Education that makes a difference to palliative and end of life care at the bedside in a resource-poor context: the situation of Cameroon

Background Current demographic trends giving rise to an ageing population worldwide, and changes in disease patterns, are increasing demands for palliative and end of life care. Nurses play a fundamental role in the care of patients with chronic and life-threatening illnesses, making it critical that nurses entering the profession should be competent and confident to provide palliative care. However, some preregistration nursing curricula, particularly those in resource-poor settings, do not include any palliative care content. Existing research identifies a lack of palliative care competencies among practising nurses, both newly graduated and student nurses. Aim The aim of this study was to develop, pilot and evaluate the impact of a palliative care course on Cameroonian preregistration nursing students’ palliative care knowledge and self-perceived competence and confidence in palliative care provision, using Kirkpatrick’s (1967) framework for training programme evaluation. Design This study is situated within the World Health Organisation’s public health model for palliative care as an overarching theoretical framework. It employed a longitudinal quasi-experimental pretest/posttest design, using both quantitative and qualitative methods. It was conducted in 3 phases. In the first phase, a 30 hours classroom based palliative care course, underpinned by experiential learning theory, was developed. In the second phase, the course was delivered to second and third year nursing students in one University in Cameroon, by nurse educators, a chaplain and palliative care trained nurses in Cameroon. In the third phase, an evaluation of the impact of the course on students’ palliative care knowledge, self-perceived competence and confidence in palliative care, and transfer of learning to practice was conducted. Course evaluation data was collected via a pretest/posttest survey, 3 focus groups and 10 individual critical incident interviews. Both descriptive and inferential statistics were used to analyse the quantitative data. The qualitative data was analysed thematically using the framework approach. Findings This study revealed a deficiency in the palliative care content of the pilot University’s preregistration nurse training curriculum, and very poor palliative care knowledge and self-perceived competence and confidence in palliative care provision, among preregistration nursing students of this University.A 30 hour classroom based palliative care course, delivered by nurse educators, palliative care nurses and a chaplain in Cameroon was found to statistically significantly improve students’ overall palliative care knowledge. In this study students’ also had improvements in their self-perceived competence and confidence in palliative care provision, though this was not statistically significant.Student nurses in receipt of palliative care education were able to transfer their learning to practice. They reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. Notwithstanding this positive finding, some factors, related to the student themselves, the qualified nurses, the practice setting or the patient and family, were found to negatively impact on the learning transfer process. The students generally felt that the course was an ‘eye opener’ and met with their expectations. They perceived the major strength of the course was the use of interactive and stimulating educational strategies, but felt that the absence of a supervised clinical practice component with dying patients was a major weakness of this course. Conclusion There is a need for a curriculum revision to include palliative care content in the preregistration nurse training curricula of the pilot University. This seems to reflect a general need by all preregistration nursing students in this country. This study’s findings reveal the need to advocate for palliative care education and practice policies, and for adequately preparing clinical placement sites for nursing students’ palliative care learning and transfer of learning in Cameroon, and possibly other resource poor settings

A qualitative evaluation of the impact of a palliative care course on preregistration nursing students' practice in Cameroon

Background Current evidence suggests that palliative care education can improve preregistration nursing students’ competencies in palliative care. However, it is not known whether these competencies are translated into students’ practice in the care of patients who are approaching the end of life. This paper seeks to contribute to the palliative care evidence base by examining how nursing students in receipt of education report transfer of learning to practice, and what the barriers and facilitators may be, in a resource-poor country. Methods We utilised focus groups and individual critical incident interviews to explore nursing students’ palliative care learning transfer. Three focus groups, consisting of 23 participants and 10 individual critical incident interviews were conducted with preregistration nursing student who had attended a palliative care course in Cameroon and had experience caring for a patient approaching the end of life. Data was analysed thematically, using the framework approach. Results The results suggest that nursing students in receipt of palliative care education can transfer their learning to practice. Students reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. They did however perceive some barriers to this transfer which were either related to themselves, qualified nurses, the practice setting or family caregivers and patients. Conclusion The findings from this study suggest that nursing student in receipt of palliative care education can use their learning in practice to provide care to patients and their families approaching the end of life. Nevertheless, these findings need to be treated with some caution given the self-reported nature of the data. Demonstrating the link between preregistration palliative care education and patient care is vital to ensuring that newly acquired knowledge and skills are translated and embedded into clinical practice. This study also has implications for advocating for palliative care policies and adequately preparing clinical placement sites for students’ learning and transfer of learning

Education that makes a difference to palliative and end of life care at the bedside in a resource-poor context: the situation of Cameroon

