutes or more, support application of learning in practice, and provide a structured tool or guideline to guide care practice. Further robust research is required to develop the evidence base; however, the findings of this review have relevance for all working in workforce education.
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Brighton LJ, Koffman J, Robinson V, Khan SA, George R, Burman R, Selman LE. 'End of life could be on any ward really': A qualitative study of hospital volunteers' end-of-life care training needs and learning preferences. Palliat Med 2017; 31:842-852. [PMID: 28056642 PMCID: PMC5613806 DOI: 10.1177/0269216316679929] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. AIMS To explore hospital volunteers' end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. DESIGN Qualitative focus groups. SETTING/PARTICIPANTS Volunteers from a large teaching hospital were purposively sampled. RESULTS Five focus groups were conducted with 25 hospital volunteers (aged 19-80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to 'refresh' training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. CONCLUSION Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals.
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Affiliation(s)
- Lisa Jane Brighton
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | - Jonathan Koffman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | - Vicky Robinson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | | | - Rob George
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,2 Guy's and St Thomas' NHS Foundation Trust, London, UK.,3 St Christopher's Hospice, London, UK
| | - Rachel Burman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,4 King's College Hospital NHS Foundation Trust, London, UK
| | - Lucy Ellen Selman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,5 Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Brighton LJ, Koffman J, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Higginson IJ, Selman LE. A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance. J Pain Symptom Manage 2017; 54:417-425. [PMID: 28782701 DOI: 10.1016/j.jpainsymman.2017.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/17/2017] [Accepted: 04/12/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. OBJECTIVES To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. METHODS Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. RESULTS From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: <30% were controlled, <15% randomized participants. Over half (n = 85) relied on staff self-reported outcomes to assess effectiveness, and 49% did not cite psychometrically validated measures. Key information (e.g., training duration, participant flow) was poorly reported. CONCLUSIONS Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing.
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Affiliation(s)
- Lisa Jane Brighton
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
| | - Jonathan Koffman
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, UK; Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Christine McDonald
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Suzanne O'Brien
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Vicky Robinson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | | | - Rob George
- Guy's and St Thomas' NHS Foundation Trust, London, UK; St Christopher's Hospice, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Lucy Ellen Selman
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK; Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Selman LE, Brighton LJ, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Ramsenthaler C, Higginson IJ, Koffman J. The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis. J Pain Symptom Manage 2017; 54:404-416.e5. [PMID: 28778560 DOI: 10.1016/j.jpainsymman.2017.04.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023]
Abstract
CONTEXT As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. OBJECTIVES To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviors. METHODS Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS, and OpenGrey) plus hand searching. Randomized controlled trials of training interventions intended to enhance generalists' communication skills in end-of-life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random-effects model. PRISMA guidelines were followed. RESULTS Nineteen of 11,441 articles were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n = 3144, trainees n = 791). Meta-analysis showed no effect on patient outcomes (standardized mean difference [SMD] = 0.10, 95% CI -0.05 to 0.24) and high levels of heterogeneity (chi-square = 21.32, degrees of freedom [df] = 7, P = 0.003; I2 = 67%). The effect on trainee behaviors in simulated interactions (SMD = 0.50, 95% CI 0.19-0.81) was greater than in real patient interactions (SMD = 0.21, 95% CI -0.01 to 0.43) with moderate heterogeneity (chi-square = 8.90, df = 5, P = 0.11; I2 = 44%; chi-square = 5.96, df = 3, P = 0.11; I2 = 50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalized feedback on recorded interactions. CONCLUSIONS The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalized feedback on recorded patient interactions may be beneficial. REGISTRATION NUMBER CRD42014014777.
