Hospice Clinical Experience in an Undergraduate Nursing Curriculum

Saturday, 28 October 2017

Stephanie M. Jeffers, PhD, MSN, BSN
School of Nursing, Widener University, Chester, PA, USA
Teresa Shellenbarger, PhD
Indiana University of Pennsylvania, Indiana, PA, USA
Anthony Forrester, PhD
School of Nursing, Rutger's University, Newark, NJ, USA

NFLA Poster Abstract

Hospice Clinical Experience in An Undergraduate Nursing Curriculum

Purpose: The purpose of this poster presentation is to discuss the leadership development of novice nursing faculty through the Nurse Faculty Leadership Academy (NFLA). The NFLA, created by Sigma Theta Tau International and funded by the Elsevier Foundation, is an 20-month program designed to foster leadership growth of novice nurse faculty (NFLA Scholars) through mentoring from accomplished nurse faculty. The NFLA scholars are required to deeply reflect on their own leadership style and behaviors, request feedback from leadership observers in their institution and create a plan to further improve performance as a leader in nursing education. In addition to reflection, the NFLA scholars each develop and implement a team project, to expand their leadership skills. The team project, initiated by this scholar, was an integration of a hospice clinical rotation into a senior medical-surgical nursing course in an undergraduate curriculum.

Background: The idea for this scholar’s team project stemmed from her passion for end-of-life care and the need for improved education on care of the dying patient. Despite the advances in end-of-life education for registered nurses, the literature has shown that registered nurses feel inadequately prepared to handle patient and family care at the end of life (Al Qadire, 2014; Cui, Shen, Ma and Zhao, 2011). Communication with patients, families and the health care team at the end of life was a significant deficit reported by registered nurses. Communication was cited as an essential skill; however, experience with having discussions with patients and families related to death and dying was a challenging task (Moir, Roberts, Martz, Perry & Tivis, 2015; Reinke, et al., 2010). Insufficient communication at the end of life may lead to a late hospice referral, aggressive care for a terminally ill patient and decreased patient advocacy (Boyd, Merkh, Rutledge & Randall, 2011). The major reason for the lack of proficiency in communication and end-of-life care cited by registered nurses was inadequate pre-licensure education (Cui, et.al, 2011; McCourt, Power & Glackin, 2013).

Methods: Following a stakeholder analysis and with guidance from the scholar’s leadership mentor and faculty advisor, the team project to incorporate a hospice clinical rotation into a senior medical-surgical nursing course was successfully implemented. The director of clinical education acquired two new clinical sites within an inpatient hospice setting. Two to four students per week rotated to one of the hospice sites for a clinical day, to observe and participate in care of the dying patient. A mixed methods study was also conducted in order to measure student attitudes towards care of a dying patient before and after the clinical experience. The Frommelt Attitudes Towards Care of the Dying (FATCOD) instrument was used to measure student attitudes before and after the hospice clinical experience. Qualitative data was obtained through reflection journals before and after the students’ hospice experience.

Results: Mean scores on the Frommelt Attitudes Towards Care of the Dying (FATCOD) instrument improved from the pre-test to the post-test period, a change that was statistically significant. Qualitative data from the reflection journals prior to the hospice experience illustrated student anxiety and fear surrounding end-of-life care. Qualitative data from the reflection journals after the hospice experience emphasized student transformation in a positive manner; students reported increased confidence in communication with patients and ability to manage emotions regarding end-of-life care.

This team project was successful and is being sustained within the Population Health course and continuing in the next academic year with an additional hospice clinical site, for a total of three sites. The scholar led the team to improve end-of-life nursing education at the pre-licensure level and transform students’ attitudes, beliefs and experiences related to care of the dying patient. The team, which consisted of the Director for Clinical Experiences, the Simulation Director and Associate Dean, remained enthusiastic about the project and worked seamlessly to create this experience for the senior nursing students.

The scholar’s scope of influence has expanded through this team project, demonstrated by presentations to the university, as well as national and international presentations to disseminate the results of the project and research study.

Conclusion: The NFLA program has been a valuable source of mentorship, support and fosters the growth of leadership behaviors in novice nurse faculty. Towards the end of the program, the scholar feels a sense of accomplishment and transformation. The NFLA program assists the scholar in recognizing one’s own strengths and challenges and encourages the scholar to strive for further leadership development. The success of the team project has allowed for new and exciting changes in the undergraduate nursing curriculum at the scholar’s university.