Background Current demographic trends giving rise to an ageing population worldwide, and changes in disease patterns, are increasing demands for palliative and end of life care. Nurses play a fundamental role in the care of patients with chronic and life-threatening illnesses, making it critical that nurses entering the profession should be competent and confident to provide palliative care. However, some preregistration nursing curricula, particularly those in resource-poor settings, do not include any palliative care content. Existing research identifies a lack of palliative care competencies among practising nurses, both newly graduated and student nurses. Aim The aim of this study was to develop, pilot and evaluate the impact of a palliative care course on Cameroonian preregistration nursing students’ palliative care knowledge and self-perceived competence and confidence in palliative care provision, using Kirkpatrick’s (1967) framework for training programme evaluation. Design This study is situated within the World Health Organisation’s public health model for palliative care as an overarching theoretical framework. It employed a longitudinal quasi-experimental pretest/posttest design, using both quantitative and qualitative methods. It was conducted in 3 phases. In the first phase, a 30 hours classroom based palliative care course, underpinned by experiential learning theory, was developed. In the second phase, the course was delivered to second and third year nursing students in one University in Cameroon, by nurse educators, a chaplain and palliative care trained nurses in Cameroon. In the third phase, an evaluation of the impact of the course on students’ palliative care knowledge, self-perceived competence and confidence in palliative care, and transfer of learning to practice was conducted. Course evaluation data was collected via a pretest/posttest survey, 3 focus groups and 10 individual critical incident interviews. Both descriptive and inferential statistics were used to analyse the quantitative data. The qualitative data was analysed thematically using the framework approach. Findings This study revealed a deficiency in the palliative care content of the pilot University’s preregistration nurse training curriculum, and very poor palliative care knowledge and self-perceived competence and confidence in palliative care provision, among preregistration nursing students of this University.A 30 hour classroom based palliative care course, delivered by nurse educators, palliative care nurses and a chaplain in Cameroon was found to statistically significantly improve students’ overall palliative care knowledge. In this study students’ also had improvements in their self-perceived competence and confidence in palliative care provision, though this was not statistically significant.Student nurses in receipt of palliative care education were able to transfer their learning to practice. They reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. Notwithstanding this positive finding, some factors, related to the student themselves, the qualified nurses, the practice setting or the patient and family, were found to negatively impact on the learning transfer process. The students generally felt that the course was an ‘eye opener’ and met with their expectations. They perceived the major strength of the course was the use of interactive and stimulating educational strategies, but felt that the absence of a supervised clinical practice component with dying patients was a major weakness of this course. Conclusion There is a need for a curriculum revision to include palliative care content in the preregistration nurse training curricula of the pilot University. This seems to reflect a general need by all preregistration nursing students in this country. This study’s findings reveal the need to advocate for palliative care education and practice policies, and for adequately preparing clinical placement sites for nursing students’ palliative care learning and transfer of learning in Cameroon, and possibly other resource poor settings

Musculoskeletal disorders among workers in the cameroon railways corporation-camrail, douala, cameroon

English Title: Musculoskeletal disorders among workers in the cameroon railways corporationcamrail, douala, cameroon Background: Occupational health is considered one of the drivers of economic development. This is why occupational diseases likemusculoskeletal disorders need to be prevented. Musculoskeletal ill health is reported among workers in the rail sector whose activities involve a lot of manual operations. Very little has been documented on musculoskeletal disorders in the rail sector in Cameroon. Objective: the objectives of this study were to determine the prevalence of musculoskeletal disorders and to identify possible  associated factors among workers of the Cameroon Railways Corporation (CAMRAIL), Douala. Methods: we conducted a cross sectional, analytic, observational study among workers of the Cameroon Railways Corporation  (CAMRAIL). Using a structured questionnaire derived from the health and safety Nordic musculoskeletal questionnaire (HSENMQ) and the Dutch musculoskeletal questionnaire (DMQ), we interviewed 300 workers chosen by convenient sampling at the central health centre of CAMRAIL in Douala. We collected information on the socio-demographic and professional characteristics of the workers, the physical and psychosocial work place factors, and lastly the occurrence of musculoskeletal symptoms in the previous year in nine bodyregions. Results: the mean age of workers was 44+/- 11years with an age range of 25 to 60 years. Male workers constituted 97% of the sample population. Technical workers formed 76% of the sample. The mean number of working years was 17+/-13.8 years. The prevalence of musculoskeletal symptoms was high at 74%. The lower back region was the commonest symptom site, with 50% of workers reporting symptoms in this area. It was also the region that caused the most work incapacity. The following factors showed significant association with musculoskeletal symptoms: age [OR=1.71,95%CI:0.81- 3.58, P=0.00119], duration of employment [OR=2.55,95%CI:1.14-5.63, P=0.0003],repetitive loading[OR=2.55,95%.CI:14-5.63,P=0.025], task control [0.47, 95%  CI:0,24-0.91, P=0.026], social support[OR=0.43,95% CI:0.23-87, P=0.017]. Conclusion: Most of the workers were technicians and predominantly maels.74% of thenm had musculoskeletal disorders, and age and duration of work at the corporation were found to be associated with symptoms. Key words: Prevalence, Musculoskeletal Disorders, Workplace, Ergonomic

Increasing access to palliative care for patients with advanced cancer of African and Latin American descent: a patient-oriented community-based study protocol

Abstract Background Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent. Methods This is a community-based participatory research study that will take place in two Canadian provinces. Patients and community members representatives have been engaged as partners in the planning and design of the study. We have formed a patient advisory council (PAC) with patient partners to guide the development of the Access to Palliative Care Strategy for people of African and Latin American descent. We will engage100 participants consisting of advanced cancer patients, families, and community members of African and Latin American descent, and health care providers. We will conduct in-depth interviews to delineate participants’ experiences of access to palliative care. We will explore the intersections of race, gender, socioeconomic status, language barriers, and other social categorizations to elucidate their role in diverse access experiences. These findings will inform the development of an action plan to increase access to palliative care that is tailored to our study population. We will then organize conversation series to examine together with community partners and healthcare providers the appropriateness, effectiveness, risks, requirements, and convenience of the strategy. At the end of the study, we will hold knowledge exchange gatherings to share findings with the community. Discussion This study will improve our understanding of how patients with advanced cancer from racialized communities in Canada access palliative care. Elements to address gaps in access to palliative care and reduce inequities in these communities will be identified. Based on the study findings a strategy to increase access to palliative care for this population will be developed. This study will inform ways to improve access to palliative care for racialized communities in other parts of Canada and globally