BACKGROUND: The provision of end-of-life care remains a significant component of work for clinicians in critical care settings. Critical care nurses report that this area of practice receives limited attention in education and training.
OBJECTIVES: The objective of this study was to identify and describe the end-of-life care content in postgraduate critical care nursing programs in Australia.
METHODS: Using a descriptive exploratory research design, an Internet search was undertaken in August 2015, identifying 17 education providers offering postgraduate critical care nursing programs. Thirteen individuals agreed to participate in a structured telephone interview regarding end-of-life content in their postgraduate program. Descriptive statistics were calculated to summarise the data obtained.
RESULTS: Twelve participants reported that end-of-life care content was explicitly addressed in their postgraduate critical care nursing programs, yet variation in actual content areas covered was evident. The majority of programs addressed content related to organ donation (92%) and legal and ethical issues (77%). However, content least commonly identified as covered pertained to the work of the nurse in providing direct clinical care to the patient at the end of life and his or her family, including the physical changes experienced by the dying patient (31%), respiratory management encompassing withdrawal of ventilation and symptom management (23%), emotional support of family (23%), care of the body after death (23%), and the process of withdrawing life-sustaining treatment (15%). Participants (92%) agreed that end-of-life content was important in postgraduate critical care nursing programs, with 77% of participants agreeing that more time should be allocated to end-of-life content.
CONCLUSIONS: This study provides preliminary evidence of the variation in end-of-life content in postgraduate critical care nursing programs in Australia. Addressing gaps in end-of-life care content in formal education, including clinical care of the dying patient, is urgently needed to address the complexity of this phase of care that is so frequently provided in critical care units.
Nurse educators have a unique role to prepare nursing students for all aspects of patient and family care, from birth through death. Knowing that death is inevitable is not the challenge. Preparing nursing students to cope with death and address personal and community myths about death and dying are the challenges. Opportunities for students to examine personal and community associations with death are essential for nursing students preparing to enter the field. Biophysiological processes and treatment protocols are an essential part of each course; however, one course in a Department of Nursing in a small university in the Midwestern United States provides students the opportunity to reflect on death and dying and includes the experience of creating a tangible symbol to “hold on to” as they professionally and thoughtfully work with dying patients and their families, as well as cope with their own experiences of loss and grief in their careers.
BACKGROUND: Many nursing schools have begun to address the gap in palliative care education. Recently released entry-to-practice competencies in palliative care can guide educators as they incorporate such material into their curriculum. In an effort to evaluate learning, educators need a reliable instrument that aligns with the updated competencies.
PURPOSE: This article describes the development of a new instrument to evaluate perceived competence to provide primary palliative care.
METHODS: The psychometric properties and performance of the new instrument in evaluating perceived competence were tested via an interprofessional palliative care simulation with medical, nursing, and social work students. Perceived competence was measured before and after the simulation.
RESULTS: The new instrument demonstrates strong reliability and validity, represents a unidimensional construct, and captures changes in perceived competence across time and disciplines.
CONCLUSIONS: The new instrument is acceptable for assessing perceived competence to provide palliative care, particularly for nursing students.
Context: Nurses play an inevitable role in providing compassionate care and support to dying patients and their families. However, it has been a bone of contention that whether the nursing curriculum is sufficiently set to achieve this goal.
Aims: The primary objective of this study is to assess the attitude of nursing students attending a private nursing school in Central Travancore region toward the care of dying using the Frommelt Attitude Toward Care of the Dying Scale Form-B (FATCOD-B).
Methodology: FATCOD-B was introduced among 146 participants and an arbitrary cutoff of 65% of the total score were chosen with those scoring more than that were assumed to have a positive attitude. A principal component analysis was done to identify the key constructs and mean score of the items within these identified constructs were calculated.
Results: The positive attitude toward dying was shown by 39% of participants. Most of the students' responses were averaging toward the option uncertain. A statistically significant increase in mean score by 3.15 (P = 0.02) was noticed among those who completed palliative care postings. The keys constructs identified included perception toward the end-of-life care, emotional engagement with the dying, and perceptions with respect to professional engagement with subgroup analysis showing an average mean score (standard deviation) of 4.36 (0.144), 2.25 (0.874), and 3.39 (0.85), respectively.
