Nursing Education Consortium Curriculum Research Articles

Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program.

Graduate nursing programs must provide end-of-life (EOL) content to prepare nurse practitioners to manage the holistic needs of patients. This project aimed to measure the End-of-Life Nursing Education Consortium curriculum's impact on student self-confidence and anxiety levels. A pretest/posttest study design was implemented using an EOL simulation and the Nursing Anxiety and Self-Confidence With Clinical Decision-Making Scale (NASC-CDM©) to compare baseline self-confidence and anxiety levels related to clinical decision-making. Results showed that the simulation increased student self-confidence, but anxiety level remained unchanged. Nurse educators should consider incorporating EOL simulation into graduate curricula to improve student confidence with clinical decision-making.

An Innovative Application of End-of-Life Nursing Education Consortium Curriculum to Increase Clinical Nurses' Palliative Care Knowledge.

Clinical nurses are in a crucial position to provide primary palliative care by advocating for patients and families at the end of life, collaborating with the health care team to optimize quality of life, and contributing to enhanced symptom management. Most clinical nurses, however, have not received the comprehensive palliative care education needed to provide high-quality palliative care. The End-of-Life Nursing Education Consortium curriculum can bridge this gap by providing nurses with the knowledge needed to promote palliative care. Following completion of an End-of-Life Education Consortium train-the-trainer program, 6 nurses from a large, metropolitan academic medical center designed and implemented a series of 20-minute educational sessions informed by a hospital-wide needs assessment and based on the End-of-Life Nursing Education Consortium curriculum. The educational sessions, Palliative Care Conversations, provide clinical nurses with the core palliative care knowledge and skills needed to advocate for and provide patient-/family-centered care throughout the serious illness trajectory and at end of life. This article describes the process, design, and content of the palliative care educational sessions.

An Innovative End-of-Life Nursing Education Consortium Curriculum That Prepares Nursing Students to Provide Primary Palliative Care.

Research has demonstrated that patients facing serious, life-limiting illnesses and their families benefit from receiving palliative care. Increasingly, however, specialty palliative care has limited resources. Prelicensure nursing students who are educated to provide primary palliative care to patients with serious illness and at the end of life can fill that gap. This article describes the development and implementation of an innovative online nursing curriculum that prepares students with essential primary palliative nursing knowledge and skills.

Promoting Palliative Care Internationally: Building Leaders to Promote Education, Practice, and Advocacy

In February 2000, nine nursing educators, practitioners, and researchers met in Nashville, Tennessee, to develop a palliative care curriculum specifically for nurses. The following month, 22 advisors from nursing organizations across the United States convened in Washington, DC to review the recommended curriculum development and dissemination plans for end-of-life care throughout nursing schools, hospitals, hospices, home care, and geriatric settings. The Robert Wood Johnson Foundation provided funding for curriculum and competency development and for six national train-the-trainer courses to be held from 2001 to 2003. The curriculum entitled the End-of-Life Nursing Education Consortium was designed to meet the needs of nurses caring for patients with serious and complex illnesses at the end of their lives. This work, beginning in 2000 with the development of the End-of-Life Nursing Education Consortium curriculum, has been taught in every state across America and in 91 countries around the world and has been translated into eight languages. Over 21,400 trainers have returned to their institutions and educated over 642,000 colleagues.

A Comparison of Lecture Versus Lecture Plus Simulation

Terminally ill patients frequently visit emergency departments for palliative care. However, studies have documented that staff do not have the knowledge base necessary to provide quality end-of-life care. This lack of educational preparedness led to a pilot study that compared 2 educational approaches to teaching emergency nurses the End-of-Life Nursing Education Consortium Curriculum. Three 8-hour lectures and three 8-hour lectures plus simulation classes were presented to nurses who volunteered from the emergency department of a level I trauma center. This study showed no statistical significance in knowledge base between the 2 educational approaches. However, the ELNEC curriculum increased the knowledge base of both groups. As a result of the course, the palliative care team has seen a significant increase in palliative care consults from the emergency department.

