Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

Objectives: To explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. Methods: Postal survey of 356 London-based GPs, assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. Results: Currently, 65% of GPs were providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role; and 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that 'palliative care is mainly district nursing (DN) work'. Many were unaware of out-of-hours DN and specialist palliative care services. Multi-variable analysis found four GP characteristics - larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of palliative care - were associated with agreement that palliative care was central to a GP's role. Conclusion: A minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion

Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion

Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care

A New Medicare End-of-Life Benefit for Nursing Home Residents

A new Medicare benefit is needed to support end-of-life care for those spending their final days in a nursing home, say the authors of this article. Arguing that the current hospice benefit is a poor fit with the nursing home setting, the authors recommend a new benefit that would enable nursing home residents to receive individualized palliative and psychosocial services in addition to rehabilitative services

The Difference of Students Attitudes Who Have and Who Have Not Yet Received Palliative Classes on Palliative Nursing Action in Universitas Advent Indonesia of West Bandung District

This research is motivated because there are still many students who do not know the real palliative care. The reason is because they have not yet received Palliative theory in class. This is important because they will be dealing directly with palliative patients when practicing in the hospital so that they know that they are doing the right thing in caring for palliative patients while the palliative nursing course is still only applied in the learning curriculum. The main purpos of the study is to analyze whether there is a significant difference between the attitudes of students who have and who have not received a palliative nursing class toward palliative nursing in Universitas Advent Indonesia, Bandung Barat Regency. The research method used is descriptive quantitative. The population in this study were Level III and Level IV S1 Study Program students in Universitas Advent Indonesia. A sample of 84 students (42 students who have received a Palliative Nursing class and 42 students who have not yet received a palliative nursing class) were determined by purposive sampling. The instrument and material used were Frommelt's Attitude Toward Care of the Dying (FATCOD) attitude questionnaire score consisting of 24 questions using a Likert scale. Results: there were significant differences between the attitudes of students who have not and those who have received a Palliative class toward Nursing actions Palliative significance (2 tailed) 0.019 <0.005 means that there are significant differences. Conclusion: After conducting research, it is known that there is a significant difference between the attitudes of students who have not and those who have already received palliative nursing classes in treating palliative patients. The results of this study are expected to be beneficial for students, lecturers, and researchers in order to improve the quality of palliative nursing in Indonesia

Philosophy of Science on The Development of Palliative Nursing Practice in The Implementation of Long-Term Care for The Elderly: A Literature Review

As people gets older can increase health problems due to degenerative processes, thus requiring long-term care. Nurses as providers of palliative nursing care are based on nursing philosophy as a guide for acting and behaving in providing nursing care. Provide scientific information to nurses related to the role of philosophy of science in the development of palliative nursing practice that supports the implementation of long-term care in elderly. A literature review study, using various databases from Pubmed, Google Scholar, Science Direct and Research Gate. The inclusion criteria for searching for literature sources is the year of publication of the articles used starting from 2017 to 2022, in English, Indonesian and full articles. The search keywords are, nursing philosophy, nursing theory, palliative nursing, palliative care. Article selection was carried out using PRISMA and critical appraisal with a final total of 20 articles. The provision of palliative care to patients is carried out through a philosophical approach that emphasizes optimal quality of life and function, mitigates symptoms that cause sadness and promotes the values of care that focuses on comfort so as to reduce suffering and improve the quality of life of patients and families. Palliative nursing includes an understanding of the disease, pain management, and general symptoms, and follow-up care planning. Nurses are expected to make the philosophy of nursing as a basic of human as a holistic being in providing palliative nursing care

EAPC task force on education for psychologists in palliative care

It is argued that psychological aspects of care and psychosocial problems are essential components of palliative care. However, the provision of appropriate services remains somewhat arbitrary. Unlike medical and nursing care, which are clearly delivered by doctors and nurses respectively, psychological and psychosocial support in palliative care are not assigned exclusively to psychologists. It is generally expected that all professionals working in palliative care should have some knowledge of the psychological dynamics in terminal illness, as well as skills in communication and psychological risk assessment. On the one hand, palliative care education programmes for nurses and doctors comprise a considerable amount of psychological and psychosocial content. On the other hand, only a few palliative care associations provide explicit information on the role and tasks of psychologists in palliative care. Psychologists’ associations do not deal much with this issue either. If they refer to it at all, it is in the context of the care of the aged, end-of-life care or how to deal with grief

