Nurses spend more time with seriously and terminally ill patients across the continuum of care than other health professionals, yet nursing students lack adequate palliative care education and experience when they transition to practice. In response to the American Association of Colleges of Nursing CARES competencies for enhanced preparation in palliative care, the End-of-Life Nursing Education Consortium developed modules for undergraduate programs. Nursing students' life experiences and their prior involvement with death and dying situations shape their potential achievement of end-of-life learning outcomes. The purpose of this study was to explore traditional and nontraditional students' perspectives and outcomes of their lived experiences in response to the End-of-Life Nursing Education Consortium modules and current palliative care program curriculum. Following university institutional review board approval, the phenomenological qualitative study included 2 focus groups of traditional and transfer students. Thematic data analysis revealed 4 primary themes with differences noted between groups in response to these themes: (1) witnessing suffering and death, (2) building courage and competence, (3) conversation challenges, and (4) curriculum issues and recommendations. Implications for future palliative care education indicate opportunities to better support students through expanded simulations and debriefing sessions, integrated roles for clinical faculty and preceptors, and interdisciplinary team collaboration opportunities across settings.
OBJECTIVE: The aim of this review was to explore the experiences of nursing students participating in end-of-life education programs.
DESIGN: A systematic review.
DATA SOURCES: Exhaustive literature searches were performed using seven electronic databases: Medline, Scopus, Web of Science, CINAHL Plus, Dialnet Plus, Eric and Cuiden Plus.
REVIEW METHODS: In total, 6572 studies published from 2008 until 2018 were examined. The Critical Appraisal Skills Program was used to assess the quality of the studies included in the review. The findings were synthesized using meta-aggregation.
RESULTS: Seventeen studies were included in this systematic review, representing a sample of 606 nursing students. Simulation methods were most common among the educational programs analyzed. The analysis of qualitative data allowed us to identify 260 illustrations which were grouped into 14 categories and three themes: feelings and emotions during the performance of the pedagogical activity, end-of-life education among nursing students and competencies acquired on death and end-of-life. The most highlighted communication skills were learning to listen and building confidence to speak with the patient, family and the general public.
CONCLUSIONS: End-of-life programs generally helped students acquire communication skills, learn concepts and improve the administration of this type of care. In addition, they perceived the experience as an opportunity to learn more about oneself, gain trust and support critical thinking. Nonetheless, the evidence available in this field is limited due to the small number of studies, plus the limited data reported. Thus, further studies on this subject are necessary.
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.
Nursing education programs and nursing textbooks often present accounts of the work of Dr Elisabeth Kübler-Ross and her “5 stages” model. In this article, we examine a sampling of recent North American nursing textbooks to illustrate the different ways those subjects are discussed. Unfortunately, the information provided is not always accurate or helpful in guiding readers. We describe why that is so and suggest some ways in which better guidance could be delivered. It is particularly timely to undertake this examination since 2019 is the 50th anniversary of the publication of On Death and Dying, the well-known book in which Dr Kübler-Ross first published her theory and descriptions of the work that led to it.
Palliative care education at the undergraduate and graduate level is necessary to improve the competency and confidence of nurses and ultimately improve the care of patients with a chronic illness. Unfortunately, the curriculum in nursing education programs lacks palliative care content, resulting in a lack of preparation and confidence among nursing students. The purpose of this study is to examine the effect of educating nursing students utilizing an interactive, multimodality palliative care class that focuses on palliative and end-of-life care. The Palliative Care Quiz for Nurses and Frommelt Attitude Toward Care of the Dying survey were used to assess nursing students before and after a newly developed palliative care class. A Wilcoxon matched-pairs signed rank test was used to determine a difference in pre and post scores. Results revealed a significant improvement in knowledge, attitude, and comfort with palliative and end-of-life care.