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Affiliation(s)
- Lucy Ellen Selman
- King's College London, Cicely Saunders Institute, London, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, United Kingdom; Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom
| | - Christine McDonald
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Suzanne O'Brien
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Vicky Robinson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Shaheen A Khan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rob George
- King's College London, Cicely Saunders Institute, London, United Kingdom; St Christopher's Hospice, London, United Kingdom
| | | | - Irene J Higginson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute, London, United Kingdom
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Palliative care education in Latin America: A systematic review of training programs for healthcare professionals. Palliat Support Care 2017; 16:107-117. [DOI: 10.1017/s147895151700061x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:The integration of palliative care (PC) education into medical and nursing curricula has been identified as an international priority. PC education has undergone significant development in Latin America, but gaps in the integration of PC courses into undergraduate and postgraduate curricula remain. The aim of our review was to systematically examine the delivery of PC education in Latin America in order to explore the content and method of delivery of current PC programs, identify gaps in the availability of education opportunities, and document common barriers encountered in the course of their implementation.Method:We carried out a systematic review of peer-reviewed academic articles and grey literature. Peer-reviewed articles were obtained from the following databases: CINAHL Plus, Embase, the Web of Science, and Medline. Grey literature was obtained from the following directories: the International Association for Hospice and Palliative Care's Global Directory of Education in Palliative Care, the Worldwide Hospice Palliative Care Alliance's lists of palliative care resources, the Latin American Association for Palliative Care's training resources, and the Latin American Atlas of Palliative Care. The inclusion criteria were that the work: (1) focused on describing PC courses; (2) was aimed at healthcare professionals; and (3) was implemented in Latin America. The PRISMA checklist was employed to guide the reporting of methods and findings.Results:We found 36 programs that were delivered in 8 countries. Most of the programs were composed of interdisciplinary teams, taught at a postgraduate level, focused on pain and symptom management, and utilized classroom-based methods. The tools for evaluating the courses were rarely reported. The main barriers during implementation included: a lack of recognition of the importance of PC education, a lack of funding, and the unavailability of trained teaching staff.Significance of results:Considerable work needs to be done to improve the delivery of PC education programs in Latin American countries. Practice-based methods and exposure to clinical settings should be integrated into ongoing courses to facilitate learning. A regional platform needs to be created to share experiences of successful training programs and foster the development of PC education throughout Latin America.
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French C, Greenauer N, Mello C. A Multifactorial Approach to Predicting Death Anxiety: Assessing the Role of Religiosity, Susceptibility to Mortality Cues, and Individual Differences. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2017; 13:151-172. [PMID: 28613993 DOI: 10.1080/15524256.2017.1331181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Death anxiety is not only experienced by individuals receiving end-of-life care, but also by family members, social workers, and other service providers who support these individuals. Thus, identifying predictors of individual differences in experienced death anxiety levels may have both theoretical and clinical ramifications. The present study assessed the relative influence of religiosity, susceptibility to mortality cues, state and trait anxiety, and demographic factors in the experience of death anxiety through an online survey distributed to members of two online communities related to end-of-life care. Results indicated that cognitive and emotional susceptibility to mortality cues, as well as gender, predicted differences in death anxiety. Conversely, religiosity and age did not increase the predictive power of the model. Thus, death anxiety may be a function of emotional, cognitive, and sociocultural factors that interact in complex, but predictable, ways to modulate the response to mortality cues that occur in one's life.
