Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors

Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study

BACKGROUND

Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment.

OBJECTIVES

To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy.

METHODS

The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program.

RESULTS

Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program.

SIGNIFICANCE OF THE RESULTS

The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.

Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program

ABSTRACT

Graduate nursing programs must provide end-of-life (EOL) content to prepare nurse practitioners to manage the holistic needs of patients. This project aimed to measure the End-of-Life Nursing Education Consortium curriculum's impact on student self-confidence and anxiety levels. A pretest/posttest study design was implemented using an EOL simulation and the Nursing Anxiety and Self-Confidence With Clinical Decision-Making Scale (NASC-CDM©) to compare baseline self-confidence and anxiety levels related to clinical decision-making. Results showed that the simulation increased student self-confidence, but anxiety level remained unchanged. Nurse educators should consider incorporating EOL simulation into graduate curricula to improve student confidence with clinical decision-making.

Attitude of nurses towards palliative care and its associated factors in Ethiopia, systematic review and meta-analysis

INTRODUCTION

Palliative care significantly improves the distressing symptoms of patients, especially those with cancer, heart disease, renal disease, and liver disease. The need for palliative care is increasing worldwide due to the growing burden of chronic disease. Nurses with an unfavorable attitude towards palliative care cannot skillfully assess the patient's needs, do not communicate effectively, and do not address the patient's problems adequately. Therefore, this study was aimed to assess the nurse's level of attitude towards palliative care in Ethiopia.

METHODS

Several databases were searched to find available articles. Microsoft Excel was used to extract and sort the data before it was exported to STATA/MP 17.0 for analysis. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Egger's test and Cochrane I2 statistics were used to assess heterogeneity and publication bias, respectively. Subgroup analysis was carried out to identify the source of heterogeneity. A log-odds ratio was employed to show the relationship between nurses' level of attitude towards palliative care and its related factors. P-value less than 0.05 was considered statistically significant.

RESULT

In Ethiopia, the pooled prevalence of favorable attitudes of nurses towards palliative care was 66.13% (95% CI: 54.00-78.27). The highest percentage of favorable attitudes towards palliative care among nurses was found in research studies done in Addis Ababa (80.31%; 95% CI: 72.00-88.63). Training on palliative care was significantly associated with the level of a nurse's attitude towards palliative care. Therefore, nurses who received palliative care training had a 2.5 times higher chance of having a favorable attitude towards palliative care than nurses who did not receive training on palliative care (AOR = 2.55; 95% CI: 2.28-2.82).

CONCLUSION

One-third of nurses had unfavorable attitude towards palliative care. Nurses who took palliative care training had a more favorable attitude than nurses who did not take palliative care training. Routine palliative care training is needed for nurses to improve their level of attitude towards palliative care.

The moderating effect of attitudes in the relationship between knowledge and self-efficacy in palliative care among nurses: A cross-sectional, correlational study

Provision of palliative care to patients with advanced chronic diseases or old populations is suboptimal, which results in unnecessary suffering of and burden to patients, caregivers, and society. Low self-efficacy in palliative care among nurses is a factor affecting suboptimal utilization of palliative care. Poor knowledge is a factor affecting low self-efficacy in palliative care of nurses. Attitudes may contribute to the relationship between knowledge and self-efficacy in palliative care, but these relationships have been rarely examined in nurses. This study aimed to determine whether nurses' attitudes moderate the relationship between knowledge and self-efficacy in palliative care. In a cross-sectional, correlational study, online or offline survey on self-efficacy, knowledge, attitudes, and covariates was conducted from 282 nurses in South Korea. PROCESS v4.1 for SPSS was used to address the study aim. Higher levels of knowledge (p = .048) and attitudes (p < .001), and the interaction term of knowledge and attitudes (p = .025) were significantly associated with higher levels of self-efficacy (F = 6.12, p < .001, R2 = .152), indicating the moderating effects of attitudes. The relationships between higher levels of knowledge and self-efficacy were significant only in nurses with highly and moderately positive attitudes (R2 change = .016, F = 5.11, p = .025), but not nurses with lack of positive attitudes. Our results supported the moderating role of nurses' attitudes in the relationship between knowledge and self-efficacy. To improve self-efficacy in palliative care in nurses, improvement in knowledge and facilitation of positive attitudes are needed.

