Gaps in Nursing Programs: EOL Care

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Introduction

EOL care needs are complex and a significant stressor to ill-prepared student nurses. Inadequate educational preparation, professional mentorship, and practicum exposure are significant barriers to optimal EOL practice. A deficit in current curricula means that most nurses entering the service lack core competencies in hospice care (Institute of Medicines, 2015). The purpose of the practicum project is to teach student nurses an EOL course to address this educational gap and contribute to optimal EOL outcomes.

Explanation of How the Gap was Addressed

The proposed EOL course addresses the educational gap through its two components: didactic training and experiential learning. In-class activities, such as lectures, simulations, case studies, and class discussions will help build competencies in pain and symptom management, communication, emotional balance, and support during grief (Jackson & Motley, 2014; Lippe & Carter, 2015; ). The experiential learning will involve hospice visits. A student will spend a cumulative 10 hours caring for a dying patient, which will improve individual self-efficacy, self-confidence, emotional awareness, and critical thinking (Ranse, Ranse, & Pelkowitz, 2018; Wittenberg, Ragan, Ferrell, & Virani, 2016). It will also lead to patient-centered care.

Overview of Steps

The course will be offered at a hospital-based nursing school. The first implementation step is obtaining the necessary IRB approvals from Hennepin Technical College and the Methodist Hospital. The second activity will entail recruiting participants. Information fliers inviting student nurses to enroll in the course will be posted on the notice board. Participants will subsequently sign an informed consent and register for the module. Those selected to participate will be English-speaking undergraduate students with no prior EOL experience. A pre-course survey will be conducted to determine baseline EOL knowledge before course delivery and evaluation.

Lesson Topic & Learning Objectives

The lesson topic is end-life-care communication, which aims to reinforce effective interaction skills required for optimal EOL care. Participants will be taught a communication protocol for delivering sad news and discussing therapeutic options with the patient/family through didactic and practicum experiences. The learning objectives are student demonstration of effective communication in the two areas, sensitivity to cultural differences, empathy, and active listening.

Teaching/Instructional Strategies & Required Materials

Three teachings/instructional strategies will be used to deliver the lesson. They include role play, simulation, and lectures. Required course materials will be drawn from diverse informational resources. They include the IOM’s 2015 report on dying in America and articles by Wittenberg et al. (2016) and Jackson and Motley (2014).

Student Learning Outcomes & Lesson Plan Details

The student learning outcomes for the EOL course are the acquisition of EOL knowledge and practice skills, positive attitudes towards hospice care, and effective communication. The competency developed is communicating sad news and treatment options to patient/family. Among the core concepts that will be covered during the lesson include EOL care, the dying process, and pain management using opioids. The required readings will come from pain management and therapeutic communication literature. Learning activities fall into three categories: experiential (simulation and role play), authentic assessment (EOL case studies), and critical thinking (reflective journal presentation).

Success Methods

Three methods will be employed to determine the educational plan’s success. First, a student assessment after the course will indicate improvement in knowledge and skills in EOL care from the baseline, for example, correct opioid dosage use to manage pain. Second, an evaluation of participant clinical competency by the preceptor will determine self-efficacy in EOL communication. Third, a post-course survey will indicate if the course reduced negative thoughts, fear, and anxiety and increased student interest in EOL care.

Decision-making Processes & Successes

Decisions to support the EOL course will involve collaborating with an interprofessional team comprising of faculty, nurse practitioners (NPS), the clergy, psychologists, and students. The teaching staff will help decide the duration (number of hours) to assign each component of the module and assessment approach. Additionally, the faculty will determine the class size, in-class learning activities, and resources. The NPS will help develop an effective preceptor model that will provide opportunities to students to apply their classroom knowledge in practice. The clergy and psychologists will counsel and support learners through this course.

The successes of this project will promote future concerted efforts involving NPs, faculty, administrators, hospitals, and nursing schools in training nurses. The shared experiences and collaborative development of the course will lead to the ownership of the curriculum. Feedback from students, patients, NPs, and faculty will help improve the module in the future. Additionally, after implementing this course, longitudinal interventions, including new programs, may be developed to expand EOL training.

Challenges & Discussion of Organization’s Plan

The challenges encountered during this project can help improve future educational interventions. This EOL course was designed for lower-level BSN students with no prior hospice experience. Advanced modules may be necessary for senior-level preservice nurses. Selecting appropriate course topics and practicum experiences was also a challenge. Future courses should emphasize the spiritual and psychological dimensions of EOL care.

The organization (HTC) plans to support this project by providing resources for implementation. Additionally, in the short term, HTC will avail counselors to support emotionally overwhelmed students during the course. The school also has a long-term vision of producing nurses well-prepared for EOL care.

Discussion of Resources & Description of MSN Outcomes

Implementation of the EOL curriculum will require human resources. Faculty members will deliver the course and evaluate students, while a nurse practitioner will play the preceptor role. Learning materials such as pens, notebooks, mannequins, and audio-visual equipment will be required for in-class activities and simulations. Additionally, a training room fitted with computers and LCD projectors will be needed for lectures.

Two MSN outcomes were integrated into this capstone project. The first one is designing innovative nursing practices to impact quality outcomes of populations. The EOL course will improve the competencies of nurses offering hospice care and patient outcomes. The second one is constructing interprofessional teams to advance a culture of excellence. The project brought together NPs, faculty, the clergy, and psychologists in preparing student nurses for EOL practice.

References

Institute of Medicine (IOM). (2015). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.

Jackson, M. J., & Motley, C. L. (2014). End-of-life educational seminar in a prelicensure bachelor of science in nursing program. Journal of Hospice & Palliative Nursing, 16(6), 348-354. Web.

Lippe, M. P., & Carter, P. (2015). End-of-life care teaching strategies in prelicensure nursing education. Journal of Hospice & Palliative Nursing, 17(1), 31–39. Web.

Ranse, K., Ranse, J., & Pelkowitz, M. (2018). Third-year nursing students’ lived experience of caring for the dying: A hermeneutic phenomenological approach. Contemporary Nurse, 54(2), 160-170. Web.

Wittenberg, E., Ragan, S. L., Ferrell, B., & Virani, R. (2016). Creating humanistic clinicians through palliative care education. Journal of Pain and Symptom Management, 53(1), 153-156. Web.

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