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Affiliation(s)
- Carrie French
- a Applied Psychology Program , The Pennsylvania State University , Berks, Reading , Pennsylvania , USA
| | - Nathan Greenauer
- a Applied Psychology Program , The Pennsylvania State University , Berks, Reading , Pennsylvania , USA
| | - Catherine Mello
- b Rehabilitation and Human Services/Applied Psychology Program , The Pennsylvania State University , Berks, Reading , Pennsylvania , USA
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Taroco ALC, Valente TCDO, Carbogim CS. Distance learning for updating health professionals in palliative care: a systematic review. BMJ Support Palliat Care 2017; 7:205-211. [DOI: 10.1136/bmjspcare-2015-001042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 08/09/2016] [Accepted: 11/08/2016] [Indexed: 11/03/2022]
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An Evidence-Based Practice Approach to End-of-Life Nursing Education in Intensive Care Units. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The feasibility of a train-the-trainer approach to end of life care training in care homes: an evaluation. BMC Palliat Care 2016; 15:11. [PMID: 26801232 PMCID: PMC4724146 DOI: 10.1186/s12904-016-0081-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background The ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care. An evaluation that compared this programme with the Gold Standards Framework found that it achieved equivalent outcomes at a lower cost with higher levels of staff satisfaction. To consolidate this learning, a facilitated peer education model that used the ABC materials was piloted. The goal was to create a critical mass of trained staff, mitigate the impact of staff turnover and embed EoL care training within the organisations. The aim of the study was to evaluate the feasibility of using a train the trainer (TTT) model to support EoL care in care homes. Methods A mixed method design involved 18 care homes with and without on-site nursing across the East of England. Data collection included a review of care home residents’ characteristics and service use (n = 274), decedents’ notes n = 150), staff interviews (n = 49), focus groups (n = 3), audio diaries (n = 28) and observations of workshops (n = 3). Results Seventeen care homes participated. At the end of the TTT programme 28 trainers and 114 learners (56 % of the targeted number of learners) had been trained (median per home 6, range 0–13). Three care homes achieved or exceeded the set target of training 12 learners. Trainers ranged from senior care staff to support workers and administrative staff. Results showed a positive association between care home stability, in terms of leadership and staff turnover, and uptake of the programme. Care home ownership, type of care home, size of care home, previous training in EoL care and resident characteristics were not associated with programme completion. Working with facilitators was important to trainers, but insufficient to compensate for organisational turbulence. Variability of uptake was also linked to management support, programme fit with the trainers’ roles and responsibilities and their opportunities to work with staff on a daily basis. Conclusion When there is organisational stability, peer to peer approaches to skills training in end of life care can, with expert facilitation, cascade and sustain learning in care homes.
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Quinn C, Hillis R. Findings from a Clinical Learning Needs Survey at Ireland's first children's hospice. Int J Palliat Nurs 2015; 21:596-601. [PMID: 26707488 DOI: 10.12968/ijpn.2015.21.12.596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Caring for children with life-limiting conditions places exceptional demands on health professionals. Staff require the optimal skills and expertise necessary to provide the highest quality of care and to achieve this it is essential to understand their learning requirements. AIM The aim is to share the main findings from a Clinical Learning Needs Survey conducted at LauraLynn, currently Ireland's only children's hospice. To date no other Irish service has conducted a formal identification of professional learning and development needs specific to the Irish context. The findings from the study assist workforce planning by providing a glimpse into the immediate study needs of staff working in a children's palliative care setting. The study had two main aims: a) Assist clinical staff within one organisation to identify their own professional learning priorities in children's palliative care and b) Inform the design and delivery of a responsive suite of workshops, programmes and study sessions for children's palliative care. RESULTS The study identified the key learning needs as end-of-life care, palliative emergencies, communication skill development and bereavement support. CONCLUSION These findings are similar to those found internationally and demonstrate the commitment of a new organisation to ensure that specific employee learning requirements are met if the organisation and wider specialty of Irish children's palliative care is to continue its evolution.