A Basic Survey on the Learning Needs of Nurses Caring for Patients with Intractable Cancer in Japan Based on Conceptual Education Integrating Oncology and Palliative Care

This small-sample pilot study sought to uncover the role of palliative care education for general nurses providing care to patients with intractable cancer. While nurses serve as total care coordinators in patient recuperation, most general nurses in Japan dealing with such patients must independently update their knowledge. A questionnaire was developed comprising 28 items from the five supportive care need categories according to the Integrating Oncology and Palliative Care (IOP) model and 22 items from the Nurses' Difficulties in Cancer Care (NDCC) scale. General nurses who had worked in cancer care for over 5 years were recruited using snowball sampling. Based on the results, we planned a lecture and free study session on IOP using information and communication technology (ICT). Four lectures were delivered to 108 nurses from Hokkaido to Okinawa and remote islands. Overall, 90% of the participants were female nurses. They were categorized into two groups based on the number of times they attended the lectures (Group 1 [G1, attended once or twice]: 45; Group 2 [G2, attended three or four times]: 63). Comparing G1 and G2 showed that the practical ability of the participants in G2 increased for the items "Patient/Family Communication" and "Knowledge and Skills." Continued education using ICT may improve the practical skills of general nurses caring for patients with intractable cancer.

Providing gender affirming and inclusive care to transgender men experiencing pregnancy

OBJECTIVES AND DESIGN

Information about providing professional and appropriate perinatal care to transgender men in the perinatal setting is scarce, and healthcare providers often have insufficient knowledge or skills to provide this care. In response, a quality improvement educational program for nursing staff was developed and implemented, with the goal of evaluating the impact of this intervention on nurses' knowledge, skills, and attitudes when caring for pregnant transgender men.

SETTING AND PARTICIPANTS

The training was offered to nursing staff of a 24-bed inpatient perinatal unit at a large, private academic medical center in a major East Coast city during the unit's quarterly staff meeting in March 2020.

INTERVENTION

The training covered the provision of affirming and inclusive perinatal care for transgender men. The content of the training was based on recommendations in the literature and reviewed by content experts.

MEASUREMENTS

Pre-test (N = 55) and post-test (N = 23) online self-administered surveys assessed nursing staff's knowledge of, comfort, and interest in providing gender affirming care for transgender men. Mann-Whitney U and Fischer's exact tests were used to determine significant changes in knowledge and attitudes over time.

FINDINGS

Findings suggest the training improved nursing staff's self-reported knowledge and skills in providing gender affirming care to pregnant transgender men over time, with participants demonstrating improved knowledge about communication around pronouns, gender identity, reproductive systems, and obstetric history. Awareness of resources for both professional development and to refer transgender patients also improved. However, persistent deficits in other knowledge, skills, and attitudes remained, suggesting that nurses would likely benefit from further support and training in transgender-specific health issues.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Findings support the utility of unit-based training in improving affirming and inclusive care in the perinatal setting. This highlights opportunities for supporting nurses' professional practice of caring for transgender patients experiencing pregnancy and may be adapted for use in other specialty units.

Educational Needs in Oncology Nursing: A Scoping Review

Care in oncology requires both technical and psychosocial skills by nursing staff, so continuous learning is necessary. Evidence suggests there are some educational gaps in oncology nursing staff, and continuing educational interventions have been effective in overcoming these deficiencies. Aim: to determine the basic educational lines that a continuous training program should have for oncology nurses. A bibliographic review study was carried out in two phases from October 2020 to January 2021. In a first phase, the main databases were analyzed: PubMed, Web of Science, Dialnet and Medline, following the PRISMA methodology; and subsequently, an analysis of the most important thematic nuclei that a training program in cancer nursing should contain. The DAFO matrix and the Hanlon prioritization method were used. Four competencies that every oncology nurse should have were described: communication, coping, self-direction of learning and technical health. The thematic contents that a training program should contain were then determined, and aspects such as stress prevention and burnout, adequate communication with patient and family, and continuous educational and technical skills were considered. The results found suggest that there are deficiencies in the education of nursing staff. Continuing education programs are effective in supplementing them. They should develop the four skills described in the results section.