Conclusion: The revision of the current curriculum incorporating more palliative care postings with specific attention toward handling emotional engagement with the dying may help in developing a positive attitude.
Being able to communicate effectively is an essential skill for all nurses. Communication in paediatric end of life care can be challenging for both the student and lecturer as it is a rare experience and challenging to teach. Innovative approaches to teaching communication skills such as role play, simulation and drama have been used; however there is a dearth of literature examining the use of drama in this specialist context. The aim of this study was to explore the effectiveness of a novel workshop in teaching transferable knowledge and skills in palliative, end of life and bereavement care communication to a convenience sample of first year pre-registration nursing students undertaking clinical skills training at a UK university. Qualitative and quantitative data were obtained from pre and post intervention questionnaires exploring student's perception of communication skills. Qualitative data were analysed thematically and quantitative data presented as standard descriptive statistics. The novel communication workshop facilitated students' exploration of how good and poor communication looks and feels and introduced aids to inform communication in clinical practice. Exposure to different learning approaches provided opportunities to both gain confidence in engaging in new learning activities and develop knowledge and skills through purposeful engagement.
Many nurses report a lack of confidence providing care for patients facing a life-threatening illness. Palliative care leaders have devised primary palliative nursing care competencies (CARES [Competencies And Recommendations for Educating undergraduate nursing Students]) that all students should achieve. In this study, nursing students participated in an innovative palliative care immersion experience, the Comfort Shawl Project. We performed a reliable content analysis of their narrative reflections. The goal was to evaluate whether reflections on their interactions with patients/families were consistent with CARES competencies. Nine female students wrote reflections after gifting each of the 234 comfort shawls to patients. Four CARES-related categories were analyzed: Individual Values and Diversity, Compassionate Communication, Fostering Quality of Life, and Self-Insight and Emotion. Reflections were highly representative (41%) of recognizing Individual Values and Diversity, representing sensitivity for patients' unique differences in values, an integral component of palliative care. The Comfort Shawl Project shows promise as an experiential immersion for introducing nursing students to CARES competencies.
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.
Introduction : alors que l'intégration de la démarche palliative aux études de médecine est un des objectifs du plan national de développement des soins palliatifs, quelles sont les attentes des internes de médecine générale quant à une formation en soins palliatifs ?
Méthode : il s'agit d'une étude descriptive, réalisée à partie d'un questionnaire envoyé par mail aux internes inscrits en Diplôme d'Etudes Spécialisées (DES) de médecine générale de l'Université de Reims Champagne Ardenne (URCA) pour l'année universitaire 2016-2017. L'enquête s'est déroulée entre le 9 octobre et le 11 novembre 2017. Résultats : 93 réponses ont été analysées. Quatre-vingt-douze pour cent des répondeurs souhaitent une formation plus approfondie en soins palliatifs. Les principaux types de formations souhaités étaient : la discussion de cas cliniques en groupes, les stages d'initiation en structures de soins palliatifs et les débriefings sur les lieux de stage avec un médecin sénior. Ils souhaitaient la mise en place de cette formation en troisième cycle des études médicales et avant confrontation à des situations palliatives.
Discussion : la mise en pratique permet de nous améliorer dans la prise en charge du patient et de créer notre propre identité professionnelle en développant nos compétences. Le modèle de formation britannique est celui qui semble le plus adapté aux attentes de nos internes. Actuellement la formation des médecins évolue, avec l'application des mesures proposées par le plan national de développement des soins palliatifs. Désormais un enseignement sur les soins palliatifs et un stage court sont proposés en deuxième cycle des études médicales. Il parait primordial d'élargir cette mesure en troisième cycle.
Conclusion : les internes de médecine générale de l'URCA souhaitent une formation approfondie en soins palliatifs au cours du DES de médecine générale, avec mise en pratique clinique.