Nursing Faculty and Care of the Dying

Background: There is a demand for effective and efficient palliative and end of life nursing care that will meet the needs of the aging Baby Boomer generation. Though advancement has been made, palliative and end of life care for the seriously ill adult is still lacking. That deficiency can be traced to deficiency in nursing education. Further still, nursing faculty attitudes, knowledge and self-efficacy in palliative care may present a barrier for adequate palliative care nursing curriculum. Objective: Explore the current knowledge, attitudes and self-efficacy of nursing faculty regarding care for seriously ill adults. Methods and Design: A quantitative, descriptive research design using an online survey was sent to current Eleanor Mann School of Nursing (EMSON) faculty and adjunct clinical instructors. Measurement tools include the Palliative Care Knowledge Test (PCKT), Frommelt Attitudes Toward Care of the Dying (FATCOD) and Death Anxiety Scale (DAS). Results of the individual surveys were assessed for correlation against each other and respondent’s demographic information as well as against respondents who had taken additional palliative care course work. Data Analysis: Descriptive analysis and ANOVA correlations were run on survey results. Results: No significant correlation was assessed between Knowledge, Attitudes, and Death Anxiety. There was no significant correlation between these measures or age. There was no significant difference between respondent’s knowledge responses or anxiety responses when comparing respondents who had taken additional palliative coursework and respondents who had not. There was a significant difference in attitude scales between respondents who had taken additional palliative coursework and those who had not; those who had additional courses had more positive attitudes. Conclusion: This preliminary study indicates the need for further studies performed on nursing faculty to fully assess the effectiveness of experiences in nursing school. While many studies are conducted utilizing student and patient data, successes and deficits in practice efficacy begin with nursing school and faculty. Teachers must advocate for implementation and focus of competencies as outlined by the American Association of Colleges of Nursing (AACN) to improve nursing curriculum in palliative and end-of-life care

Knowledge Gaps: Addressing the Need for Palliative Care Education for University Nursing Students

This study aimed to analyze undergraduate nursing students’ primary palliative care knowledge to determine if there is a need for further palliative care education in undergraduate, pre-licensure curriculums. To make this determination, this study utilized the Undergraduate Nursing Palliative Care Knowledge Survey (UNPCKS), created by Dr. Andra Davis and Dr. Megan Lippe, a 27-question survey that addresses the 6 domains of holistic palliative care; i) holistic, patient-centered care (Whole person care), ii) collaborative (Interprofessional), iii) understanding of primary palliative care as a resource and how to support patients/families (Advocacy and Knowledge of Primary Palliative Care), iv) the importance of understanding patient’s priorities (Goals of Care), v) the importance of informed conversations with patients and families (Communication), vi) physical care (Symptom Care) and vii) support after a loss (Bereavement). The survey was administered to students enrolled in the undergraduate nursing program at the University of New Hampshire-Durham, and the data was collected through an online survey distributed to every undergraduate nursing student. The UNPCKS scores were then analyzed to determine if there was a knowledge deficit in the primary palliative care knowledge of undergraduate nursing students, and whether those deficits correlated between participant answers and the demographic experiential questions. After the results had been examined, 3 significant correlations were extracted, the most notable of which was between the total UNPCKS score and having provided postmortem care. While we were unable to identify concrete correlations that pointed to significant gaps in nursing students primary palliative care knowledge, it is important to acknowledge the current and future need for palliative care education in nursing curriculums. This research is important and relevant because there is an aging population in the United States that requires increased healthcare for an increasing rate of complex, chronic and life-limiting disease processes for which palliative care is indicated

A modified systematic review of research evidence about education for pre-registration nurses in palliative care

Background: We undertook a modified systematic review of research regarding educational approaches to and effectiveness of pre-registration palliative care nursing, to inform the development of a short course in palliative care for pre-registration nursing students in Cameroon. The aim of this review was to examine educational approaches applied to pre-registration palliative care nursing education and their effectiveness, and to discuss implications for the development of palliative care curricula in resource-poor countries. Method: A modified systematic review of research on palliative care educational interventions, conducted with pre-registration student nurses was undertaken. Relevant literature was gathered from CINAHL, EMBASE, MEDLINE and PsychINFO databases for the period 2000–2013. Inclusion was limited to studies of educational interventions evaluating the effectiveness and outcomes of palliative and end of life care education with pre-registration student nurses. Results: 17 studies were found, all of which were conducted in resource-rich countries: United States of America, Canada, Australia, and United Kingdom. Palliative care nursing education at pre-registration level is either delivered as a discrete course within the curriculum or palliative care content is embedded into other nursing specialty courses throughout the wider curriculum. Palliative care education is delivered to students at a variety of stages in their nursing program, using a mix of both didactic and experiential educational strategies. Course facilitators span palliative care specialists, educators who have attended ‘train-the-trainer’ courses in palliative care, and nurses with hospice experience. Education is underpinned by transformative and experiential learning theories and reported as effective in improving students’ attitudes towards care of the dying. Conclusion: The educational strategies identified in this review may be applicable to resource-poor countries. However, there are challenges in transferability because of the lack of availability of specialist palliative care practitioners who can serve as educators, specialist palliative care units/institutions for experiential learning, funds to design and use high fidelity simulations, and palliative care textbooks and other educational materials. There is thus a need for innovative educational strategies that can bridge these barriers in resource-poor countries. There is also a need for further research into how palliative care education impacts on pre-registration student nurses’ knowledge and practice