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Affiliation(s)
- Claire Quinn
- Head of Research, LauraLynn, Children's Hospice, Dublin Ireland/Honorary Lecturer, National University of Ireland, Galway
| | - Rowan Hillis
- Research and Data Officer, Laura Lynn, Ireland's Children's Hospice, Dublin, Ireland
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Selman L, Robinson V, Klass L, Khan S, George R, Shepherd K, Burman R, Koffman J. Improving confidence and competence of healthcare professionals in end-of-life care: an evaluation of the 'Transforming End of Life Care' course at an acute hospital trust. BMJ Support Palliat Care 2015; 6:231-6. [PMID: 26597902 PMCID: PMC4893143 DOI: 10.1136/bmjspcare-2015-000879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022]
Abstract
Background UK policymakers, clinicians and public wish to see improvements in end-of-life care (EoLC). However, healthcare professionals’ skills and knowledge to deliver high-quality care are often lacking. Since May 2012, palliative care staff in an inner-city tertiary hospital have run a 2-day Transforming End of Life Care (TEoLC) course to improve EoLC confidence, and competence among hospital and community staff. Aim To evaluate course participants’ self-rated confidence, competence and knowledge of EoLC topics. Evaluation design A before-and-after design using self-completion questionnaires, precourse and postcourse. 14 self-assessment questions examined confidence, understanding and knowledge of EoLC topics. Mean change scores and paired t tests were calculated and free-text responses analysed thematically. Participants 236 staff members completed the course between May 2012 and April 2014. 42% worked in hospitals and 55% in the community; the most frequent staff roles were qualified nurses (49%), senior nurses (16%) and general practitioners (15%). Results All 14 self-assessment topics improved significantly (p<0.001); most improved was ‘understanding and implementing Fast Track discharge’. Qualitative data showed increased knowledge and confidence in EoLC, particularly in communication, commitment to team work and holistic care. Overall, 217 (92%) participants would recommend the course and 215 (98%) indicated it would influence their practice. Conclusions The TEoLC course improved participants’ self-rated confidence, competence and knowledge in EoLC. Findings have utility beyond the UK in light of the international policy recommendations to improve the palliative care skills of generalist healthcare providers.
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Affiliation(s)
- Lucy Selman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | | | - Lara Klass
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Shaheen Khan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rob George
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kate Shepherd
- King's College Hospital NHS Foundation Trust, London, UK
| | - Rachel Burman
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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Bergman J, Ballon-Landa E, Lerman SE, Kwan L, Bennett CJ, Litwin MS. Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education. Am J Hosp Palliat Care 2015; 33:748-54. [PMID: 26261373 DOI: 10.1177/1049909115598741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. METHODS Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. RESULTS 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p < .01) were all associated with linking to auxiliary resources via hyperlinks. When adjusting for confounders, β coefficient estimates and least squares estimation demonstrated that participants clicking on both hyperlink types were more likely to score higher on all knowledge and attitude items, and demonstrate increased score improvements. CONCLUSION Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Eric Ballon-Landa
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA University of California Irvine School of Medicine, Irvine, CA, USA
| | - Steven E Lerman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol J Bennett
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Baron K, Hodgson A, Walshe C. Evaluation of an advance care planning education programme for nursing homes: A Longitudinal study. NURSE EDUCATION TODAY 2015; 35:689-695. [PMID: 25638279 DOI: 10.1016/j.nedt.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To evaluate the success of a programme of Advance Care Planning education for nursing homes by examining the effect on staff knowledge, Advance Care Planning practice within the home and end-of-life hospital admission rates. METHOD Three longitudinal questionnaires assessing staff knowledge, Advance Care Planning Practice and hospital deaths completed before and after the initiation of the Advance Care Planning education programme by homes that had completed the training and those yet to undergo the training. RESULTS Superior Advance Care Planning knowledge was evident in those staff that had completed the training. There was an increase of 85% in the number of Advance Care Plans completed in the training homes and an overall reduction in hospital deaths of 25% for residents from training homes. CONCLUSION A programme of Advance Care Planning education for nursing homes is successful in improving nursing home staff knowledge, increasing Advance Care Planning practice and reducing hospital deaths.