Effectiveness of International Hospice and Palliative Care Training for Health Care Professionals in Countries of the Western Pacific Region

As hospice and palliative care is a holistic service grounded in spirituality, training in spiritual care is essential. This study aimed to describe an international workforce training program for hospice and palliative care that emphasized spiritual care and evaluate the effectiveness of the training implementation. A quasi-experimental study was conducted with 28 health care professionals from 4 countries in the Western Pacific Region, who attended the international workforce trainings on hospice and palliative care. Data were collected before and after the trainings using a self-reported survey questionnaire. The participants' palliative care knowledge, spiritual well-being, perceived stress, and compassion competency were analyzed to evaluate the training program. Whereas the participants' knowledge of hospice and palliative care ( P < .001) and compassion competency increased ( P = .004), their perceived stress decreased post training ( P = .002). This study provided an extensive description of an international workforce training program of hospice and palliative care for potential replication of the training in other regions of the world. Because training in hospice and palliative care positively influenced health care professionals' spiritual care competency, future training and studies should consider spiritual care factors, along with intellectual aspects.

Development and validation of a questionnaire to evaluate the knowledge, attitude, behaviour and care preference of family members of Chinese older adults related to palliative care

AIM

To develop and validate a questionnaire on knowledge, attitude, behaviour and care preference of family members of Chinese older adults related to palliative care.

DESIGN

A descriptive study design and STROBE checklist were applied in this research.

METHODS

The theoretical framework of the questionnaire was knowledge-attitude-behaviour model. An additional dimension of palliative care preference of family members was set up in the questionnaire. Items were generated from a rapid review of international literature and interviews with 61 family members of the older adults living either in an aged care service organization or the community. The content validity was examined by five experts. A preliminary questionnaire with 69 items was then set up, and its psychometric property was assessed.

RESULTS

A final version of questionnaire with 42 items under four dimensions was constructed. The content validity index of the overall questionnaire was 0.93 and of each item ranged 0.80-1.00. The factor loading of all items was higher than 0.50 as per exploratory and confirmatory factor analysis; the average variance extracted for each dimension was higher than 0.50; the composite reliability was higher than 0.90; and the absolute value of the correlation coefficient of each dimension was <0.50 and less than the square root of the average variance extracted. The Cronbach's alpha value and the split-half reliability value of the overall questionnaire were 0.93 and 0.97, respectively.

CONCLUSIONS

This questionnaire has good validity and reliability, but needs further testing in multi-centered settings.

Every Dying Patient Should Experience a Peaceful Death: A Mixed-Methods Approach to Assessing the Benefits of Palliative Care Training on Nursing Practice

Providing appropriate end-of-life care is not only a critical part of palliative care but a basic human right. Nurses are well positioned to perform this role; however, the delivery of end-of-life care is difficult. The purpose of this project was to prepare nurses to meet the challenges associated with end-of-life care and to optimize the opportunity for a peaceful death. The project comprised a mixed-methods design, analyzing a palliative care training program for a quantitative and qualitative impact on practice. Preintervention focus group discussions resulted in 6 primary themes concerning the care of these patients: ethical challenges, cultural/spiritual difficulties, troubling emotional aspects, communication challenges, frustrations, and basic unfamiliarity with end-of-life care. Nurses expressed uncertainties about their role in end-of-life care and how best to manage challenges within their scope of practice. There was a statistically significant increase in testing scores from pretraining to posttraining. Postintervention discussions identified changes within nursing practice expressed through 5 primary themes: enhanced communication, symptom management, improved emotional response, improved understanding of ethical principles, and the trajectory of death. Nurses need to receive education to understand their role within end-of-life care and effectively care for the dying patient when cure is no longer an option.

