A Framework for Integrating Oncology Palliative Care in Doctor of Nursing Practice (DNP) Education

Doctor of Nursing Practice (DNP) faculty play a critical role in preparing students to meet the complex needs of the nation as the number of cancer rates and survivors rise (National Cancer Institute, 2018) and as an unprecedented number of older Americans enter into the healthcare system with complicated comorbidities (Whitehead, 2016). Palliative care has dramatically expanded over the past decade and has been increasingly accepted as a standard of care for people with cancer and other serious, chronic, or life-limiting illnesses. Advanced practice registered nurses (APRNs) are recognized as important providers of palliative care (Walling et al., 2017). A 2-day course was held with support from the National Cancer Institute to enhance integration of palliative oncology care into DNP curriculum. The course participants (N = 183), consisting of DNP faculty or deans, practicing DNP clinicians, and students, received detailed annotated slides, case studies, and suggested activities to increase student engagement with the learning process. Course content was developed and delivered by palliative care experts and DNP faculty skilled in curriculum design. Participants were required to develop goals on how to enhance their school\u27s DNP curriculum with the course content. They provided updates regarding their progress at integrating the content into their school\u27s curriculum at 6, 12, and 18 months post course. Results demonstrated an increase in incorporating oncology palliative care in DNP scholarly projects and clinical opportunities. Challenges to inclusion of this content in DNP curricula included lack of: perceived time in curriculum; faculty educated in palliative care; and available clinical sites

The Impact of an Advance Care Planning Simulation on the Communication Skills of Palliative Care Nurse Practitioner Students

Background: Effective communication is the cornerstone of a therapeutic relationship, especially when dealing with serious, life threatening illness. Decisions based upon a patient and family’s wishes, goals and values need to be guided by clinicians equipped to engage in complex advance care planning (ACP) conversations. Given its importance, communication skill proficiency has been identified as a core competency for the Advanced Practice Registered Nurse (APRN) in palliative care. Although simulation utilizing a standardized patient model has been employed for communication skills training in healthcare education, little is known about its usefulness in preparing palliative care nurse practitioner students for these challenging ACP discussions. Objectives: The purpose of this pilot study was to evaluate the impact of advance care planning simulations upon the communication skills and self-efficacy of palliative care nurse practitioner students enrolled in a college of nursing. Methods: A prospective, quantitative study using a one-group pretest-posttest design was implemented to measure student communication skills and self-confidence. A convenience sample (N=19) of students enrolled in New York University’s College of Nursing was obtained for the study. Students engaged in two ACP discussion simulations with actors playing the role of a newly diagnosed oncology patient. In addition to demographic information, the participants completed a self-confidence tool prior to the first and after the second simulation. An independent faculty member scored the students’ performances for each simulation using a communication skills checklist based on the SPIKES protocol. Statistical analysis of the study variables was performed using paired t test and Wilcoxon signed-rank test measurements. Statistical significance was set at p \u3c .05. Results: The majority of participants were between the ages of 20-30, had 4-10 years of nursing experience and reported having exposure to patient discussions surrounding healthcare proxy, code status and breaking bad news during their clinical rotations. Fifty-six percent (n =5) of the participants demonstrated improvement in communication skills (t = -.098, p = .924), while ninety-three percent (n = 14) reported increased self-confidence (t = 4.725, p\u3c .001) after completion of the second simulation encounter. Statistical significance for nine of the 14 self-confidence tool items was confirmed by the Wilcoxon signed-rank test. Study limitations included attrition, sample size, intervention timing and scheduling. Conclusion: Despite mixed results, this pilot provided key insights into the potential for repetitive simulation in communication skills education and the feasibility for future research of this pedagogy in the palliative care nurse practitioner student population