A Countrywide Assessment of Omani Undergraduate Nursing Students' Palliative Care Knowledge and Attitudes Towards End-of-Life Care

Palliative care (PC) is a vital part of the responses needed to address the outcomes of cancer and other non-communicable diseases such as chronic pain, terminal illnesses, and end-of-life situations. Until today, there is a significant lack of access to PC in most developing countries, where the majority of the global population lives. Deficiencies in nurses' knowledge and attitudes exacerbate the lack of access to PC and end-of-life care (EOLC) in these countries. This study was conducted in Oman to assess undergraduate nursing students' (NS) PC knowledge and attitudes towards EOLC. A cross-sectional design was used to collect data from 276 NS in all undergraduate programs in Oman. The PC knowledge and attitude towards EOLC were measured using the PEACE-Q and FATCOD-B. The NS had a borderline level of PC knowledge but favorable attitudes towards EOLC. The NS were least knowledgeable about the philosophy of PC, delirium, side effects of opioids, cancer pain, and dyspnea. There were differences in PC knowledge and attitudes across programs. The findings highlight potential deficiencies and opportunities that can be utilized to augment future nursing human resources for PC and EOLC in Oman. We recommend a national interdisciplinary PC education and training consortium (NIPCET-C) to dialogue, develop, promote, monitor, and evaluate PC and EOLC education in Oman.

Nursing Students’ Experiences With Patient Death and Palliative and End-of-life Care: A Systematic Review and Meta-synthesis

AIM

To synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settings BACKGROUND: Nurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.

DESIGN

A qualitative systematic review and meta-synthesis METHODS: PubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012-25 Feb 2023. Qualitative studies of any design reporting nursing students' experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso's 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.

RESULTS

The review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.

CONCLUSIONS

While caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.

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

OBJECTIVES

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

DESIGN

A meta-analysis of observational studies.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

Evidence informed generalist palliative care content for undergraduate nursing curriculum: An integrative review

BACKGROUND

Clinicians delivering palliative care require the specific knowledge, skill and understanding to meet the needs of the dying. Research shows that undergraduate nursing students report feeling inadequately prepared to provide safe and effective palliative care.

OBJECTIVES

To identify existing empirical evidence on generalist palliative care content within international undergraduate nursing curricula and to synthesize existing generalist palliative care topics.

DESIGN

An integrative systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO).

DATA SOURCES

Keywords were searched in six electronic databases CINAHL, Medline, APA PsycINFO, SCOPUS, Cochran Library and ProQuest Nursing & Allied Health Database, between January 2000 and February 2022.

REVIEW METHODS

Studies were selected as per a pre-determined inclusion and exclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Tabulation of the author, year, country, aim, participants and setting, method, generalist palliative care content topics, additional findings and limitations were compiled. A thematic analysis of the data was conducted to organise and categorise generalist palliative care topics into an additional table followed by a narrative synthesis.

RESULTS

Of the n = 1014 papers retrieved, n = 13 studies of varying methodological quality were included in the analysis (n = 8 quantitative descriptive, n = 5 mixed method). Most studies were published in high income countries with developed economies. Methods used to obtain data include survey, extraction of secondary data and expert consensus. Generalist palliative care topics were presented as a list reporting frequency taught/discussed/cited (n = 10), recommended competencies (n = 2), and teaching modules (n = 1). A large variety of topics were identified with differing levels of detail and clear differences in topics identified globally. Overall, the most frequently mentioned generalist palliative care topics were pain and symptom management (n = 12), grief loss & bereavement (n = 12) and communication (n = 11).

CONCLUSIONS

This review demonstrates for the first time that international primary research evidence on generalist palliative care content in undergraduate nursing curriculum is minimal, of varying methodological quality, with visible inconsistencies among studies designed to inform curriculum verses studies reporting what is taught to students. More research is required to create evidence informed generalist palliative care content for undergraduate nursing curriculum.

RECOMMENDATIONS

It is recommended for future research to use international consensus-based methods to inform and develop internationally agreed educational topics to optimise patient care at the point of nurse registration.

Student nurses' knowledge about the management of chemotherapy-induced neutropenia: Multi-national survey

BACKGROUND

Chemotherapy-induced neutropenia is a serious global health concern. It is essential that student nurses who are the future of healthcare are equipped with the right knowledge to care for the unique needs of patients with neutropenia.

OBJECTIVE

The study assesses student nurses' knowledge of neutropenia management and examines the difference in their knowledge with regard to their demographics.

DESIGN

A descriptive cross-sectional survey design was used.

SETTINGS

Participants for this survey were recruited from four nursing schools from three countries: Jordan, Oman, and Saudi Arabia.

PARTICIPANTS

The study sample comprised 230 student nurses representing all three countries.

METHODS

Online data collection was implemented. A message including the link to the study questionnaire was sent to students through their university portal. Demographic data and the neutropenia knowledge questionnaire were collected.

RESULTS

The student nurses showed poor knowledge of neutropenia and its management (mean = 10.1 out of 30). The bridging students (M = 12.6, SD = 9.8) had significantly higher mean total knowledge scores than the regular students (M = 9.8, SD = 5.5) (t = 2.9, df = 38.9, p = 0.006). However, students who had received previous education about neutropenia management (M = 11.6, SD = 5.0) had significantly higher mean knowledge scores than those who had not (M = 9.5, SD = 5.6) (t = -2.73, df = 134.8, p = 0.007).

CONCLUSIONS

The study findings underscore the overarching necessity to improve students' knowledge of neutropenia and its management. However, addressing this concern is multifaceted and requires deliberate effort from various agencies. Developing innovative strategies to increase the coverage of oncology nursing in the curriculum, improving faculty expertise, enhancing staff nurses' knowledge and skills, provision of funding, and adoption of oncology-related competencies in the nursing program need to be explored as key solutions.