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

BACKGROUND: 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. PURPOSE: 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. METHOD: 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. RESULTS: All eight of the NCP domains align with the Essentials. There were clear areas of overlap between the documents and unique areas of emphasis. CONCLUSION: 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.

A Systematic Review of Interprofessional Palliative Care Education Programs.

CONTEXT: Interprofessional education (IPE) involving palliative and end-of-life content benefits learners by addressing interprofessional and palliative care (PC) competency needs. OBJECTIVES: A synthesis of educational approaches promoting interprofessional PC in academic and clinical settings would address research gaps and promote effective teaching. METHODS: A systematic review of interprofessional PC educational studies was conducted to summarize current approaches in PC IPE and to appraise teaching and research methods. Characteristics of excellence in interprofessional PC education established by Donesky et al. served as a framework for evaluating studies in this systematic review. RESULTS: A total of 39 articles met inclusion criteria for this review. Learners from medicine and nursing were the most included professions. University programs represented most studies, and evaluation methods demonstrated achievement of mostly self-reported outcomes like learner attitude and self-efficacy. While the effect of interprofessional collaboration on patient outcomes is well-documented, the effect of IPE on PC delivery is not. Although content spanned all interprofessional and PC domains, few studies addressed cultural aspects and fewer addressed well-being for the care provider. CONCLUSION: In light of the current healthcare landscape, there is an imminent need to address culture and provider well-being more directly through interprofessional PC education. Education and research must also move beyond university programs into health systems to support the professional development of clinicians for systems integration, sustainability, and impact on patient outcomes. Future evaluation of interprofessional PC education would be strengthened by multisite studies, randomized controlled trials, and repeated measures looking at outcomes over time.

Fostering collaborative learning and leadership through near-peer mentorship among undergraduate nursing students.

BACKGROUND: Innovative teaching strategies in nursing education are essential with increasing enrollment. Collaborative learning and leadership (CLL) activities encourage near-peer learning through mentorship between senior-level and novice students while supporting teaching ratios in lab and clinical. In this study, senior nursing students' perceptions and performance during CLL activities were explored. METHODS: Final-semester senior students participated in CLL activities and were evaluated on their leadership and engagement. Grading rubric results were summarized using descriptive statistics. Thematic analysis of students' post-CLL reflections supported common themes. RESULTS: Students' average scores (97.53%) confirm students were prepared and engaged in CLL activities. Senior students enjoyed "building confidence" through these activities, with a consistent theme of "becoming a leader," noted in reflections. CONCLUSION: Near-peer learning activities assisted senior students in development of leadership and communication skills, preparing them for nursing practice. Recommendations include developing instructions for varied CLL activities and exploring faculty perspectives regarding this experience.

Addressing the Perioperative Nursing Shortage Via a Perioperative Nursing Preceptorship for Baccalaureate Nursing Students.

A growing demand for perioperative nurses, insufficient interest in the perioperative nursing specialty, and nurse retirements have resulted in a perioperative nursing workforce shortage. Undergraduate nursing students' limited exposure to perioperative content, along with facility hiring practices that exclude recently graduated nurses, further contribute to this shortage. To address these concerns, a large health care system in the midwestern United States partnered with a college of nursing to institute a perioperative preceptorship for baccalaureate nursing students during their final semester. After completing the preceptorship, students reported increased understanding of perioperative nursing roles and responsibilities, time management, and patient safety skills; ability to work effectively as a part of an interdisciplinary team; and independence in the perioperative setting. Future study is needed to examine rates of matriculation among program graduates into perioperative nursing positions and the program's effect on the length of orientation for recently graduated nurses and nurse retention.

Palliative care knowledge and self-awareness in active and observing undergraduate nursing students after end-of-life simulation.

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.

Relationships among nursing student palliative care knowledge, experience, self-awareness, and performance: An end-of-life simulation study.

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.

Writing Across the Curriculum: Reliability Testing of a Standardized Rubric.

BACKGROUND: Rubrics positively affect student academic performance; however, accuracy and consistency of the rubric and its use is imperative. The researchers in this study developed a standardized rubric for use across an undergraduate nursing curriculum, then evaluated the interrater reliability and general usability of the tool. METHOD: Faculty raters graded papers using the standardized rubric, submitted their independent scoring for interrater reliability analyses, then participated in a focus group discussion regarding rubric use experience. RESULTS: Quantitative analysis of the data showed a high interrater reliability (α = .998). Content analysis of transcription revealed several positive themes: Consistency, Emphasis on Writing Ability, and Ability to Use the Rubric as a Teaching Tool. Areas for improvement included use of value words and difficulty with point allocation. CONCLUSION: Investigators recommend effective faculty orientation for rubric use and future work in developing a rubric to assess reflective writing. [J Nurs Educ. 2018;57(6):366-370.].

A Concept Analysis of Palliative Care Nursing: Advancing Nursing Theory.

The American Association of Colleges of Nursing specifies that all nurses must be prepared to deliver high-quality palliative care upon entry into practice. To achieve this aim, a clear understanding of palliative care nursing is needed. The Walker and Avant model for concept analysis was used to review and analyze relevant literature from 2000 to 2016. The authors utilized findings of this extensive review to develop a concept model and other practical resources for guiding nurses, educators, and researchers in applying and evaluating competence in the delivery of high-quality palliative nursing care.