Palliative care management of head and neck cancer patients among otolaryngology surgeons: a novel national survey assessing knowledge, decision making, perceived confidence and training in the UK

Objective

Management of head and neck cancer patients provides unique challenges. Palliation serves to optimise quality-of-life by alleviating suffering and maintaining dignity. Prompt recognition and management of suffering is paramount to achieving this. This study aimed to assess perceived confidence, knowledge and adequacy of palliative training among UK-based otolaryngologists.

Method

Eight multiple-choice questions developed by five palliative care consultants via the Delphi method were distributed over five weeks. Knowledge, perceived confidence and palliative exposure among middle-grade and consultant otolaryngologists were assessed, alongside training deficits.

Results

Overall, 145 responses were collated from middle-grade (n = 88, 60.7 per cent) and consultant (n = 57, 39.3 per cent) otolaryngologists. The mean knowledge score was 5 out of 10, with 22.1 per cent (n = 32) stating confidence in palliative management. The overwhelming majority (n = 129, 88.9 per cent) advocated further training.

Conclusion

A broad understanding of palliative care, alongside appropriate specialist involvement, is key in meeting the clinical needs of palliative patients. Curriculum integration of educational modalities such as simulation and online training may optimise palliative care.

An Evolutionary Concept Analysis of Palliative Care in Oncology Care

This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.

Development of an End-of-Life Nursing Care Protocol for Intensive Care Units: Delphi Survey Method

Because of the lack of guidelines and standardized protocols for end-of-life nursing care in intensive care units in Korea, many nurses have reported facing difficulties when providing care for patients. This study attempted to develop a standardized end-of-life nursing protocol for use in intensive care units. A draft of the end-of-life nursing care protocol was developed after a literature review. A Delphi survey was carried out twice with 30 experts, and the content validity ratio of the items was investigated. The draft end-of-life nursing care protocol was divided into 3 separate stages with 24 items: 8 initial end-of-life care assessment items, 5 ongoing end-of-life care items, and 11 post-end-of-life care items. The content validity ratios of the first and second rounds were 0.33 or greater in each category, demonstrating the validity of the proposed draft as a standardized protocol. Furthermore, at the suggestion of the experts, an extra item was added in the last stage, resulting in 25 items. The results of this study are expected to help leading hospitals in South Korea outline the roles and range of tasks for end-of-life care in an intensive care unit and thereby resolve difficulties for nurses. Furthermore, this will improve the medical services that family members receive during end-of-life care.

Early Palliative Care for Oncology Patients: How APRNs Can Take the Lead

BACKGROUND

Patients with cancer need expert and multidisciplinary care throughout the trajectory of their illness. Palliative care should be instituted early in the course of their disease. Early palliative care enables patients and their families to control physical, psychological, social, and spiritual symptoms of the disease. In our current health-care system, early palliative care is not being integrated due to a lack of education of providers and nurses, an infrastructure that does not support palliative medicine, and poor communication skills among practitioners.

METHODS AND RESULTS

The Palliative Care Quiz for Nursing (PCQN) completed by nurse practitioners at a large Midwest cancer center found that those nurse practitioners had a poor understanding of the basic precepts of palliative care. This is consistent with the current literature.

CONCLUSION

Advanced practice nurses should be educated on the principles of palliative care, as they are perfectly situated to advance the integration of early palliative care in the oncology setting.

Thai Nurses' Experiences of Spiritual Care for Older Adults at End of Life

Most Thai registered nurses who provide end-of-life care emphasize the physical dimension of care rather than spiritual care. There is a need to explore the experiences of Thai nurses who provide spiritual care. The purpose of the study was to explore the experiences of Thai palliative care nurses providing spiritual care for older adults at the end of life. A descriptive qualitative research design was used. The 8 participants were Thai nurses with experience of palliative care in hospitals in the central, northeastern, northern, and southern regions of Thailand. A focus group discussion was used for data collection. Content analysis was used to analyze data. Five themes were as follows: (1) spiritual care was searching for meaning in patients' lives, (2) spiritual self-preparation of nurses for making sense and connecting to patients' spirituality, (3) caring for patients' spiritual needs by recognizing psychological and religious beliefs, (4) facilitating ways to ease patients' suffering, and (5) assuring confidence of patients and relatives for receiving the best care. These findings that should be included in training registered nurses are honoring the patients' lives, addressing spiritual needs to decrease patients' suffering, and enhancing patients' perceptions of care through spiritual self-preparation and spiritual concern of nurses.

