Les étudiants en soins infirmiers répondent activement aux exigences universitaires. Ils seront amenés à relever des défis autour d’une pratique soignante légiférée. Les professionnels, les cadres, les apprenants sont tous concernés par les concepts en sciences infirmières pour argumenter le « prendre soin ». La recherche infirmière évolue au regard de l’accélération des progrès scientifiques et techniques. Celle-ci est indissociable des soins relationnels pour développer des compétences transversales, au bénéfice des personnes soignées. Ce dictionnaire permet d’ancrer une identité professionnelle au regard de la singularité des individus, dans un contexte académique. La terminologie favorise l’acquisition d’une posture dite réflexive.
Cette 5e édition est enrichie avec des concepts interprofessionnels. L’approche reste humaniste. Elle est basée sur des apports théoriques en psychologie sociale. Des spécialistes ont rédigé des articles innovateurs pour s’inscrire dans le champ de la recherche interdisciplinaire. Ce dictionnaire sera utile dès le premier semestre en formation initiale pour construire des « analyses de pratiques » jusqu’au mémoire de fin d’études. Les infirmier.ières en pratique avancée y chercheront des repères. Les professionnels y trouveront une aide précieuse pour interroger la relation soignant-soigné.
Background: Palliative sedation is used as a last-resort option to treat refractory symptoms of dying patients. Nurses are important participants in the process of sedation. However, little is known about palliative sedation from a nursing perspective.
Objectives: To analyze the practices and attitudes of nurses concerning palliative sedation.
Data sources and review methods: A scoping review guided by Arksey and O`Malley`s methodological framework was used to analyze existing peer-reviewed empirical research on the topic of the practices and attitudes of nurses related to the palliative sedation of patients aged 18 years and older. Of the 316 publications identified from the PubMed, CINAHL and Cochrane Library, 17 full-text articles were included in this review. The data of the included articles were charted (author(s), year of publication, country, objectives, study design, data collection, setting, respondents, definition of palliative sedation, focus of the study and key findings), and the results were summarized with inductive content analysis. The PRISMA-ScR checklist was used as a guideline for the reporting in this review.
Results: During the decision-making concerning the start of palliative sedation, nurses usually have an advocatory and supportive role, although the role varies between different countries. This role then changes to a relatively independent performance of sedation; including administration of the medication, monitoring the effectiveness of sedation, and in some cases taking decisions concerning the medication and dosage policy. Further, nurses provide information and compassionate care to both the patient and the family during the process of palliative sedation. Most nurses view palliative sedation as a positive and sometimes necessary last resort therapy to relieve refractory suffering of dying patients. However, sedation poses ethical problems for many nurses. These problems especially concern the essential elements of deciding to use palliative sedation, the depth of sedation, the potential for shortening life, and the loss of social interaction.
Conclusions: Nurses play a key role in palliative sedation, as they often perform sedation independently and have important information about the needs and wishes of both patients and their families due to their unique position at the bedside of the patient. Although nurses generally see palliative sedation as a positive practice for selected patients, many of them feel it is ethically controversial. This scoping review reveals a great need for further research and discussion on the practices and attitudes of nurses regarding palliative sedation.
Hospice care requires person-centered holistic approaches from interprofessional health care teams. Traditional curricular models include teaching hospice care in discipline-specific didactic settings. There are limited opportunities for prelicensure students to engage in real-life and hands-on hospice care. Students are often observers and lack meaningful interactions with patients, families, and interprofessional teams. Using “IPEC Core Competencies for Interprofessional Collaborative Practice” and “AACN CARES” as the framework, nursing and social work faculty collaborated to develop, implement, and evaluate an interprofessional home hospice simulation incorporating standardized patients. The purpose of this interprofessional simulation was to facilitate hands-on application of complex health care concepts in an authentic home hospice setting. Twenty-three Bachelor of Science in Nursing students and 10 Master of Social Work students participated as interprofessional teams to provide home hospice care for patients and families. Faculty evaluated the simulation experience through analysis of presimulation and postsimulation guided reflections, intrasimulation observations, and postsimulation debriefing. Evaluation indicated students gained a greater understanding of how to provide quality person-centered end-of-life care, increased comfort with assessing spiritual needs, increased confidence in initiating sensitive interactions, and greater appreciation for working in an interprofessional health care team. This interprofessional simulation provided a robust learning environment paving the way for future simulations incorporating additional members of the health care team.
