New Competencies for Graduate Nursing Education in Primary Palliative Care: G-CARES

Master’s and Doctor of Nursing Practice (DNP) nursing students will play a critical role in the care of the more than 117 million Americans, from pediatric to geriatric patients, who are living with serious illness (CDC, 2018). These patients require palliative care; however, the number of specialty palliative care practitioners will not be able to meet the future demand. Thus, it is critical that graduate nursing students be prepared to address this gap by becoming educated about primary palliative care. These future nurse leaders must learn principles of primary palliative care in order to advocate for and provide quality palliative care in their roles in clinical practice, administration, or academia (American Nurses Association (ANA) and Hospice and Palliative Nurses Association (HPNA) Call for Action: Nurses Lead and Transform Palliative Care, 2017).However, nurses cannot practice what they do not know. A generous three-year grant from Cambia Health Foundation is supporting a group of nationally known palliative care nursing leaders to develop competencies and an online curriculum to educate graduate level nursing students.

In August, 2018, a group of 15 experts in nursing education and palliative care came together to develop graduate level primary palliative care competencies. They identified the importance of separating out competencies that must be met by all students, whether providing direct or indirect patient care, as well as specific competencies for those who will be providing direct care. The document, G- CARES (Graduate- Competencies And Recommendations for Educating Nursing Students) was submitted to the American Association of Colleges of Nursing (AACN) in December 2018 for their review and endorsement. Previously, AACN endorsed the CARES Document, 17 palliative care competencies for undergraduate nursing students in January, 2017. CARES guided the development of an online curriculum in 2017 that is preparing undergraduate students to provide basic primary palliative care to seriously ill patients across the lifespan. In the first 20 months since the launch of the online curriculum, over 230 nursing programs across the nation and more than 20,000 students have enrolled in the curriculum. The creation of the G-CARES document and development of an easily accessible online curriculum is modeled after this successful undergraduate project. G-CARES is a timely and essential document regarding nursing education to lead change, design and implement innovative models of primary palliative care delivery, build and lead interprofessional teams, and evaluate the outcomes of safe, evidence-based, and effective care.

G-CARES: Primary Palliative Care Competencies for Master’s and DNP Nursing Students

The G-CARES document contains two sets of competencies. These competencies align with the AACN Master’s and DNP Essentials and the 4^th edition of the NCP Guidelines for Quality Palliative Care. The first eight primary palliative care competencies are expected of all graduate nursing students, including master’s, (i.e. advanced practice registered nurses (APRN), Clinical Nurse Leaders (CNL), nurses in education, administration, informatics, and public health, etc.) and Doctor of Nursing Practice (DNP) students who will be directly or indirectly providing primary palliative care for seriously ill patients and their families, from infants and children through geriatric populations, and across the illness trajectory. The second five primary palliative care competencies are expected of graduate nursing students who will be providing direct primary palliative care across any clinical, community, or technology-mediated (telehealth) setting.

Ensuring Students Achieve the Competencies Outlined in the G-CARES Document

Master’s and DNP programs across the U.S. should adopt these competencies and ensure that students are prepared to provide and promote quality palliative care for the growing number of patients with serious illness. The G-CARES project nursing educators have begun to develop an online curriculum that will meet these competencies. The curriculum is six one-hour modules addressing: Principles of Palliative Care; Communication in Serious Illness; Pain Management; Symptom Management; Care During Final Hours; and Leadership in Ensuring Quality Palliative Care. Each module is interactive and contains video simulations of APRNs providing primary palliative care and advocating for palliative care services as nurse leaders. Case studies are woven throughout the modules. After successful completion of the six-module curriculum, students are awarded a certificate of training in palliative care. The online curriculum will be released August 2019.

The online curriculum makes integration of the palliative care content into saturated graduate programs smooth and feasible. The modules can be incorporated into a student assignment and completed according to the flow of the program and courses required. Faculty will be able to individualize the use of the curriculum based on the program timeline.

Future graduate-prepared nurses, working in any clinical, administrative or education setting, can now be prepared to meet the needs and demands of the growing population of patients with serious illness and their families with the G-CARES competencies and corresponding online primary palliative care curriculum.