Exploring the knowledge of community-based nurses in supporting parents of preterm babies at home: A survey-based study

Aim

This study aimed to investigate the confidence levels, knowledge base and learning needs of community‐based nurses relating to the care of preterm babies and parents, to explore what education is required and in what format.

Design

An online survey methodology was used.

Methods

A 32‐item questionnaire was distributed via social media platforms to community‐based nurses in Australia.

Results

Descriptive analysis was undertaken relating to knowledge base, confidence levels, previous training, learning and resource needs and barriers to education. It was deemed vital to expand confidence and knowledge in this area. Gaps in learning resources were identified and a need for more training in topics such as developmental outcomes, feeding, expected milestones, weight gain, growth trajectories and supporting parents. Online resources were the preferred format to teach key knowledge to community‐based health professionals, tailored to the specific features of preterm babies and support needs of parents.

Israeli Nurses' Palliative Care Knowledge, Attitudes, Behaviors, and Practices

OBJECTIVES

To describe and compare self-perceived end-of-life (EOL) knowledge, attitudes, behaviors, and practices of intensive care unit (ICU) nurses compared to oncology nurses.

SAMPLE & SETTING

126 Israeli nurses (79 oncology nurses and 47 ICU nurses) who were members of the Israel Association of Cardiology and Critical Care Nurses and the Israeli Oncology Nurses Organization.

METHODS & VARIABLES

This cross-sectional study used an online survey to gather demographic information, clinical setting, and study measures (EOL knowledge, attitudes, behaviors, and practices).

RESULTS

Oncology nurses and ICU nurses showed moderate levels of self-perceived knowledge and attitudes toward palliative care; however, their self-reported behaviors were low. Oncology nurses scored slightly higher than ICU nurses on knowledge and attitudes but not behaviors, although the difference was not statistically significant.

IMPLICATIONS FOR NURSING

Contrary to the current authors' expectations, oncology nurses and ICU nurses have similar levels of knowledge, attitudes, and behaviors regarding palliative care. Nurses in both settings need to be better trained and empowered to provide such care.

The Specialist Palliative Care Nurses' in an Italian Hospital: role, competences, and activities

Background and aim of the work:

Many authors tried to clarify the palliative care nurses’ role, overall in the home care setting, but little is known in different settings of care. We aim to present a Specialist profile of palliative care (PC) nurses in an Italian hospital-based Palliative Care Unit.

Methods:

With an organizational case study approach, we conducted a literature review on PC nurse’s role, and we presented the Specialist PC nurses’ profile, describing competences and key related activities.

Results:

Our specialist profile highlights that clinical activities are similar to the experiences described in the literature (symptom assessment and management, communication, interprofessional work), while training and research activities are new fields of interest that it’s important to explore and promote, most of all in our country.

Conclusions:

Sustaining the flexibility of the role, being recognized by colleagues and keeping the three dimensions connected are the major challenges: drawing up a specialist palliative care nurses’ profile can help the team to better define the role framework in an interdisciplinary context.