Palliative care as a foundation for patient-centered care is not adequately covered in nursing curricula. This gap in education means that pediatric oncology nurses may lack necessary palliative care competencies to provide comprehensive care to patients. A literature review was performed to determine if nurses believe that they are prepared to provide clinical palliative care to pediatric patients and how pediatric palliative care best practices can be better integrated into nursing education programs. According to the literature review, studies suggest that providing pediatric palliative care education in nursing programs can build nurses' confidence and better prepare them to competently care for patients and families.
BACKGROUND: Undergraduate nursing students encounter patients at the end of life during their clinical training. They need to confront dying and death under supportive circumstances in order to be prepared for similar situations in their future career.
AIM: To explore undergraduate nursing students' descriptions of caring situations with patients at the end of life during supervised clinical training.
METHODS: A qualitative study using the critical incident technique was chosen. A total of 85 students wrote a short text about their experiences of caring for patients at the end of life during their clinical training. These critical incident reports were then analysed using deductive and inductive content analysis.
FINDINGS: The theme 'students' transformational learning towards becoming a professional nurse during clinical training' summarises how students relate to patients and relatives, interpret the transition from life to death, feel when caring for a dead body and learn end-of-life caring actions from their supervisors.
IMPLICATIONS: As a preparation for their future profession, students undergoing clinical training need to confront death and dying while supported by trained supervisors and must learn how to communicate about end-of-life issues and cope with emotional stress and grief.
The study examined the influence of training on first-year nursing department students’ attitudes on death and caring for dying patients. Utilizing the experimental model, the study sample consisted of 81 first-year students attending the nursing department of a university. Death Attitude Profile-Revised and Frommelt Attitude toward Care of the Dying Scale were used for data collection. Data analysis included means, standard deviation, and t test for related samples. Student attitudes toward death were measured as 146.43 (16.741) and 152.75 (15.132) for pre- and posttraining, respectively. Student attitudes toward caring for dying patients were established to be 103.02 (7.655) during pretraining period and 111.02 (10.359) at posttraining period. The difference between pre- and posttests for mean attitudes toward death and caring for the dying patient was statistically significant. Study results determined that training was effective in forming positive student attitudes toward death and caring for dying patients.
L'universitarisation de la formation infirmière engagée depuis 2009 vise la professionnalisation des futurs professionnels de santé dans un environnement hospitalier mouvant. Cette approche fondée sur les compétences, la réflexivité et l'agentivité de l'étudiant nécessite un accompagnement pédagogique individualisé. L'accompagnement pédagogique est au coeur des relations entre le cadre de santé formateur et l'étudiant infirmier.
Ce travail de recherche questionne l'impact de l'accompagnement pédagogique sur l'agentivité de l'étudiant au service de sa professionnalisation. Afin de confronter nos hypothèses mettant en évidence l'intérêt de l'agentivité et de l'auto-efficacité dans la formation à la réalité, nous avons rencontré des étudiants en soins infirmiers en milieu de formation. Qui de plus au fait de leur vécu de formation et de leur apprentissage que les étudiants eux-mêmes ?
Les situations de soins palliatifs ou de fin de vie peuvent être difficiles à gérer pour les étudiants en soins infirmiers.
L'évolution de la formation infirmière a permis la mise en place d'enseignements de soins palliatifs et des moyens d'accompagner les étudiants dans leur apprentissage de ces situations.
Le suivi pédagogique des étudiants et l'analyse de pratiques professionnelles pourraient être des moyens de gérer les situations de soins palliatifs et de fin de vie, en développant la pratique réflexive et les compétences des futurs professionnels.
Des étudiants ont participé à cette recherche, les résultats ont permis d'ouvrir la réflexion et d'élargir l'hypothèse.
La professionnalisation en serait-elle la clé ?
