Nursing Students' Perceptions of Learning Needs Toward End-of-Life Care: A Focus Group Exploration

Monday, 30 October 2017: 3:45 PM

Patricia Anne Poirier, PhD
School of Nursing, University of Maine, Orono, ME, USA

Changes in the healthcare environment, initiatives from the Institute of Medicine (IOM) and accrediting agencies, and formal and informal feedback from graduating students led the faculty of a pre-licensure baccalaureate school of nursing to implement a major curriculum re-design. One of the changes was the addition of an online one-credit course in care of patients and families at the end of life.

The increasing numbers of elderly Americans, structural barriers in access to health care, a fragmented healthcare system, and concerns about the impact of the Affordable Care Act on healthcare decision making have focused attention on care of the dying (IOM, 2014). Nurses play a key role in caring for seriously ill patients and their families through management of complex physical and emotional symptoms and helping patients and families navigate the healthcare system. The American Association of Colleges of Nursing (AACN) (2016) published CARES: Competencies and recommendation for educating undergraduate nursing students: Preparing nurses to care for the seriously ill and their families. Faculty of the End of Life Nursing Education Consortium (ELNEC) has been providing training to nurses since 2001. This January ELNEC launched a program for undergraduate nursing education.

Thus there are both regulatory and policy support and resources available for providing EOL and palliative care education to undergraduate nursing students. Previous studies have shown that many nursing students lack basic knowledge and comfort in providing EOL and palliative care (Adenisa, DeBellio, & Zannettino, 2014; Edo-Gual, Tomás-Sábado, Bardallo-Porras, & Royo, 2014; Ek, et al., 2014; Jafari et al., 2015; Nguyen, Jansen, Hughes, Rasmussen, & Weckmann, 2015; Watts, 2014). Education, through a variety of formats, has been shown to increase students’ knowledge and comfort in caring for patients and families at end of life (Bailey & Hewison, 2014; Lippe & Becker, 2015; Venkatasalu, Kelleher, & Shao, 2015). No study was found that investigated what students want to know or feel they need to know regarding EOL care. The purpose of this study was to explore undergraduate nursing students’ perceptions of their cognitive and affective learning needs as a basis for development of a one-credit on-line course on EOL care to be delivered in the first semester senior year.

Students who would be enrolled in the EOL course (n=55) in the coming semester were invited to participate in a focus group. Four focus groups were conducted with a total of 16 participants. Three focus groups were held face to face and one focus group was web based. Initial questions asked included: “What experience have you had in caring for persons who were dying? What areas of caring for patients and families at the end of life are you comfortable with? Uncomfortable with? What areas would you like to see emphasized in an end of life course?” Additional probing questions were asked based on participant responses. With the permission of the participants the sessions were audiotaped and transcribed verbatim. Content analysis was used to analyze the data. To ensure trustworthiness a second researcher skilled in qualitative research also reviewed the transcripts. Member check also was used to enhance trustworthiness.

Three overarching themes were identified: “comfort comes with experience”, “empowerment”, and “fear of saying the wrong thing”. Areas that participants felt comfortable with included speaking with patients about end of life issues, providing comfort measures, and listening. Areas that participants felt uncomfortable with included talking to families, managing complex symptoms, ethical issues, and caring for the body after death. Participants expressed a desire to know more about pain and symptom management, techniques for communicating with families, and legal and ethical issues surrounding EOL care.

Limitations of this study included small sample size limited to one school of nursing. However the study provided valuable insight as to what students perceived as their learning needs regarding provision of end of life care. This information along with content from the ELNEC curriculum was used to develop the one-credit on-line EOL course. This course will help to ensure that new graduates have the knowledge and skills to provide palliative and end of life care to seriously ill patients and their families. This is congruent with the theme of the 44th Biennial convention: Influence through Action: Advancing Global Health, Nursing and Midwifery. A future study will incorporate pre and post testing as a means of evaluating the EOL course.