Palliative Care Competencies Research Articles

Interprofessional primary palliative care: Do the AACN Essentials prepare nurses for collaborative practice?

Palliative care specialists alone cannot meet the rising needs for palliative care. Primary palliative care, delivered interprofessionally by generalist health professionals, is essential to ensure equitable access. Educational competencies and clinical practice guidelines prepare these clinicians to integrate palliative care principles into practice. The purpose of this project was to evaluate how the AACN Essentials prepares entry-level professional nursing students to function as members of the interdisciplinary primary palliative care team, as described in the National Consensus Project (NCP) for Quality Palliative Care Clinical Practice Guidelines. A team of nurse educators utilized a crosswalk mapping process with the Essentials domains, the Competencies and Recommendations for Educating Undergraduate Nursing Students (CARES) statements, and the NCP Guidelines. All eight of the NCP domains align with the Essentials. There were clear areas of overlap between the documents and unique areas of emphasis. This project identifies how educational competencies and clinical guidelines can guide competent palliative care practice. It also describes how nurses are prepared to collaborate in the delivery of palliative care.

Death education for Palliative care: a european project for University students

BackgroundThe need to spread the culture of palliative care and to train health care professionals from undergraduate courses is recognised internationally. The article presents the outcomes of a project devoted to palliative care training in university courses in four countries.AimsThis article considered the outcomes of a course designed for university students who had the potential to work in a palliative care team. The main aim was to check the efficacy of the course and the motivation to work in palliative care settings, considering the impact of fear and representations of death.MethodsThe project presented the essential contents related to palliative care, using psychodramatic and photo-voice techniques. Longitudinal measurements were taken using a quantitative method design to detect changes among the students involved. The project involved 341 students at the first administration of the survey consisted of a protocol composed of standardized questionnaires in five countries (Austria, Israel, Italy, Poland and Romania), of whom 276 completed the pre- and post-surveys—165 of them in the experimental group and 111, in the control group.ResultsThe experience showed that it is possible to address death-related issues seriously and competently without necessarily causing discomfort and despondency in students. The results of the changes over time in the experimental and control groups highlight how the view of death as annihilation is correlated with the fear of death and the need for avoidance of thoughts concerning dying. The main result is that competence in palliative care facilitates familiarisation with issues of death and dying, as well as the ability to work in this area, thereby enhancing interpersonal skills.ConclusionThe project showed that it is possible to implement death education on palliative care topics in undergraduate courses to increase motivation to work in this field.

Simulation-based learning in palliative care in postgraduate nursing education: a scoping review

BackgroundNurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education.MethodsThe aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O’Malley’s (Int J Soc Res Meth 8(1):19–32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework.ResultsThis review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one’s ability to communicate during emotionally challenging situations; and impact and relevance to one’s own clinical practice.ConclusionsThe use of SBL in palliative care in postgraduate nursing education seems to enhance students’ understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students’ confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students’ experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.

Psychometric properties of the Korean version of the Palliative Care Nursing Self-Competence scale for infant use

BackgroundDespite the significant advances in neonatal treatment and care over the past 30 years, palliative care in the neonatal intensive care unit has not been fully provided in South Korea. Neonatal nurses are essential professionals in palliative care as they are directly involved in the care, but there is little information on their palliative care competency because no assessment instrument is available in Korea. ObjectivesThe aim of this study was to develop and test the validity and reliability of the Korean version of the Palliative Care Nursing Self-Competence scale for neonatal palliative care. MethodsThis scale for infant care was developed through parallel translation techniques and revised based on cognitive interviews. Survey data were then collected from 220 neonatal nurses who worked in 13 neonatal intensive care units in Korea. Internal consistency reliability, construct validity based on exploratory factor analysis, and criterion-related validity were tested. ResultsThe final version of the scale included 40 items in five domains that explained 53.4% of the variance. Criterion-related validity was confirmed based on a positive correlation with the Korean version of the attitudes towards neonatal palliative care measurement tool. The Cronbach's alpha for the scale was 0.95. ConclusionsThe Korean version of the Palliative Care Nursing Self-Competence scale for infant care has satisfactory construct validity and reliability to measure palliative care self-competence of neonatal nurses in Korea and evaluate an education program in future studies.