Nursing students, who have been receiving the End-of-Life Nursing Education Consortium (ELNEC) Core training throughout their Bachelor of Science in Nursing program, have a unique perspective of the benefits of this training. In addition, they have insight as to where an online ELNEC module series specifically for undergraduate nursing students would best be integrated within the curriculum. This study used a mixed methods strategy to evaluate students' opinions on the placement of end-of-life care education within the curriculum and their experience of having received ELNEC training previously throughout their program. Senior-level nursing student opinions on the placement of the ELNEC modules within the curriculum were equally divided, with one-third suggesting placement at the sophomore level, one-third suggesting placement at the junior level, and one-third suggesting placement at the senior level. Students also offered a recommendation for an end-of-life care simulation integration into the Bachelor of Science in Nursing curriculum. Students who have been receiving ELNEC training integrated throughout the curriculum reported feeling comfortable with providing end-of-life care after graduation. Themes extracted from students' suggestions on improving end-of-life care education were as follows: (1) The quality and consistency of instruction needs to be enhanced, (2) palliative care education should be delivered using various methods, and (3) methods to assess education on palliative care should be improved. Students reported that ELNEC training helped them to gain insight into the key elements in palliative care, to understand the differences and similarities between palliative care and hospice, and to understand the nurse's role in palliative care and hospice.
Primary palliative care education should be provided within prelicensure programs to maximize nurses’ preparation to care for patients with serious, life-limiting illness before entering professional practice settings. Curricula need to be assessed to identify current content integration across nursing programs. The specific aim of this feasibility study was to evaluate the effectiveness of a survey methodology to assess primary palliative care content integration within prelicensure nursing curricula in multiple programs. A secondary aim was to compare content integration across nursing programs. Faculty teaching in prelicensure courses at 3 accredited nursing programs were recruited to complete a 50-item curriculum assessment survey based on the End-of-Life Nursing Education Consortium Undergraduate Curriculum. Response rates were 73%, 26.7%, and 18.8%, respectively. All content areas were reported as being taught by at least 1 faculty member per institution. Lecture was the primary pedagogy to teach all End-of-Life Nursing Education Consortium Undergraduate content areas, followed by clinical conference/debriefing and simulation. Content was primarily taught in Critical Care, Maternity, Adult Health, Gerontology, and Fundamentals courses. The disparate response rates suggest that survey dissemination may prove ineffective for multisite curricula evaluation. Implications for nursing education and clinical practice will be discussed.
BACKGROUND: The need to provide care for the dying patient and his/her family may occur in every medical setting. Newly graduated nurses and physicians should therefore be prepared to deliver it at a high-quality level.
OBJECTIVES: To explore (a) the primary difficulties participants anticipate they will encounter whilst working with dying patients, (b) their interest in developing competencies in caring for dying patients, and (c) their interest in working in palliative/hospice settings or with dying patients in the future.
DESIGN: A cross-sectional study.
SETTINGS: A medical university in Poland.
PARTICIPANTS: Convenience sample of nursing (=112) and medical students (=101) at the end of their undergraduate education.
METHODS: Questionnaire distributed online and in hard-copy format.
RESULTS: Half of the participants anticipated experiencing various emotional and professional difficulties in caring for dying individuals, especially medical students. These difficulties pertained mostly the reaction of family members to the patient's death, addressing the psychological needs of the dying person, and coping with his/her own emotions when dealing with the patient's death. Students reported that working with dying patients could cause occupational stress - more so among medical students. The majority of them showed an interest in improving knowledge regarding palliative care and also in this case this was mostly true of medical rather than nursing students. However, more than half of the participants preferred avoiding work in palliative/hospice settings, with no differences between the two groups. Participants attributed this attitude to two factors: (a) the desire to avoid negative emotions and stress that could be triggered by dealing with death and dying; and (b) because they felt they lacked the required skills and personal abilities to handle such situations.
CONCLUSIONS: Undergraduate curricula that include strategies for coping with negative emotions associated with facing the process of death and dying should be developed. Interprofessional education should be encouraged, especially regarding the psychosocial aspects of end-of-life care.
Background: Educational deficiencies among hospice and palliative medicine (HPM) physicians contribute to suboptimal utilization of palliative radiotherapy (PRT) for patients with advanced cancer.
Objective: to survey HPM fellowship program directors regarding the need for PRT education in HPM fellowship.