Influence of Physical Activity on Pain, Depression and Quality of Life of Patients in Palliative Care: A Proof-of-Concept Study

Introduction: Palliative care not only focuses on physical ailments associated with the disease, but also considers the psychological, social and spiritual needs of the patients. The aim of this study is to assess the impact of physical activity on palliative care patients, with special regard to the subjective assessment of severity of total pain and quality of life. Materials and methods: The study was conducted on 92 palliative care patients either in a hospice or at home. The tool used to assess the patients was an original questionnaire focusing on the area of their independence and motor abilities. The study attempted to understand whether an appropriate physical activity and the instruction of palliative care patients and their families in the field of independence would improve the quality of life and reduce the intensity of total pain in the patients. Results: All of the patients were at an advanced stage of cancer. The survey at time “0”, conducted before the start of the instructions for patients and their relatives, showed that a majority of patients (47, 51.09%) often experienced limitations during the performance of daily activities. In the fourth visit, conducted one week after the fourth educational session, there was a significant increase in patients who did not experience any limitations in performing their daily activities or experienced them just sometimes. Conclusions: The ultimate effect of the proposed educational program on physical activity was an increase in the quality of life, a reduction in pain and a mood improvement. These results would need confirmation with more extensive studies.

Impact of a Nurse-Driven Opioid Titration Protocol on Quality of Orders at End of Life

At our community teaching hospital, orders for end of life often lacked instructions to titrate opioids based on evidence-based principles and failed to address nonpain symptoms. An order set and a nursing-driven opioid titration protocol were implemented in August 2016 after extensive education. The purpose of this retrospective preintervention and postintervention study was to evaluate the impact of this intervention on the quality of end-of-life orders. We evaluated 69 patients with terminal illness receiving morphine infusions. After implementation, more morphine infusion orders included an as-needed bolus dose with an objective indication and appropriate instructions on when and how to titrate the infusion compared with before the intervention (94.6% vs 18.8%, P < .0001). Morphine infusion orders were also significantly more likely to include a maximum dose (P = .041) and an initial bolus dose (P < .0001). In addition, prescribers were more likely to order additional medications to manage nausea/vomiting, constipation, anxiety, or pain using a nonopioid (P < .05 for all). In this study, implementation of a standardized opioid titration protocol and symptom management order set led to an improvement in the quality of morphine infusion orders for pain management at the end of life and increased the use of medications to manage nonpain symptoms in dying patients.

Nurses' Role in Providing Comprehensive Communication, Prognostication, and Palliative Care During the COVID-19 Pandemic

This article presents the case of a mother of young children who has terminal stage IV cancer with whom providers had not discussed goals of care and prognostication. Communications about prognostication and goals of care are commonly initiated by physicians. Adolescents and young and middle-age adults with complex chronic or terminal illness often are not provided with timely, clear, complete information or palliative care support. Early palliative care for chronically ill patients facilitates discussions of prognostication and goals of care, in addition to providing symptom management. Such discussions do not diminish hope but rather allow patients to adjust hope to attain an optimal quality of life. Nurses can become active, confident advocates for patients with terminal illness of any age, and they are well positioned to assess patients and engage in goals of care and end-of-life conversations. It is especially important that palliative care nurses promote and maintain these early and comprehensive discussions during the COVID-19 pandemic because this population is at a high risk of complications from the coronavirus.

Knowledge, attitude and self-efficacy towards palliative care among nurses in Mongolia: A cross-sectional descriptive study

Background

Nurses have a primary role in providing palliative and end-of-life (EOL) care. Their knowledge of EOL care, attitudes toward care of the dying, and palliative care self-efficacy are important in care delivery. Little is known regarding palliative care preparedness among Mongolian nurses. This study examines palliative care knowledge, attitude towards death and dying, and self-efficacy among Mongolian nurses, and examines predictors of self-efficacy.

Methods

A cross-sectional descriptive study was conducted. Participants were 141 nurses employed at the National Cancer Center in Mongolia. Data was collected using a self-administered questionnaire.

Results

The median score for the knowledge of palliative care was 8.0/20. “Psychosocial and spiritual care” was the lowest score on the palliative care knowledge subscale. The mean score for attitude toward care of the dying was 69.1%, indicating positive attitudes. The mean score for the palliative care self-efficacy was 33.8/48. Nurses reported low self-efficacy toward communicating with dying patients and their families, and managing delirium. Palliative care knowledge and duration of experience as an oncology nurse significantly predicted self-efficacy toward palliative care, accounting for 14.0% of the variance.