Increasing palliative care capacity in primary care: study protocol of a cluster randomized controlled trial of the CAPACITI training program

BackgroundPrimary care providers play a critical role in providing early palliative care to their patients. Despite the availability of clinical education on best practices in palliative care, primary care providers often lack practical guidance to help them operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to provide an early palliative approach to care. The entire program consists of 12 sessions (1 h each), divided evenly across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Coordinate for Ongoing Care. We report the protocol for our planned evaluation of CAPACITI on its effectiveness in helping primary care providers increase their identification of patients requiring a palliative approach to care and to strengthen other core competencies.MethodsA cluster randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning, consisting of online access to program materials; and 2) facilitated learning, which also includes live webinars where the online materials are presented and discussed. The primary outcomes are 1) percent of patients identified as requiring palliative care (PC), 2) timing of first initiation of PC, and self-reported PC competency (EPCS tool). Secondary outcomes include self-reported confidence in PC, practice change, and team collaboration (AITCS-II tool), as well as qualitative interviews. Covariates that will be examined are readiness for change (ORCA tool), learning preference, and team size.Primary care teams representing interdisciplinary providers, including physicians, nurse practitioners, registered nurses, care coordinators, and allied health professionals will be recruited from across Canada. The completion of all three modules is expected to take participating teams a total of six months.DiscussionCAPACITI is a national trial aimed at behavior change in primary care providers. This research will help inform future palliative care educational initiatives for generalist health care providers. Specifically, our findings will examine the effectiveness of the two models of education delivery and the participant experience associated with each modality.Trial registrationClinicalTrials.gov NCT05120154.

Competências em cuidados paliativos entre estudantes do curso de medicina

Abstract Competencies have been defined as the set of knowledge, skills and attitudes that a professional should acquire to perform a certain work activity. This study aimed to assess competencies in palliative care among students enrolled in a Brazilian medical course. All enrolled students were invited to participate and answer the Palliative Competence Tool. The data obtained were calculated in scores between zero and 100 and compared between the ten competencies and academic cycles. The results showed four patterns, the most frequent being a reduction in scores among students in the basic and intermediate cycles, with partial recovery in the internship. Only ethical competence and decision-making increased in the internship. It was concluded that the acquisition of palliative care competencies in undergraduate medical education remains fragile. New teaching strategies could be adopted to improve their acquisition in the future.

Palliative care competence among medical students

Resumen Las competencias son un conjunto de conocimientos, habilidades y actitudes que debe adquirir el profesional para desempeñar una actividad laboral. Este estudio pretende evaluar las competencias en cuidados paliativos entre los estudiantes de medicina matriculados en el grado de medicina en Brasil. Todos los inscritos recibieron invitación a participar y completaron la Palliative Competence Tool. Los datos obtenidos se calcularon en puntuaciones entre 0 y 100 y se compararon entre las diez competencias y los ciclos académicos. Los resultados mostraron cuatro patrones; el más frecuente fue la reducción de la puntuación entre los estudiantes de ciclos básico e intermedio, con recuperación parcial en las prácticas. Solo la competencia ética y la toma de decisiones presentaron una alta puntuación en las prácticas. Sigue siendo débil la adquisición de competencias en cuidados paliativos en medicina. La adopción de nuevas estrategias de enseñanza puede mejorar la adquisición de las competencias en el futuro.

Palliative care competence among medical students

Resumo Competências foram definidas como o conjunto de conhecimentos, habilidades e atitudes que um profissional deverá adquirir para exercer determinada atividade de trabalho. O objetivo deste estudo foi avaliar as competências em cuidados paliativos entre os estudantes matriculados em um curso de medicina brasileiro. Todos os estudantes matriculados foram convidados para participar e preencheram a ferramenta Palliative Competence Tool. Os dados obtidos foram calculados em escores entre zero e 100 e comparados entre as dez competências e os ciclos acadêmicos. Os resultados mostraram quatro padrões, sendo o mais frequente a redução dos escores entre estudantes dos ciclos básico e intermediário, com recuperação parcial no estágio. Apenas a competência ética e tomada de decisão mostrou elevação no estágio. Concluiu-se que a aquisição de competências em cuidados paliativos na graduação médica ainda é frágil. Novas estratégias de ensino poderão ser adotadas com intenção de aprimorar a aquisição de competências no futuro.

A DEDICATED APPROACH TO PALLIATIVE DEMENTIA CARE

Abstract Nursing staff play a central role in the palliative care for people with dementia. Development of their palliative care competences may support timely recognition and addressing of individual needs of persons with dementia and their family caregivers in long term care. In the DEDICATED (Desired Dementia Care Towards End of Life) project, we aim to develop materials to support nursing staff in providing palliative dementia care. The first step of the project concerned a needs assessment, mapping the perspectives of nursing staff, family caregivers and people with dementia (scoping review, surveys and semi-structured interviews). Using these studies’ results as a starting point, an intervention (the DEDICATED approach) was built, using an iterative co-creation approach involving nursing staff and educators (N=12). These ‘ambassadors’ were also trained to disseminate the approach within their care teams and nursing curricula. First reactions from the pilot study regarding the DEDICATED-materials are positive and nurses and nurse educators are eager to use the materials (www.dedicatedwerkwijze.nl). Currently the DEDICATED-approach is being evaluated using a mixed methods pretest-posttest controlled design comparing three groups: a design group (12 wards), a test group (28 wards, 28 new-trained ambassadors) and a control group (12 wards). The main outcomes of study are e.g. self-efficacy, empowerment and engagement in providing palliative care for people with dementia. A secondary outcome involves longitudinal trends of the quality of dying of persons with dementia within the group.