The COVID-19 (coronavirus disease 2019) pandemic has raised the visibility of serious health-related suffering and increased mortality worldwide, underscoring the critical need for improved access to quality palliative care in all health care delivery settings The palliative nursing role—now, more than ever—is central to alleviating symptomatic and psychosocial distress, as well as achieving patient-identified goals throughout the continuum of serious illness and bereavement care. Currently, the primary goal of many health and palliative care organizations at national and international levels is palliative care integration throughout all of health care, including timely and safe access to controlled essential medicines and primary and specialist palliative care services in acute, long-term care, and community-based settings, and dignified care at the time surrounding death. Nurses, as the largest component of the health care workforce, have a professional, ethical mandate to ensure palliative care as a human right, to improve the quality of life for patients, their families, and caregivers.
PURPOSE: This study aimed to determine the palliative care difficulties experienced by nursing students during their clinical practice.
DESIGN AND METHODS: This descriptive and cross-sectional study was conducted with 305 nursing students at a university in Turkey. Data were collected using a student identification form and the palliative care difficulties scale.
FINDINGS: Nursing students experience a moderate level of difficulty in providing care for palliative care patients and receiving expert support facilitates their care initiatives.
PRACTICE IMPLICATIONS: It is important to support nursing students during their nursing education courses and clinical training, along with psychiatric nursing skills.
BACKGROUND: Nurses play an important role in assessing and managing pain. However, this is often poorly managed for people living with dementia.
AIM: To explore nurses' experiences of pain management in end-of-life dementia care.
METHODS: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic narrative review of research papers published in English between 2008 and 2018 was conducted. Data sources were CINAHL, Medline, PsycINFO, ScienceDirect and SocIndex. Articles focused on nursing at the end of life and pain management in people with dementia.
FINDINGS: Eight articles were retrieved that met the search criteria. Four studies used qualitative methodology, two quantitative and two mixed methods. Studies from the UK dominated (n=5), the remainder were from Sweden, Norway and the US. Following thematic analysis, three themes were identified: training and education in pain management at the end of life for people with dementia, challenges in identifying pain and pain assessment tool use.
CONCLUSION: The review revealed inadequate education for nurses concerning end-of-life care for people living with dementia, notably concerning pain recognition and use of assessment tools. It is recommended that specialist education is mandated for all nurses working with this client group to improve care delivery.
Aim: The purpose of this quasi-experimental one-group repeated measure (pre-test/post-test) study was to determine the effect of an end-of-life (EoL) simulation-based experience (SBE) on active and observer nursing students' palliative care knowledge and self-awareness.
Background: Baccalaureate nursing (BSN) graduates must demonstrate competence in EoL care; however, gaining EoL experience is challenging given constraints on nursing faculty and clinical sites. Research also is needed to determine whether similar outcomes are achieved by active and observer participants after EoL SBE.
Method: Senior-level BSN students' palliative care knowledge and self-awareness of active and observer participants were measured before and after an EoL SBE.
Results: Knowledge and self-awareness increased (P<0.001) post-SBE in all participants, with equivalent post-test scores (P=0.248) for active (Mattitude=130.1; Mknowledge=80.5) and observer (Mattitude=128.3; Mknowledge=77.9) participants.
Conclusion: EoL SBE is an effective method for increasing student palliative care competence. Student observers benefit as much as active participants on knowledge and self-awareness outcomes.
BACKGROUND: In the Arab and Islamic world, data on palliative and end-of-life (PEOL) care education are minimal.
OBJECTIVES: The current study's primary aim was to identify what PEOL care education is delivered to undergraduate nurses in Egypt and the teaching strategies used to deliver this education. A secondary aim was to assess the feasibility of using online surveys in nursing research in Egypt.
DESIGN: This is a cross-sectional survey.
SETTINGS: Ten randomly selected faculties of nursing across Egypt.
PARTICIPANTS: Nursing educators who were working at three academic departments; Medical-Surgical Nursing, Critical Care Nursing, and Gerontological Nursing; in the participating faculties.