Design: We conducted a cross-sectional survey of HPM fellowship program directors in June 2018. We used a 5-point Likert-type scale to assess agreement with statements related to PRT education.
Setting/Subjects: program directors for all United States Accreditation Council for Graduate Medical Education-accredited HPM fellowship programs with at least one enrolled fellow at the time of survey distribution were included.
Results: eighty-one of 120 eligible program directors completed the survey (68% response rate). Nearly all of the respondents agreed that HPM physicians should possess a working knowledge of PRT and that the principles of PRT should be formally taught in HPM fellowship. Thirty percent of HPM fellowship programs, however, lacked a PRT curriculum and only 14% of programs provided more than two hours of PRT education. Limited didactic time, lack of interest among fellows, and lack of collaboration with radiation oncologists were not perceived to be significant barriers to incorporating PRT education into HPM fellowship. More than 75% of program directors indicated that they would consider implementing a PRT curriculum designed specifically for HPM physicians if one were available.
Conclusion: There is a need for PRT education in HPM fellowship. This need may be best addressed by developing a widely accessible PRT curriculum designed to meet the needs of HPM physicians.
Background: Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care.
Objective: to assess the need for PRT education in HPM fellowship.
Design: A cross-sectional survey of HPM fellows was conducted in June 2018.
Setting/Subjects: The survey was distributed to accredited HPM fellowship programs in the United States for distribution to enrolled fellows; 114 fellows responded to the survey.
Results: Nearly all respondents agreed that the principles of PRT should be taught in HPM fellowship, yet 51% had received no PRT education and 35% had received only one or two hours. Only 25% of respondents rated their working knowledge of PRT as sufficient, 40% felt confident in identifying radiation oncology emergencies or managing radiotherapy side effects, and 52% felt confident in assessing which patients to refer for radiotherapy. More than 75% agreed that were they more knowledgeable about PRT, they would be more likely to consider referral to radiation oncology, to collaborate with radiation oncologists, and to advocate for a short course of treatment based on a patient's prognosis or goals or care. Fellows who received PRT education in fellowship had significantly greater knowledge of and more favorable attitudes toward the use of radiotherapy. This difference was the greatest among fellows who had received at least five hours of PRT education.
Conclusion: There is a need for PRT education in HPM fellowship. Efforts to address this need may lead to more appropriate utilization of PRT for patients with advanced cancer.
BACKGROUND: The need to provide quality end-of-life care is universally accepted. International research and policies encourage innovative ways that effective culturally appropriate care can be provided. Higher education institutions and practice settings are tasked with ensuring that nurse graduates have the knowledge, skills and insight to deliver person-centred end-of-life care.
RESEARCH AIMS AND OBJECTIVES: The aim was to explore student evaluation of end-of-life care learning within a three-year undergraduate adult nursing degree programme. Objectives were to assess student perceptions of the content and level of learning achieved, explore usefulness of learning, highlight areas that were most useful, and identify suggestions to improve learning.
DESIGN: A 3-year quantitative longitudinal design was used. A questionnaire containing open and closed questions was designed to incorporate the personal and professional learning strategies indicated by the Nursing and Midwifery Council (NMC) (2010).
SETTING AND PARTICIPANTS: The evaluation was completed at the same time point over a three-year period from April 2015–April 2017. The participants were year three student nurses, from 3 consecutive years, enrolled on a pre-registration adult nursing course at one university. There was a 66% response rate (n = 336).
METHODS: Participant information sheets and questionnaires were distributed and time to complete them facilitated. Responses from closed questions were coded and analysed using descriptive statistics (SPSS 24) and thematic analysis used for open questions.
RESULTS: Students expressed satisfaction with their learning, 88.7-97% of students reported a positive impact on their knowledge. They developed an understanding of the impact the nurse can have on the patient and family experience, reporting more confidence and competence in most aspects of end-of-life care. They noted improved ability to utilise this in their subsequent practice experience 88.1-97%.
CONCLUSIONS: Structured end-of-life care within the curriculum is essential to equip graduate nurses to provide effective evidence informed care. Planning should continue for curriculum development that encompasses person-centred end-of-life care across cultures.