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway.

Patients, relatives and nurses were involved in this study. The aim was to explore patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting after implementation of the Coordination Reform in Norway. Secondary analysis of qualitative interviews. Data from interviews with 19 participants in a nursing home setting: severely ill older patients in palliative care, relatives and nurses. Data triangulation influenced by Miles and Huberman was used. The overall theme was "Being in an unfamiliar and uncaring culture leaves end-of-life patients in desperate need of holistic, person-centred and co-creative care". The main themes were: "Desire for engaging palliative care in a hopeless and lonely situation", "Patients seeking understanding of end-of-life care in an unfamiliar setting" and "Absence of sufficient palliative care and competence creates insecurity". The patients and relatives included in this study experienced an uncaring culture, limited resources and a lack of palliative care competence, which is in direct contrast to that which is delineated in directives, guidelines and recommendations. Our findings reveal the need for policymakers to be more aware of the challenges that may arise when healthcare reforms are implemented. Future research on palliative care should include patients', relatives' and nurses' perspectives.

Palliative Care Competencies in Nephrology: A Scoping Review

Introduction: There is a growing need to train nonpalliative physicians in palliative care, as it is increasingly recognized by the medical profession. Political and opinion leaders are also becoming aware of the urgent and growing need for palliative care education. Objective: The aim of this study is to provide an overview of the information available in the literature on the topic of palliative care competencies for nephrologists, using clearly defined and transparent methods to search, summarize, and interpret the relevant literature based on a systematic review approach. Methods: The scoping review is based on the Joanna Briggs Institute methodology. The search was conducted in December 2019 using publications in national and international databases and grey literature in English, Spanish, French and Portuguese. Results: Of the total 4668 publications, 168 were eligible for review based on title and abstract. A full-text review of these 168 publications resulted in the selection of 27 articles that met the predefined inclusion and exclusion criteria and were therefore included in the study. The following competencies were considered necessary to provide high quality PC in various nephrology settings: Communication skills (21.3%); End-of-life care, loss, grief, and bereavement (18.6%); Control of pain and other renal symptoms (16%); Advance care planning (16%); Ethical and legal issues in dialysis decision making (12.2%); Teamwork (6.6%); Ability to provide psychosocial and spiritual support to patients and families (5.6%). Application of palliative care principles (3.7%). Percentage refers to the number of publications addressing each topic. Conclusion: The implementation of an integrated care model that includes both PC and curative treatments places high demands on nephrologists, who must acquire PC competencies. Training in palliative care should be included in the curricula for nephrologists.

Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia

IntroductionPalliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice. MethodsThis study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique. ResultsSEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model. ConclusionIt can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.

Development of a Primary Palliative Nursing Care Competence Model and Assessment Tool: A Mixed-Methods Study.

The purpose of this study was to develop a new primary palliative nursing care (PPNC) competence model and assessment tool. Consensus guidelines, a national position statement, and new nursing program accreditation standards require nurses to be educated in providing PPNC. A means to assess PPNC competence for prelicensure nursing students and entry-level nurses is needed. The mixed-methods study utilized a three-phase design encompassing in-depth document analysis and expert workgroups; focus groups with palliative care educators, practitioners, and administrators; and stakeholder focus groups. Findings across all phases resulted in development of a PPNC competence model and assessment tool, each composed of nine domains and associated competency statements. There is a global imperative for nurses to provide high-quality PPNC. Both the model and assessment tool are vital to develop a nursing workforce with the skills to care for persons with serious illness and their families.

Effects of the ELNEC Graduate Curriculum on Nurse Practitioner Students' Perceptions of Primary Palliative Care Competency.

Jizba, Theresa DNP, AGACNP-BC, ACHPN; Iverson, Lindsay DNP, APRN, ACNP-BC; Hall, Alexander MS Author Information

Updated palliative care competencies for entry-to-practice and advanced-level nursing students: New resources for nursing faculty.