The ELDER Project

The purpose of this year-long pilot study was to measure end-of-life care knowledge among health care providers (nurses, nursing assistants, therapists, spiritual care) in 5 home-care and long-term-care settings before and after attending educational sessions. The End of Life Nursing Education Consortium curriculum was used to inform 10 interactive, interprofessional educational sessions. Sessions were offered once per month for 10 months at each of the 5 partnering agencies. Quantitative data on end-of-life knowledge were gathered using a nursing-focused instrument that was modified for this study to address variation in provider role and educational level. Qualitative data via journal entries and structured interviews were also gathered. After session completion, mean scores (N = 34) improved significantly in 3 instrument categories (culture, communication, quality of life) and improved slightly in the remaining 6 instrument categories (nursing care, pain, symptom management, ethics/legal, grief and loss, and death), suggesting improved end-of-life knowledge among this sample. Qualitative results revealed participants perceived that they had gained knowledge for use in their current and future practice. Use of interactive small-group sessions focused on end-of-life care for interprofessionals was an effective method for increasing knowledge in these settings.

Bundling the death and dying learning experience for prelicensure nursing students.

One of the greatest challenges in nursing education lies in linking classroom content to the clinical environment. Simulation is now an established method for allowing students to practice the skills and techniques discussed in didactic nursing education and to allow this to occur in a safe, controlled environment before moving into the real world of clinical practice. Multidimensional learning bundles, such as the End-of-Life Nursing Education Consortium curriculum, provide an opportunity to link theoretical content with practice, yet time constraints may limit implementation of the full curriculum. A compacted learning bundle with a didactic component, unfolding case study, and video-recorded family conference to prepare students for a simulation on care of the dying patient is being used in 1 accelerated bachelor of science in nursing program to address students' learning needs.

Palliative Care in Kyrgyzstan

There is a growing awareness of the need for improved end-of-life care around the globe. Kyrgyzstan, the second poorest country in Central Asia, is poised to begin palliative care initiatives, despite facing inadequate health care funding, lack of education about palliative care, and limited availability of necessary medications. With the combined efforts of clinicians and educators, along with support from governmental and nongovernmental agencies, a national program for palliative care is in development, and nursing is playing a leading role. The strategy to integrate palliative care includes 3 pillars: building clinical services, coordinating efforts to increase the availability of necessary drugs, and developing educational programs. As part of a coordinated educational program for nurses and physicians, several courses have been presented based on the End-of-Life Nursing Education Consortium curriculum. Health care professionals, educators, and representatives of government and nongovernmental organizations have participated in these courses. The Minister of Health has subsequently approved a curriculum based on End-of-Life Nursing Education Consortium for students in the college of nursing and postgraduate continuing education. The barriers faced and these educational efforts will be described as they are an essential part of a comprehensive strategy to improve the quality of life for people within this country.

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Introduction: Despite a staggering 1 in 5 U.S. patients dying in the ICU and projected growth in the aging population, many critical care providers are not adequately trained or skilled at GOC/EOL focused discussions. To address this issue, we created a novel all-inclusive ICU based GOC/EOL focused program with the goal of providing a multidisciplinary communication approach for families of the critically ill patient. Hypothesis: A multidisciplinary ICU team intervention regarding GOC/EOL communication will enhance the clinical abilities of all critical care providers when discussing GOC/EOL issues and increase ICU staff comfort level, while improving transitions to a comfort care approach. Methods: This study was done at an academic tertiary surgical/trauma 24-bed ICU with an average of 15 deaths per month. An initial survey was circulated amongst the critical care staff for baseline expectations, satisfaction, and understanding of GOC/EOL care. A robust intervention was begun including the creation of a multidisciplinary GOC/EOL team, communication tools for providers, patient family pamphlets, standardized EOL order sets, and formalized didactic sessions (based partly on the EOL Nursing Education Consortium curriculum). Subsequently, the same survey was circulated and compared to baseline data. Results: The intervention was provided to nursing, ancillary staff, housestaff, and attending physicians. It generated heightened interest in improving family communication and provided focal direction to foster this growth. Based on the serial surveys, specific staff improvements were seen in caregiver knowledge regarding ability to promote EOL care and family perceptions regarding GOC communication. Improved congruence between families and healthcare providers regarding decisions over intensity of care were also noted. Conclusions: We created a novel unit based multidisciplinary program for improved EOL/GOC approaches in the critical care setting. A similarly formatted program could be adapted by other ICUs. Benefits of such a program include improving caregivers’ perceptions regarding EOL/GOC issues and fostering critical care team growth.