Conclusions

Palliative education for nurses should address the knowledge gaps in EOL care and focus in increasing palliative care self-efficacy. Considering palliative care knowledge and nursing experience as an oncology nurse were significant predictors of self-efficacy toward palliative care, more effort is needed to fill the knowledge gaps in EOL care among nurses, especially for less experienced nurses.

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

BACKGROUND

Palliative care is a patient-centred, integrated approach for improving quality of life for both patients facing life-threatening illnesses and for their families. Although there has been increased interest in palliative care for non-cancer patients, the palliative care competency of nurses who care for non-cancer patients has rarely been investigated. This study described the palliative care knowledge, attitude, confidence, and educational needs in nurses who care for patients with congestive heart failure, stroke, end-stage renal disease, and end-stage liver disease; explored the relationships between those variables; and identified factors affecting nurses' palliative care confidence.

METHODS

A cross-sectional, descriptive, correlational design was employed; data collection was conducted at a tertiary hospital in Seoul, Korea. Nurses who were working in general wards and intensive care units (N = 102) completed valid and reliable self-administered questionnaires. Descriptive statistics, frequencies, independent t-tests, one-way ANOVA, Pearson's correlations, and multiple regression were conducted to analyse the data.

RESULTS

Nurses' palliative care knowledge level was low (9.73 ± 2.10; range = 0-20) and their attitude toward palliative care was moderate (87.97 ± 6.93, range: 30-120). Knowledge was significantly correlated with attitude (r = .29, p = .003). Nurses were highly confident in pain and symptom management but demonstrated high educational needs for managing human and material resources to provide palliative care. Previous training in hospice, palliative, and EOL care was a significant and modifiable factor that affected nurses' confidence (std. β = 0.25, p = .010).

CONCLUSIONS

To facilitate high-quality palliative care for non-cancer patients and families, nursing education programs should be developed to address nurses' knowledge level, confidence level, and educational needs. This study provides relevant information that can be utilised to develop palliative care educational programs for nurses who care for non-cancer patients.

Content analysis of the effects of palliative care learning on the perception by nursing students of dying and dignified death

BACKGROUND

Providing care for dying people and the death of patients are stressing situations faced by nursing students during their clinical practice. Learning about palliative care improves the management of emotions and the ability to cope when caring for patients in end-of-life processes. However, there is little knowledge on the effect of this learning on the students' perceptions of their own death.

OBJECTIVES

To determine the effect of a palliative care course on the thoughts of nursing students about their own death.

DESIGN

A qualitative, descriptive, and comparative study was conducted based on content analysis, administering an open-ended questionnaire on dying and death at the start and end of a palliative care course.

PARTICIPANTS

The study included 85 volunteers studying Palliative Care in the second year of their Nursing Degree at the University of Granada (Spain).

RESULTS

Students described their perceptions in more detail after the course, with more numerous code citations, and their post-course responses evidenced a reduction in anxiety about their own death and an increased recognition of the need to respect the decisions of patients for a dignified death.

CONCLUSIONS

Palliative care learning modifies the perception by nursing students of their own death and their understanding of a dignified death, which may enhance the care they deliver to patients at the end of life.

Palliative Care Communication: Outcomes From COMFORT, a Train-the-Trainer Course for Providers

BACKGROUND

With increasing support for the integration of palliative care and standard oncology, communication training programs are needed to teach oncology nurses and other providers about palliative care communication.

OBJECTIVES

This study reports on the outcomes of COMFORTTM SM Communication for Oncology Nurses, a train-the-trainer communication course to educate oncology nurses about palliative care communication and improve patient-centered communication and cancer care.

METHODS

355 oncology nurses attended the two-day course. This study used 6- and 12-month follow-up data from nurses who provided feedback on the progress of these goals.

FINDINGS

Nurses taught an additional 9,720 oncology providers, conducted needs assessments of communication processes, and initiated institutionwide palliative care communication training. Barriers to completing outcome goals included a lack of institutional support, specifically an absence of leadership, financial backing, and dedicated time.