PURPOSE: This study attempted to examine the influence of resilience, life satisfaction, and psychological well-being on attitude to death.
METHODS: A predictive correlational design was used. The participants were 184 nursing students from three universities of Korea. They responded to a self-report questionnaire, with items on demographics, resilience, life satisfaction, psychological well-being, and attitude to death.
RESULTS: The mean score for attitude to death was 2.77±0.39 (range, 1-4), and a significant difference was observed depending on age, grade, and death-related education. Attitude to death was positively correlated with death-related education, resilience, life satisfaction, and psychological well-being. Results of the hierarchical multiple regression analysis indicated that death-related education and psychological well-being were significant predictors of attitude to death, explaining 26.6% of the latter. The most important factor was psychological well-being.
CONCLUSION: Although death-related education and psychological well-being are two of the most influential factors among nursing students, no more than 30.4% of this study's participants received death-related education. Death-related education is necessary to help nursing students so that they can cope positively with stressful situations by finding positive meaning. It is necessary to develop a systematic curriculum so that these students can establish a positive attitude to death.
BACKGROUND: End-of-life care is challenging on health professionals' mental and emotional state. Palliative care education can support health professional students' transition, helping them to cope with the challenges of working in this complex setting. Students feel that they need more preparation in this area.
PURPOSE: To collate the relevant information regarding how to teach health professional students about palliative care.
METHOD: The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC, and EMBASE via Elsevier were searched until April 7, 2019. Inclusion criteria were randomized controlled trials of group interventions that aimed to increase health professional students' knowledge, skills, or attitudes in palliative care. Studies were appraised using the PEDro scale. Data were synthesized using meta-analysis.
RESULTS: The results favored the intervention and were statistically significant for knowledge and attitudes but not for skills. A 2-hour seminar accompanied by readings seems sufficient to improve both knowledge and attitudes. Quality assessment scores ranged from 1/10 to 7/10 (mean 5, standard deviation 1.73). When studies at high risk of bias were excluded, then only knowledge improved significantly. Key areas where rigor was lacking were in concealing the randomization, omitting intention-to-treat analysis and not blinding of participants, therapists, or assessors.
CONCLUSIONS: Palliative care education is effective in improving health professional students' knowledge and attitudes toward palliative care. More research is required into skill development. This review highlights the need for more high-quality trials in both the short and long-term to determine the most effective mode of palliative care education.
CONTEXT: There is a need to improve both primary palliative care (PPC) education and its assessment in graduate medical education (GME). We developed an instrument based on published palliative care (PC) competencies to assess resident competency and educational interventions.
OBJECTIVES: To describe the development and psychometric properties of a novel, competency-based instrument to measure resident knowledge and self-efficacy in PPC.
METHODS: We created a 2-part instrument comprised of a knowledge test (KT) and a self-efficacy inventory (SEI) addressing 18 consensus, core PC resident competencies across 5 domains: pain and symptom management; communication; psychosocial, spiritual, and cultural aspects of care; terminal care and bereavement; and PC principles and practice. The instrument was distributed to 341 internal medicine residents during academic years 2015 to 2016 and 2016 to 2017. A standard item analysis was performed on the KT. Internal consistency (Cronbach a) and variable relationships (factor analysis) were measured for the SEI.
RESULTS: One hundred forty-four residents completed the survey (42% response). For 15 KT items, difficulty ranged from 0.17 to 0.98, with 7 items ranging 0.20 to 0.80 (typical optimum difficulty); discrimination ranged from 0.03 to 0.60 with 10 items =0.27 (good to very good discrimination). Cronbach a was 0.954 for 35 SEI items. Factor analysis of combined 2015 to 2016 items yielded 4 factors explaining the majority of variance for the entire set of variables.
CONCLUSION: Our instrument demonstrates promising psychometric properties and reliability in probing the constructs of PC and can be further utilized in PC GME research to assess learners and evaluate PPC educational interventions.