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Affiliation(s)
- Kirsten Baron
- Wigan and Leigh Hospice, Kildare St., Wigan, Greater Manchester WN2 3HZ, United Kingdom.
| | - Aruna Hodgson
- Wigan and Leigh Hospice, Kildare St., Wigan, Greater Manchester WN2 3HZ, United Kingdom
| | - Catherine Walshe
- Division of Health Research, Furness Building, Lancaster University, Lancaster LA1 4YG, United Kingdom
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Loucka M, Pasman RH, Brearley SG, Payne SA, Onwuteaka-Philipsen B. Self-reported knowledge, attitudes, and behaviour towards hospice care and how are these related to training in palliative care: An online survey among oncologists in the Czech Republic and Slovakia. PROGRESS IN PALLIATIVE CARE 2015. [DOI: 10.1179/1743291x13y.0000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Park K, Yeom H. Factors influencing Korean nurses’ attitudes towards hospice care. Int Nurs Rev 2014; 61:563-9. [DOI: 10.1111/inr.12135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- K.S. Park
- Keumho Nursing Home; College of Nursing; The Catholic University of Korea; Seoul Korea
| | - H.A. Yeom
- Research Institute for Hospice/Palliative Care; College of Nursing; The Catholic University of Korea; Seoul Korea
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Farrington CJ. Blended e-learning and end of life care in nursing homes: a small-scale mixed-methods case study. BMC Palliat Care 2014; 13:31. [PMID: 24994948 PMCID: PMC4080686 DOI: 10.1186/1472-684x-13-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background A ‘blended’ (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. This paper evaluates the impact of the course on participants’ understandings of and confidence in delivering end of life care in one nursing home, while also considering barriers to change in practice. Methods A mixed-methods case study approach, incorporating pre- and post-course questionnaires (SHA East of England End of Life Care Education Programme ‘ABC’ Project Work Force C or Non Nurse Workforce B Pre and Post Course Questionnaire; E-Learning in End of Life Care Study Pre and Post Course Questionnaire), documentary analysis, semi-structured interviews, and observation of course workshops. Participants were 20 members of staff at a nursing home in a city in the East of England, including 14 Health Care Assistants (carers) and 6 others (administrative, activities, hosting, and catering staff). The questionnaires and interviews assessed understandings of and confidence towards end of life care delivery. Results Improvements in participants’ confidence in delivering end of life care were observed, particularly in the core competency areas of symptom management, communication, and advance care planning. A shift towards more detailed and more holistic understandings of end of life care was in evidence; some participants also championed end of life care in the home as a result of the course. Several barriers to changes in practice were encountered, including uneven participation, the absence of mechanisms for disseminating new insights and knowledge within the home, and a widespread perception that nurses’ professional dominance in the home made sustainable change difficult to enact. Conclusions While blended e-learning courses have the potential to generate positive change in participants’ understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes.
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Affiliation(s)
- Conor Jt Farrington
- Cambridge Centre for Health Services Research (CCHSR), Cambridge Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
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Pype P, Symons L, Wens J, Van den Eynden B, Stes A, Deveugele M. Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study. BMC FAMILY PRACTICE 2014; 15:36. [PMID: 24552145 PMCID: PMC3936999 DOI: 10.1186/1471-2296-15-36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/17/2014] [Indexed: 11/28/2022]
Abstract
Background There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care professionals and professionals from organizations who provide training and education. Methods Five focus groups were brought together in Belgium, with a total of 29 participants, including members of the three categories mentioned above. They were analysed using a constant comparison method. Results The analysis revealed that undergraduate education and continuing medical education (CME) while in practice, is insufficient to prepare GPs for their palliative work. Workplace learning (WPL) through collaboration with specialized palliative home-care nurses seems to be a valuable alternative. Conclusions The effectiveness of undergraduate education might be enhanced by adding practical experience. Providers of continuing medical education should look to organize interactive, practice-based and interprofessional sessions. Therefore, teachers need to be trained to run small group discussions. In order to optimize workplace learning, health care professionals should be trained to monitor each other’s practice and to provide effective feedback. Further research is needed to clarify which aspects of interprofessional teamwork (e.g. professional hierarchy, agreements on tasks and responsibilities) influence the effectiveness of workplace learning.
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Affiliation(s)
- Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, UZ-6 K3, De Pintelaan 185, 9000 Gent, Belgium.
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Chong L, Khalid F. Paediatric palliative care in Malaysia: Survey of knowledge base and barriers to referral. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x13y.0000000074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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