Confidence and Competence in Palliative Care: A Comparison of Traditional and Nontraditional Transfer Nursing Students' Lived Learning Experiences.

Nurses spend more time with seriously and terminally ill patients across the continuum of care than other health professionals, yet nursing students lack adequate palliative care education and experience when they transition to practice. In response to the American Association of Colleges of Nursing CARES competencies for enhanced preparation in palliative care, the End-of-Life Nursing Education Consortium developed modules for undergraduate programs. Nursing students' life experiences and their prior involvement with death and dying situations shape their potential achievement of end-of-life learning outcomes. The purpose of this study was to explore traditional and nontraditional students' perspectives and outcomes of their lived experiences in response to the End-of-Life Nursing Education Consortium modules and current palliative care program curriculum. Following university institutional review board approval, the phenomenological qualitative study included 2 focus groups of traditional and transfer students. Thematic data analysis revealed 4 primary themes with differences noted between groups in response to these themes: (1) witnessing suffering and death, (2) building courage and competence, (3) conversation challenges, and (4) curriculum issues and recommendations. Implications for future palliative care education indicate opportunities to better support students through expanded simulations and debriefing sessions, integrated roles for clinical faculty and preceptors, and interdisciplinary team collaboration opportunities across settings.

Symptom Assessment and Hospital Utilization in a Home-Based Palliative Care Program.

Palliative care delivery is shifting to the home, yet data are limited on symptom assessment tools and protocols for that setting. A quality improvement project was done in a home-based palliative care program to imbed the Edmonton Symptom Assessment System into the electronic health record. The purpose of the quality improvement project was to track symptom severity and collect utilization data. Baseline data were collected on 35 patients for symptom presence and severity as well as hospital utilization and readmission. The most common symptoms were tiredness, pain, and a lack of feeling of overall well-being. The most severe symptoms, those with a rating of 6 of 10 or higher, were pain, drowsiness, and anxiety. Seventy-seven percent of the symptoms within the Edmonton Symptom Assessment System showed an improvement over the 3-month QI project per the electronic health record data. Hospitalization rates also went from 4.2% to 2.6% and 30-day readmissions were reduced from 15% to 0%. The results suggest that the palliative care program was able to improve symptoms through the use of Edmonton Symptom Assessment System and that that may have affected hospital utilization.