Origine : BDSP. Notice produite par BIUSANTE HR0xrBID. Diffusion soumise à autorisation
Worldwide, more than 19 million people require palliative care because of an advanced stage of disease. Undergraduate nursing education should include palliative care as the European consensus suggests. In 2004, the European Society of Palliative Care issued a guide for the development of palliative nurse education in Europe. This study aims to describe the extension and characteristics of palliative care education within all of the nursing degree curricula in Italy, as well as to what extent their topics match the European Society of Palliative Care guide. A descriptive study was conducted through the universities web pages. For each degree, the curricula of the academic years from 2010 to 2014 were analyzed. Sixty percent of the curricula had formal education in palliative care, heterogeneously distributed in different courses and provided few compulsory and mandatory teaching hours. Data on clinical training suggested that education was essentially theoretical, with poor theory and practice integration. The increasing need for palliative care in different settings corresponds to increasing attention to nursing education in palliative care from the undergraduate level. The inclusion of palliative care teaching in universities at all levels of education and research development represent the future challenges for this discipline.
BACKGROUND: Health-care providers report a lack of training in end-of-life care and limited opportunities exist to learn about the dying process in home settings where most prefer to die.
AIM:: To evaluate the effectiveness of a Community Action, Research, and Education (CARE) program designed to promote empathy and self-efficacy communicating with and caring for terminally ill patients.
METHODS: This mixed-methods study collected preâ€“post data from 18 undergraduates (7 men= 11 women) in a 8-week immersive program where they served as primary caregivers in residential homes for the dying providing 200 hours of bedside care to hospice patients during their final days. Quantitative measures assessed empathy using the Jefferson Scale of Empathy-Health Professions (JSE-HPS) version and self-efficacy using a 20-question palliative care skill assessment. Qualitative analyses were conducted on reflective journals to further assess knowledge, skill, and value development.
RESULTS: Paired t tests revealed significant increases in empathy ( P < .05) and self-efficacy ( P < .001) to provide end-of-life care. Thematic analysis of reflective journals further demonstrated specific instances of empathy and self-efficacy.
CONCLUSIONS: Community-run residential homes for the dying offer a unique opportunity for skills training in end-of-life care. The opportunity to serve as a caregiver for the dying improved students' confidence and ability to provide empathic patient- and family-centered end-of-life care to hospice patients in their final days.
Chaque année, des dizaines de milliers de jeunes gens, filles et garçons, se lancent dans des études en soins infirmiers.
Entre cours théoriques, exercices pratiques et stages sur le terrain, ils devront acquérir un grand nombre de connaissances, maîtriser de nombreux gestes techniques et se préparer à endosser de lourdes responsabilités.
Ce film retrace les hauts et les bas d’un apprentissage qui va les confronter très tôt, souvent très jeunes, à la fragilité humaine, à la souffrance, aux fêlures des âmes et des corps. C’est pourquoi il nous parle de nous, de notre humanité.
Background: Palliative care education and experience are needed for student competence in delivering high-quality palliative nursing care. Simulation has been linked to acquired clinical competency among pre-licensure students. A known literature gap is measurement of students' performance during end-of-life simulations.
Objectives: The aim of this study was to determine relationships among previous palliative care nursing experience, knowledge, self-awareness, and performance in nursing students during an end-of-life simulation.
Design/Setting/Participants: A quasi-experimental pretest/posttest design was used to assess these variables with a convenience sample of 75 senior nursing students during an end-of-life simulation at a Midwest Jesuit university.
Methods: Self-awareness was measured with the Frommelt Attitudes Toward Care of the Dying, Form B. The Palliative Care Quiz for Nursing measured participants' knowledge. Participants' performance during the simulation was measured using a modified version of the Creighton Competency Evaluation Instrument®. Palliative care nursing self-awareness and knowledge were assessed before and after the simulation. Previous end-of-life care experience was assessed with a single demographic question at pretest only.