Health science student teachers' perceptions of teacher competence: A qualitative study

BACKGROUND

Health science teacher competence is multifaceted and continuously changing according to national and international healthcare standards. Organizational restructuring and emphasis on cost effectiveness is changing the scope of health science teachers' practical work and their role in healthcare (worldwide).

AIM

This study aimed to describe student teachers' perceptions of the competencies needed to work as an educator in the healthcare field. Objective of study was to gain new knowledge which can be used in the development of teacher education programs in nursing science and to define a broader definition of the health science educators.

METHODS

A qualitative study was conducted. Data were collected from 23 Finnish students completing a master's degree in teaching in the healthcare context using focus group interviews. The data were analyzed by inductive content analysis.

RESULTS

The student teachers identified eight main categories of teacher competence: leadership and management competence; evidence-based practice competence; subject competence; ethical competence; pedagogical competence; collaboration competence; internationalization competence; and continuous professional development competence.

CONCLUSION

This study identified essential teacher competencies that can be evaluated among students to develop health science teacher curricula. The findings can be used in follow-up studies or comparative research to investigate competence differences between novice and experienced teachers.

Educating the Existential View to Nurses in Cancer Care: A Review

Background:

The aim of this study was to review the interventional studies about educating existential concepts to the nurses working in cancer care.

Materials and Methods:

In this systematic narrative review, the papers published in English and Farsi databases of PubMed, Elsevier, web of since, Scopus, ProQuest, ERIC, Google Scholar and Ovid, MagIran and SID, from 1990 to 2018 were reviewed. Methodological quality of the studies was independently assessed by, using checklists developed by Greenhalgh, and Cochrane Center. No statistical pooling of the outcomes was performed, due to heterogeneity of the outcomes.

Results:

After wide search, the 17 studies entered to this narrative study. The results showed that educating the existential concept to the nurses dealing with cancer patients can improve their self-competency in providing efficient care to these patients and their ability in decision making. It also enhances their quality of life and decreases the death anxiety and emotional exhaustion.

Conclusions:

There were limited and low quality interventional studies about the effects of educating existential concepts to the nurses dealing with cancer patients. These studies showed that knowing this philosophy can help nurses to address caring needs of cancer patients more efficiently. The specific method or content of education cannot be recommended because of the large differences in the methodologies between the studies.

Applying a Balm: Medicating the Patient to Treat the (Moral) Distress of Caregivers

Moral distress occurs when a nurse knows the right action but is impeded from taking that right action because of institutional constraints. Caring for patients who are dying might evoke distress, including moral distress. The distress from a difficult clinical situation is likely to permeate other areas of practice. In this article, 2 cases are used as a means to distinguish moral distress from other distress arising from clinical situations. Opportunities to alleviate distress include increasing knowledge, improved communication, enhanced collaboration, and development of institutional supports.

Enhancing Cancer Pain Assessment and Management in Hospice

Pain is one of the most common symptoms in individuals with cancer and is directly associated with significantly reduced quality of life. The purpose of this project was to enhance assessment and management of cancer-related pain for patients in the hospice setting. Nurse attitudes and knowledge about pain were evaluated using the Nurses' Knowledge and Attitudes Survey Regarding Pain before and 6 weeks after an educational program. Nurses completed a pain assessment at each home visit and followed an algorithm based on the National Comprehensive Cancer Network Clinical Practice Guidelines to manage pain. Baseline data were collected on the last 30 patients admitted into hospice with cancer as the primary diagnosis before project implementation. Following the practice change, chart audits of the patients' reported pain and adherence to recommended management were manually extracted from 26 patient records. Results revealed statistically significant differences in acquired knowledge (t = 3.95, P < .05) and attainment of patient-identified pain goals (t = 23.904, P < .05). Patient-reported pain levels decreased by 21%, and comprehensive pain assessment completion rates increased by 10% during the project. Current knowledge of evidence-based pain interventions and a management algorithm improved pain control in patients with cancer.