METHODS: After face-to-face recruitment of participants, data were collected using an online questionnaire with an adjunctive use of paper questionnaires. The questionnaire assessed participants' and courses' characteristics, the inclusion of the PEOL Care Index content in the surveyed courses, and teaching strategies used to deliver this content.
RESULTS: A total of 95 nursing educators were involved in the current study (response rate = 86.4%). All participants were female, and 87.4% responded via online questionnaires. The overall coverage of the PEOL care content ranged from 76% to 100%. End-of-life care and spiritual care were the least frequently reported PEOL care topics; on average, by 19.6% and 36% of the educators, respectively. Lecture was the most frequently used teaching strategy, followed by clinical field practice (mean percentages of utilization: 77.7% and 53.6%, respectively).
CONCLUSIONS: In Egypt, most PEOL care topics are covered in undergraduate nursing curricula. Yet, educating these topics is predominantly theoretical. End-of-life care and spiritual care are the least frequently covered PEOL care topics. Online surveys are feasible for multisite curricular assessment, and this feasibility may be augmented by face-to-face recruitment of participants and adjunctive use of paper questionnaires.
Professional values reflect nurses' understanding of how to deliver professional care, which might influence nurses' attitudes and caring behaviors during end-of-life care. However, limited research has been conducted to explore nurses' experiences of professional development during end-of-life care, and theoretical explanations are scarce about how nurses enact their professional values during the caring process. This study explored the social process of professional values involved in end-of-life care in the Chinese cultural context by adopting a constructivist grounded theory approach. Twenty semi-structured in-depth interviews among 15 nurses from three hospitals in southeastern China were conducted. A theoretical framework emerged when focusing on the social process of "reframing the meaning of life and professional values" to facilitate professional care for dying patients. Three main categories were sequentially identified as "recognizing the dilemmas when caring for dying patients," "applying strategies to deal with values conflict," and "reconstructing values." This theoretical framework may be applied as a practical framework for equipping nurses with effective strategies to cultivate professional values, including the provision of adequate end-of-life knowledge, and a supportive workplace environment.
OBJECTIVES: Many studies regarding nursing student's first experience of facing the death of a patient have focused on classroom methods or exploring attitudes towards death and related fears or anxieties. This review is the first to identify the mechanisms that facilitate practice learning as a result of students' first time experience of handling a patient's death.
DESIGN: A realist review as a form of a systematic review of the literature.
DATA SOURCES: The literature search focused on the earliest death experience of baccalaureate nursing students and end-of-life care, using databases MEDLINE, CINAHL, SCOPUS, ERIC, PSYCINFO.
REVIEW METHODS: Three research questions were addressed following a five-step process of (1) defining the scope of review and developing a theoretical framework, (2) conducting a theory-driven purposive search for evidence, (3) appraising evidence and extracting data, (4) synthesizing data and drawing conclusions, and (5) disseminating findings; with iterative expert consultation and discussion to answer the five questions of any realist review: 'what works, for whom, in what circumstances, how and why'.
RESULTS: Thirteen publications were included. Practice learning involves both changes and context improvements to be assessed and discussed by managers, leaders, nurse educators-facilitators and students. The environment and nursing role models are an inherent part of practice learning. Further work is needed to theorize the twelve key outcomes laid out in this review. These proposals require further consensus and the inclusion of inputs from both students and nurses.
CONCLUSION: The student nurse receives contradictory messages during the first experience of facing the death of a patient under their care. Considering the importance of this experience, specific indicators should be developed to track and guarantee and the optimal achievement of required competencies.
A hematopoietic stem cell transplant (HSCT) is an intense treatment approach for patients with a hematologic malignancy and brings a significant risk for morbidity and mortality. HSCT brings hope of cure for patients; however, treatments are lengthy and burdensome from both a physical and psychosocial perspective. As the culture of HSCT has traditionally been cure-oriented, it leaves little room for a potential partnership with palliative care services, and when palliative care services are introduced, it is often too late for significant benefit. The need to standardize palliative care involvement for patients with hematologic malignancies receiving a HSCT has become necessary, yet there are challenges with the best way to create such a partnership. Nurse practitioners are a steadily growing professional body possessing the knowledge and skill necessary to fill the gap in palliative care delivery for HSCT patients. The proposed Nurse Practitioner Early Palliative Care for HSCT patients (NEST) algorithm will seek to provide a pathway in which to foster a partnership between hematology/HSCT teams and palliative services to yield the best care possible for patients.