Results: The sample was highly experienced in end-of-life care (93.3% reporting experience pre-simulation). Although pretest self-awareness (M = 124.5; ±1.3) and knowledge (M = 57.1%; ±2.2) were higher in students with two or more types of end-of-life experience (n = 42), there were no significant differences (p > .10) in these outcomes by groups pre- or post-simulation. Self-awareness (M = 130.1; ±1.2), knowledge (M = 80.5%; ±2.6), and performance (M = 94.1%; IQR 87.5 to 100) scores were high for student participants (n = 36) post-simulation, with moderate correlations found between some scores (rpb < -0.40 or 0.40).
Conclusions: Findings support self-awareness and knowledge as antecedents of high quality palliative nursing care. Students demonstrated increased post-simulation knowledge, self-awareness, and quality performance of palliative nursing care regardless of previous end-of-life experience. End-of-life simulation is supported as an education method for increasing palliative care nursing competence and assessing student performance of palliative care nursing interventions.
BACKGROUND: It is important that education on palliative care begin early in prelicensure nursing education because of the complex care needs of patients requiring end-of-life care.
PROBLEM: Nursing students often lack confidence and skills in providing quality care for these patients.
APPROACH: Nursing students' attitudes on end-of-life care were assessed using the Frommelt Attitudes Toward Care of the Dying scale. Students were tested as sophomores, then again as seniors, in a nursing program where the End-of-Life Nursing Education Consortium (ELNEC) curriculum had previously been integrated.
OUTCOMES: Seniors reported improved comfort levels providing end-of-life care.
CONCLUSION: Assessing for improved comfort levels among nursing students who receive ELNEC training could help support ongoing efforts to integrate this education in all nursing programs. Students who had formal education in end-of-life care were more comfortable caring for patients at end of life and had a better understanding of their role.
Spiritual care is a part of integrated care and should not be considered as a separate aspect of palliative care. Spirituality is seen as a requirement that must be met for all patients. The aim of this study is to determine the influence of palliative care on the perception levels of student nurses regarding spirituality and spiritual care. The research was carried out as a single-group pretest–posttest intervention study. The study was conducted with 70 student nurses. Data were collected via personal information form and spirituality and spiritual care grading scale (SSCGS). Frequency, percentage, average, standard deviation, paired sample t-test and Wilcoxon test were used to analyze the data. 55.7% of the students who participated in research stated that they had never heard of spiritual care, and 81.4% of the students stated that they had not obtained any information regarding spiritual care. The point average of the student nurses related to SSCGS was found to be 3.27 ± 0.21 before training and 3.35 ± 0.22 after training. The difference between the total point averages of the student nurses pre- and posttraining was found to be statistically significant (p < 0.05). As a result of the research, the perception of the student nurses regarding spirituality and spiritual support was found to be above the middle and increased significantly after the training. In accordance with these results, it is suggested that spiritual care training should be included more into nursing education.
This mixed methods study explored the impact of the End-of-Life Nursing Education Consortium (ELNEC)–Undergraduate Curriculum on perceived preparedness of undergraduate nursing students in the care of dying patients and the relationship between personal loss experience and undergraduate nursing students’ attitudes regarding the ELNEC-Undergraduate Curriculum. Of the 36 undergraduate nursing students who completed ELNEC, 24 reported a personal loss of a close family member or friend to death and 12 reported no loss. Findings confirmed the overall positive impact and acceptability of ELNEC, but this effect was observed differently between students with and without previous loss. Students with personal loss were more aware of the challenges of end-of-life care before taking ELNEC and incorporated the content into a greater sense of preparedness. Study recommendations include placing ELNEC within didactic instruction by well-prepared faculty, creating simulation debrief groups composed of both students with and without loss, and faculty attention to the loss experiences of students.
BACKGROUND: Palliative care education for non-specialist health professionals is an important strategy for widening access to palliative care.
AIM: To describe Cameroonian nursing students' experiences and perceptions of the strengths and weaknesses of a palliative care course, with a view to refining the course.
METHODS: Three focus groups were conducted with 23 students, and data were analysed thematically using the framework approach.
RESULTS: The students reported connecting with their past personal and professional experiences in the care of patients with palliative care needs during the course. The main course strength reported was its use of a variety of interactive educational strategies, such as role plays, group discussions and case studies. The course's main reported weakness was the lack of supervised clinical practice in palliative care.