The impact of end-of-life curriculum content on the attitudes of associate degree nursing students toward death and care of the dying

Because end-of-life care competes with other nursing content for a place in the curriculum, nurse educators are challenged to select effective teaching strategies to prepare graduates to care for dying patients. An elective course using the End-of-Life Nursing Education Consortium curriculum was compared with a 3-hour lecture embedded in a larger medical–surgical course. Results suggested that both content-delivery methods positively impacted the attitude of students toward death and care of the dying to some extent; however, significant positive changes were noted in both intervention groups and in the control group that viewed the film Wit.

Addressing Life Limiting Illness in Elders

Background: Elder patients often experience chronic life limiting conditions, such as vascular diseases, malignancies, renal or liver failure, stroke, advanced heart or lung disease, neurodegenerative disorders, and dementia. The 1995 SUPPORT study demonstrated a pervasive lack of communication between patients and their health care providers about goals of end of life care, significant levels of inadequately treated pain in seriously ill and dying patients, and, most importantly, discrepancies between stated preferences of care and continued use of aggressive care. Purpose: To address this issue in elder patients, Massachusetts General Hospital developed The RN Residency: Transitioning to Geriatrics and Palliative Care, an innovative program funded by the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration. Methodology: The RN Residency program is a nine-month residency program. This program utilizes cohort learning to build skills and competencies to improve practice and initiate unit based quality improvement. The National Consensus Project for Quality Palliative Care's Clinical Practice Guidelines serve as the blueprint for end of life education, along with The End of Life Nursing Education Consortium Curriculum and other resources from the Center to Advance Palliative Care and Hospice and Palliative Care Nurses Association. The John A Hartford Foundation Evidence-based geriatric curriculum serves to structure education for the older adult patient. Findings: Evaluation is ongoing, including qualitative assessments and pre- and post-test of skills and attitudes toward seniors. Summary Concluding Statement: The RN Residency provides nurses knowledge and expertise through state of the science, evidence-based palliative care and geriatric education, thereby improving end of life care for elder patients.

Learning pain assessment and management: a goal of the End-of-Life Nursing Education Consortium.

Relief of pain for patients requires that palliative care practitioners have knowledge and skill in both pain assessment and the use of pharmacologic and complementary therapies. Pain assessment and management and the teaching strategies suggested within the End-of-Life Nursing Education Consortium curriculum are presented. By addressing the pain experienced by patients with life-limiting illnesses and those at the end of life, the quality of care can be greatly improved. As a multidimensional phenomenon that relates to physical, emotional, and spiritual well-being, the relief of pain enhances the quality of life of patients and lessens the stress experienced by family caregivers. The relief of pain and suffering is consistent with the philosophy and goals of nursing as a profession and is a nursing responsibility.

Ethical and legal issues in end-of-life care: content of the End-of-Life Nursing Education Consortium curriculum and teaching strategies.

The End-of-Life Nursing Education Consortium (ELNEC) is a train-the-trainer educational program to help nursing faculty integrate care of dying patients and their families in the nursing curriculum. This article presents techniques derived from the ELNEC project regarding teaching the ethics module and the key content areas for developing ethical decision-making skills in end-of-life care. Competent end-of-life nursing care begins with an understanding of ethics and the potential affect on care of dying patients and their families.

End-of-life nursing education consortium curriculum: an introduction to palliative care.

End-of-life nursing education consortium curriculum: an introduction to palliative care.