Preparing Undergraduate Nursing Students to Provide Primary Palliative Care to Patients With Serious Illnesses

Monday, 30 October 2017

Polly M. Mazanec, PhD, ACNP-BC, AOCN, ACHPN, FPCN1
Betty R. Ferrell, PhD, MA, FAAN, FPCN2
Pam Malloy, MN3
Rose Virani, MHA, BSN, RN, OCN, FPCN2
(1)FPB School of Nursing, CWRU, Cleveland, OH, USA
(2)Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA
(3)American Association of Colleges of Nursing, Inc, Washington DC, DC, USA

With more persons being diagnosed with chronic, life-limiting illnesses that can significantly impact quality of life, the demand for nursing competency in palliative care has risen to the forefront. Palliative care has become the essential element of quality care for patients with serious illness and their families. Today, the emphasis is on palliative care across the illness trajectory from the time of diagnosis of a serious illness through end-of-life, across the lifespan and in all clinical settings. However, the specialty of palliative care cannot possibly meet the demand for its services nationally or globally. Education in primary palliative care is needed in all health care professions to address the gap in availability of specialty palliative care. It is imperative that nurses be educated in primary palliative care and that all nursing students be prepared during their undergraduate education with the knowledge and skills needed to provide primary palliative care by the time of graduation. Support for the importance of preparing future nurses in primary palliative nursing comes from The Institute of Medicine Reports on Dying in America (2014) and the Future of Nursing (2011) as well as the 3rd edition of the National Consensus Project Guidelines for Quality Palliative Care (2013) and professional organizations such as the American Nurses Association and the Hospice and Palliative Nurses Association, which recognize that caring for patients with serious illness is integral to the practice of all nurses.

In October 2015, in response to the need to improve undergraduate nursing education in palliative care, an expert panel of twenty-five nursing faculty and leaders in palliative care, funded by the Cambia Health Foundation, gathered to develop the competencies in palliative care that nursing students needed to achieve by graduation. The new document, released in Feb. 2016, is the American Association of Colleges of Nursing (AACN) CARES document. In order to help schools of nursing meet the 17 competencies outlined in the AACN CARES document, the Cambia Health Foundation provided additional support to develop an innovative online curriculum. The national End-of-Life Nursing Education Consortium (ELNEC) Team, in collaboration with Relias Learning, developed a curriculum for undergraduate nursing students which was released January 2017. The ELNEC-Undergraduate Curriculum ensures that primary palliative nursing education is available for all nursing students, especially those attending schools in rural or underserved areas where faculty expertise in palliative care may be limited.

The curriculum is comprised of six one-hour, interactive modules: “Introduction to Palliative Nursing”; “Communication in Serious Illness”; “Pain Assessment and Management”; “Symptom Assessment and Management”; “Loss, Grief, and Bereavement”; and “Final Hours”. Each module contains minimal text, and offers the student the opportunity to see and hear national and international leaders in nursing talking about palliative care, videos that role-model excellent primary palliative nursing skills, and case studies. There are over 70 state board registered nursing exam style questions. Following successful completion of all module quizzes, students receives a certificate of training that can be placed in their portfolios for future employment.

ELNEC-Undergraduate Curriculum is easy for students to access and use. It is a tremendous support for nursing faculty who are wanting their students to have this preparation but are challenged by how to teach it. Most schools of nursing already have packed curricula and adding another content topic is difficult due to limits on curricula space and time. Many schools do not have the faculty expertise to teach this content, but with this online curriculum, faculty can coach the student through the content without having to actually “teach” it. Supplemental faculty materials are available for each module that can augment the curriculum for schools which choose to go beyond the six -hour content. Within the first three weeks of availability, the feedback has been overwhelmingly positive from faculty and more than 50 schools have accessed the curriculum with more than 500 users enrolled.

This innovative curriculum will help increase access to palliative care education in all nursing schools, meet the palliative care competencies outlined in the AACN CARES document, strengthen the palliative care workforce nationwide, and improve palliative care to patients with serious illness and their families. Although it is only available in the English language at this time, it can be used by schools around the globe to meet the international need for primary palliative nursing education as well.