Retention of staff presents major challenges within children's palliative care; this has substantial implications for children, families and the nursing workforce. To address this, a programme was undertaken that provided pathways of professional development for senior nurses working in this field. This study reports the views of nurses completing this programme, the overall project manager (PM) and the day-to-day programme lead (PL) as well as factors that influence nurse retention within children's palliative care nursing. The study drew on an Appreciative Inquiry approach that comprised of interviews with the PM and PL as well as focus groups and questionnaires with senior nurses from the children's palliative care sector, who participated in the training programme. Thematic analysis of data from interviews and focus groups revealed factors influencing nurse retention: speciality, positivity and making a difference, support, provision of adequate resources, tailored education/professional development and resilience. These themes were supported by the questionnaire findings. The programme was perceived as having a positive influence on nurse retention within the children's palliative care workforce. In addition, it was felt to be very beneficial in terms of shared learning and development. Participants highlighted the need for similar opportunities in the future.
The purpose of the current inquiry is to measure Jordanian student nurses' attitudes towards the care of dying patients using a cross-sectional survey. The sample of this study comprises 300 nursing students. Data was collected using the Frommelt's Attitude Toward Care of the Dying Form B (FATCOD-B). Most of the students were female (72%) in their second year (40.3%). The mean total score of all FATCD-B items was 95.8 out of 150 (SD 8.7). Student nurses had low mean scores for their attitude towards care of the dying. Two approaches could be taken to improve this situation. First, research is needed to fully understand and explain students' attitudes towards the care of dying patients. It might be more appropriate to utilize mixed research methods. The second is to integrate end-of-life care courses within the curricula of nursing programmes, currently the mainstay in improving students' knowledge and attitudes toward care of the dying.
PURPOSE: Defining patients as 'terminally-ill' may be difficult. Therefore, determining when to shift the goal of care from curative to comfort care may be extremely challenging. The aim of this study was to merge when and how Registered Nurses (RNs) and Nurses' Assistants (NAs) adjust end-of-life care to pursue patient comfort at the end of their lives.
METHODS: A descriptive qualitative study based on multiple focus groups was performed in 2017 according to the COnsolidated criteria for REporting Qualitative research guidelines. In all, 25 RNs and 16 NAs across seven north-east Italian facilities that provide end-of-life care, voluntarily participated in the study. Each focus group was conducted following the same interview guide with open-ended questions, and was audiotaped. A thematic analysis was applied to interview transcripts.
RESULTS: The process of nursing care plan adjustment is based upon two main themes, around 'when' and 'how' to adjust it. Regarding when, 'Detecting the turning point', and 'Being ready to change continuously until the end' emerged as the main sub-themes. Regarding how, 'Weighing harms and benefits of nursing care interventions'; 'Advocating for patients' wishes', 'Sharing the adjustments inside the team at different levels', 'Involving family in the adjustments of nursing care'; and 'Allowing care to move away from evidence-based practice' were the sub-themes emerged.
CONCLUSIONS: Shedding light on the implicit decisional processes that inform care adjustments and the implementation of related strategies is essential to improve the quality of end-of-life care given that an early detection of the terminal phase has been reported to result in changes of care improving outcomes.
But de l’étude : La possibilité de passer sa fin de vie chez soi est un enjeu de santé publique qui répond à la demande de la population et aux contraintes du système de santé. L’organisation de l’offre de soins et des acteurs infirmiers est donc centrale dans le développement des soins palliatifs à domicile. L’objectif de cette étude était de décrire la place des différents acteurs de soins infirmiers dans la prise en charge des situations palliatives avancées et terminales à domicile.
Matériel et méthodes : Une enquête de pratique a été réalisée au moyen d’un questionnaire en ligne auprès des médecins généralistes installés en Gironde. Le repérage des situations palliatives était réalisé avec le "Supportive & Palliative Care Indicators Tool" en version française (SPICT-FR™).
Résultats : En tout 89 médecins ont décrit la prise en charge de 607 patients en situations palliatives avancées et terminales en cours de suivi, et celle de 260 patients décédés à domicile au cours des 12 derniers mois à l’issue d’une pathologie en situation palliative. Les infirmiers libéraux assuraient, seuls, 64 % de l’ensemble des prises en charge en cours, et 56 % de celles le mois précédant le décès. Ils intervenaient également dans la majorité des situations où les infirmiers des services d’hospitalisation à domicile et des services de soins infirmiers à domicile étaient présents.