CONCLUSION: The use of a variety of interactive educational strategies-including supervised clinical practice-is considered by nursing students as vital to enhancing learning in palliative care education. However, the lack of supervised palliative care clinical practice opportunities is a challenge in Cameroon.
BACKGROUND: It is not known if standard nursing actions are tailored to patient preferences for comfort measures during End of Life (EOL) care.
OBJECTIVES: Determine the effect of a brief teaching intervention on student care of EOL patients.
DESIGN: Pre-test/post-test intervention design.
SETTINGS: Two large public universities and one smaller private Catholic institution (all in the United States [U.S.]).
PARTICIPANTS: 471 nursing students attending class as part of their required nursing curriculum.
METHODS: A previously developed aggressiveness of nursing care scale was modified to determine students' behavioral intentions for the care of the EOL patient before and after a standardized lecture. The lecture was designed to help students recognize that nursing care priorities for the EOL patient may need to be different than for other patients in order to provide the best quality of remaining life.
RESULTS: Nursing students prior to the lecture had aggressiveness of care scores similar to those of experienced staff nurses, and were more likely to provide more aggressive care to younger patients without DNR orders than to older patients with a DNR order. Following the lecture, aggressiveness of nursing care scores decreased significantly for all EOL patients, and students reported similar behavioral intentions for all EOL patients, regardless of patient age or code status. Student age was marginally related to change in behavior following the lecture. Prior experience in caring for a dying patient or relative did not have a significant effect on aggressiveness of care scores before or after the lecture.
CONCLUSIONS: This study demonstrates the effectiveness of a brief teaching intervention to help student nurses take patient preferences and needs into consideration when selecting nursing interventions for the EOL patient.
BACKGROUND: While palliative care (PC) competencies for medical school graduates have been defined, the lack of established curriculum models and assessment tools hampers curricular evaluation.
OBJECTIVE: To describe the scope and content of the University of Rochester's longitudinal, integrated four-year PC curriculum after 17 years of implementation, review student evaluative responses, and compare the curriculum to national competency standards.
DESIGN AND SETTING: Combining and reorganizing a published PC curriculum assessment tool and a list of medical school PC competencies, we created a novel nine-topic framework to assess the content coverage of our curriculum. We queried our electronic medical school curriculum database and surveyed course and clerkship directors, as well as PC, pain, ethics, and humanities faculty, to locate where and when PC topics are taught and to collate student responses to these experiences.
RESULTS: We present a comprehensive list of PC curricular activities over a four-year medical school experience. The curriculum covers all nine PC topics longitudinally in multiple formats. Five in-depth activities cover multiple PC topics in a format that integrates biological, psychological, and social dimensions; these activities have survived and evolved over 17 years in our setting. A majority of year 3 University of Rochester students feel "well" or "extremely well" trained in PC.
CONCLUSIONS: Our four-year PC curriculum provides robust and developmentally appropriate training that addresses all nine evidence-based core topics for PC education. Medical student feedback and their Association of American Medical Colleges (AAMC) survey responses suggest that they find their PC learning experiences rewarding. This curriculum could serve as a model for other schools.
The purpose of this study was to analyze the impact of interprofessional pediatric end-of life simulations for health professions students. A quasiexperimental design was used with three TeamSTEPPS® tools. Forty-one students were enrolled (nursing = 20, medicine = 10, pharmacy = 10, public health = 1). TeamSTEPPS 2.0 Teamwork Attitudes Questionnaire and Teamwork Perceptions Questionnaire analysis indicated a significant difference in mean pretest and posttest scores (p = .015 and p = .028, respectively). The Team Performance Observation Tool indicated statistical significance between simulations (p < .001, df = 18, r = .8). Simulations were significantly related to an increase in faculty observation scores, TeamSTEPPS 2.0 Teamwork Attitudes Questionnaire pre-post scores, and TeamSTEPPS 2.0 Teamwork Perceptions Questionnaire pre-post scores.