American Association of Colleges of Nursing's Essentials: Core Concepts for Professional Nursing Education (2021) established four spheres of care across the lifespan with diverse populations, one of which is hospice/palliative/supportive care. A team of palliative nursing leaders and nurse educators sought to evaluate alignment of the new Essentials with existing palliative care competency statements. The rigorous process resulted in the revision of these palliative care competency statements to align with the new Essentials more accurately. The second edition of the Competencies And Recommendations for Educating nursing Students (CARES) reflect updated palliative care expectations for entry-to-practice nursing students. Similarly, second edition Graduate Competencies And Recommendations for Educating nursing Students (G-CARES) statements describe advanced-level student competency. The team also aligned CARES/G-CARES (2nd ed.) with the Domains, Competencies, Sub-Competencies, and Concepts of the new Essentials. The updated palliative care competency statements can guide faculty in integrating palliative care education into their programs and assessing alignment of programmatic outcomes with AACN's Essentials hospice/palliative/supportive care sphere of care.

Self-reported practices, competence and difficulties towards palliative care among nurses: A cross-sectional study.

Nurses' palliative care practice ability is the key to evaluating the quality of palliative care. This study aimed to identify the current situation of palliative care practices, competence and difficulties among nurses and determine whether difficulties play a mediating role between practices and competence. A cross-sectional study was conducted. The online survey comprised demographics, the Palliative Care Self-Reported Practices Scale, the Palliative Care Nursing Self-competence Scale and the Palliative Care Difficulties Scale. Data were analysed by using descriptive statistics, univariate analysis, linear regression and mediation analysis. A total of 284 questionnaires were included for statistical analysis. The mean scores for practices, competence and difficulties were 67.81 (SD = 13.60), 124.28 (41.21) and 44.32 (12.68), respectively. There was a correlation between practices, competence and difficulties (p < 0.01). Competence and difficulties were independent predictors of practices (R2 adj =0.384, p < 0.001). Furthermore, difficulties mediated the relationship between practices and competence (b = 0.052, 95% confidence interval: 0.008-0.155). Continuous efforts should be made to enhance nurses' practices, competence and problem-solving abilities in palliative care. This study suggested further targeted education programmes, especially in special symptom management, interagency and multidisciplinary communication.

The OUTREACH study: oncologists of German university hospitals in rotation on a palliative care unit—evaluation of attitude and competence in palliative care and hospice

PurposeThe effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear.MethodsThis national prospective multicenter pre–post survey conducted at twelve German University Comprehensive Cancer Centers prospectively enrolled physicians who were assigned to training rotations in specialized palliative care units for three, six, or twelve months. Palliative care knowledge [in %] and palliative care self-efficacy expectations [max. 57 points] were evaluated before and after the rotation with a validated questionnaire.ResultsFrom March 2018 to October 2020, questionnaires of 43 physicians were analyzed. Physicians participated in a 3- (n = 3), 6- (n = 21), or 12-month (n = 19) palliative care rotation after a median of 8 (0–19) professional years. The training background of rotating physicians covered a diverse spectrum of specialties; most frequently represented were medical oncology (n = 15), and anesthesiology (n = 11). After the rotation, median palliative care knowledge increased from 81.1% to 86.5% (p < .001), and median palliative care self-efficacy expectations scores increased from 38 to 50 points (p < .001). The effect of the 12-month rotation was not significantly greater than that of the 6-month rotation.ConclusionAn educational rotation presented in a specialized palliative care unit for at least six months significantly improves palliative care knowledge and palliative care self-efficacy expectations of physicians from various medical backgrounds.

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

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

How do wound care nurses structure the subjective frame on palliative wound care? A Q-methodology approach

BackgroundPalliative wound care is important for stability in terminal care. It addresses both the physical and psychological needs of patients and facilitates other aspects of terminal care. Appropriate competencies of nurses regarding palliative wound care can improve patient outcomes and raise their quality of life. The purpose of this study was to identify how wound care nurses structure the subjective frames regarding palliative wound care.MethodThis study utilized Q-methodology to analyze their subjective viewpoints. Forty nurses experienced in palliative wound care were asked to completely classify 35 Q-statements into a normal distribution shape. The PQ-Method program was used to conduct principal factor analysis and varimax rotation for data analysis.ResultsThis study revealed 4 Q-factors of palliative wound care: “Focusing on care within the boundary of current patient demands,” “Comparing continuously the priorities on wound healing and disease care,” “Preparing and preventing from worsening via tracking care in advance,” and “Moving forward with a clear direction by confronting the declining condition.”ConclusionWe hope that the results of this study are used in the development of nursing education that reflects professional perspectives of palliative wound care, thus helping to improve nursing competencies in palliative care.

What's Your Level of Palliative Care Competency? (GP702)

What's Your Level of Palliative Care Competency? (GP702)