Conclusion : Alors que la représentation commune tend à considérer l’infirmier du service d’hospitalisation à domicile comme l’acteur majoritaire des situations palliatives avancées et terminales à domicile, cette enquête montre que les infirmiers libéraux ont une place prépondérante dans ces situations. Le développement des soins palliatifs à domicile et de la culture palliative passera par une meilleure reconnaissance et le soutien de ces acteurs.
Background: There are no data on the provision of palliative nursing care in Egyptian adult intensive care units (ICUs). The Palliative and End-Of-Life (PEOL) Care Index is reliable and content valid; however, its construct and criterion validities have not been examined.
Aims and objectives: First, to assess palliative care education, practice, and perceived competence among adult ICU nurses in Egypt. Second, to explore factors related to palliative care nursing practice and perceived competence. Third, to assess the construct and criterion validities of the PEOL Care Index.
Design: A cross-sectional survey.
Methods: Nurse managers and staff nurses in 33 adult ICUs completed self-administered questionnaires. The questionnaires assessed nurses' palliative care practice and perceived competence. A multilevel regression analysis was used to determine the best predictors of palliative care practice and perceived competence. Theory evidence construct validity and predictive criterion validity of the PEOL Care Index were examined.
Results: Thirty-three nurse managers and 403 staff nurses participated in the study—response rate = 100% and 72.5%, respectively. On a 0-100 scale, the mean scores of undergraduate education, practice, and perceived competence were 54.0 ± 18.7, 49.7 ± 18.1, and 54.5 ± 17.0, respectively. Palliative care practice was significantly related to receiving in-service training on palliative care or end-of-life care (regression coefficients: 3.39), higher job satisfaction (0.97), and higher organizational support (1.85). Palliative care perceived competence was significantly related to older nurses' age (0.20), higher job satisfaction (0.97), and higher palliative care undergraduate education (0.63).
Conclusions: Palliative care education, practice, and perceived competence among adult ICU nurses in Egypt are inadequate, especially in terms of spiritual and cultural care. The PEOL Care Index is construct and criterion valid.
Relevance to clinical practice: Palliative care education should begin in nursing schools and extend through clinical in-services. Guidelines should be developed to maximize staff collaboration and the utilization of chaplains in ICUs.
BACKGROUND: Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care.
PROBLEM: There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content.
APPROACH: In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate-Competencies and Recommendations for Educating Nursing Students in primary palliative care for master's degree and doctor of nursing practice students.
OUTCOMES: During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions.
CONCLUSION: Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.
Along their professional career, nurses can find patients who require palliative care (PC). It is necessary to have at least a basic education in this area, that should be acquired during their university education. The objective of this descriptive online-survey set in five nursing Colleges was to analyze Spanish nursing students' knowledge in PC, offering an image of the status of education in PC. 619 students took an online questionnaire with the Spanish version of the Palliative Care Quiz for Nurses (PCQN-SV), which also collected information about their education in the field of PC. Univariate and bivariate analyses were performed, and a predictive binary logistic regression model was developed. Students obtained an average 45.65% of right answers in PCQN-SV, with differences related to the college and academic year in which they were enrolled and to their education in PC. In the regression model having theoretical education in PC (OR = 1.70) and academic year (OR = 1.35) showed to be both predictors of getting a result in PCQN-SV over 45% of correct answers. This study showed that Spanish nursing students have a medium-low level of knowledge in PC, and it also supports the need to develop a common framework for nurses' education in PC.
BACKGROUND: Conversations about death are often associated with fear, anxiety, avoidance and misunderstandings. Many adults feel that these discussions are inappropriate and confusing for young people. In this project, two fourth-year nursing students partnered with a local palliative care team to examine death education for children. The nursing students focused on children's understandings of death and their coping abilities, the lack of appropriate discussions about death with children, and the implementation of death education in public schools. Three online death education resources were identified and evaluated for use in public schools. This project fueled preliminary local discussions and advocacy efforts in the provision of death education for children. In the future, death education will need to be incorporated into education plans at local schools, and could be done in collaboration with the local palliative care team.