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Wu Q, Zhu P, Ji Q, Shi G, Qian M, Xu H, Gu X, Wang W, Zhang Q. The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design. NURSE EDUCATION TODAY 2023; 126:105809. [PMID: 37058871 DOI: 10.1016/j.nedt.2023.105809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/26/2023] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service. OBJECTIVES To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death. DESIGN This study was designed using a mixed-methods design. SETTING Two campuses of a university school of nursing in China. PARTICIPANTS First grade Bachelor of Nursing Science students (n = 191). METHODS Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis. RESULTS The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing. CONCLUSION Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.
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Affiliation(s)
- Qiwei Wu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Pingting Zhu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China; Jiangsu Key Laboratory of Zoonosis, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China.
| | - Qiaoying Ji
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Guanghui Shi
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Meiyan Qian
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - HuiWen Xu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Xinyue Gu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Wen Wang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Qianqian Zhang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
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Lyttle KA, Schenker Y, Kelsey RC, Larbi DA, Ivonye C, Johnson MS, Abdulhay LB, Arnold RM. An Educational Intervention to Enhance Palliative Care Training at HBCUs. J Pain Symptom Manage 2023; 65:418-427. [PMID: 36682671 DOI: 10.1016/j.jpainsymman.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023]
Abstract
CONTEXT Primary palliative care training is important for clinicians at Historically Black Colleges and Universities (HBCUs) given the decreased access to specialty palliative care among Black patients and patients' preferences for race concordant care. OBJECTIVES To describe the impact of a palliative care educational intervention at two HBCUs. METHODS We administered a palliative care educational intervention in family and internal medicine residency programs at Morehouse School of Medicine and Howard University College of Medicine. Pre- and post-intervention surveys were sent to residents assessing attitudes toward their palliative care education and their perceived competency in specific palliative care domains. The results were analyzed using Chi-squared analysis. RESULTS A total of 105 of 191 (response rate 55%) residents completed pre-intervention surveys and 101 of 240 (42%) completed post-intervention surveys. Prior to the intervention, 50% of residents rated their overall preparedness in palliative care as a 7 or above (0-10 Likert scale); 78% (P < .01) of respondents reported ≥7/10 after the educational intervention. While post-intervention residents did not feel better prepared to treat symptoms, a higher percentage reported feeling well prepared to deliver bad news (41% post-intervention vs. 23% pre-intervention) and conduct a family meeting (44% post-intervention vs. 27% pre-intervention) (P < .05). Pre-intervention, 14% of residents felt their overall palliative care education was very good or excellent, while post-intervention ratings increased to 30% (P < .01). CONCLUSION Residents' confidence in their preparedness to provide palliative care, particularly in their communication skills increased after an intervention at two HBCUs.
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Affiliation(s)
- K Ashley Lyttle
- Meharry Medical College (K.A.L.), Nashville, Tennessee, USA.
| | - Yael Schenker
- Palliative Research Center (PaRC) and Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine (Y.S., R.M.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riba C Kelsey
- Department of Family Medicine (R.C.K.), Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Daniel A Larbi
- Department of Medicine (D.A.L.), Howard University College of Medicine, Washington D.C., USA
| | - Chinedu Ivonye
- Department of Medicine (C.I.), Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Mark S Johnson
- Department of Community and Family Medicine (M.S.J.), Howard University College of Medicine, Washington DC, USA
| | | | - Robert M Arnold
- Palliative Research Center (PaRC) and Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine (Y.S., R.M.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative and Supportive Institute, UPMC Health System (R.M.A.), Pittsburgh, Pennsylvania, USA
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Abdulhay LB, Viera-Ortiz L, Lyttle KA, Indralingam R, Arnold RM, Schenker Y. A Novel Educational Program for Medical Students to Increase Diversity in Palliative Care. J Pain Symptom Manage 2022; 64:e373-e377. [PMID: 35963446 PMCID: PMC9669224 DOI: 10.1016/j.jpainsymman.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Lindsay B Abdulhay
- Chippenham Hospital (L.B.A.), Richmond, Virginia, USA; University of Puerto Rico School of Medicine (L.V.O.), San Juan, Puerto Rico, USA; Meharry Medical College (K.A.L.), Nashville, Tennessee, USA; University of Pittsburgh School of Medicine (R.I.), Pittsburgh, Pennsylvania, USA; Division of General Internal Medicine (R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (R.M.A., Y.S.),, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Liliana Viera-Ortiz
- Chippenham Hospital (L.B.A.), Richmond, Virginia, USA; University of Puerto Rico School of Medicine (L.V.O.), San Juan, Puerto Rico, USA; Meharry Medical College (K.A.L.), Nashville, Tennessee, USA; University of Pittsburgh School of Medicine (R.I.), Pittsburgh, Pennsylvania, USA; Division of General Internal Medicine (R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (R.M.A., Y.S.),, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kadeen Ashley Lyttle
- Chippenham Hospital (L.B.A.), Richmond, Virginia, USA; University of Puerto Rico School of Medicine (L.V.O.), San Juan, Puerto Rico, USA; Meharry Medical College (K.A.L.), Nashville, Tennessee, USA; University of Pittsburgh School of Medicine (R.I.), Pittsburgh, Pennsylvania, USA; Division of General Internal Medicine (R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (R.M.A., Y.S.),, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Renusha Indralingam
- Chippenham Hospital (L.B.A.), Richmond, Virginia, USA; University of Puerto Rico School of Medicine (L.V.O.), San Juan, Puerto Rico, USA; Meharry Medical College (K.A.L.), Nashville, Tennessee, USA; University of Pittsburgh School of Medicine (R.I.), Pittsburgh, Pennsylvania, USA; Division of General Internal Medicine (R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (R.M.A., Y.S.),, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Chippenham Hospital (L.B.A.), Richmond, Virginia, USA; University of Puerto Rico School of Medicine (L.V.O.), San Juan, Puerto Rico, USA; Meharry Medical College (K.A.L.), Nashville, Tennessee, USA; University of Pittsburgh School of Medicine (R.I.), Pittsburgh, Pennsylvania, USA; Division of General Internal Medicine (R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (R.M.A., Y.S.),, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Chippenham Hospital (L.B.A.), Richmond, Virginia, USA; University of Puerto Rico School of Medicine (L.V.O.), San Juan, Puerto Rico, USA; Meharry Medical College (K.A.L.), Nashville, Tennessee, USA; University of Pittsburgh School of Medicine (R.I.), Pittsburgh, Pennsylvania, USA; Division of General Internal Medicine (R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (R.M.A., Y.S.),, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Marcewicz L, Kunihiro SK, Curseen KA, Johnson K, Kavalieratos D. Application of Critical Race Theory in Palliative Care Research: A Scoping Review. J Pain Symptom Manage 2022; 63:e667-e684. [PMID: 35231591 DOI: 10.1016/j.jpainsymman.2022.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/13/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
CONTEXT Structural racism negatively impacts individuals and populations. In the medical literature, including that of palliative care, structural racism's influence on interracial differences in outcomes remains poorly examined. Examining the contribution of structural racism to outcomes is paramount to promoting equity. OBJECTIVES We examined portrayals of race and racial differences in outcomes in the palliative care literature and created a framework using critical race theory (CRT) to aid in this examination. METHODS We reviewed the CRT literature and iteratively developed a rubric to examine when and how differences between races are described. Research articles published in The Journal of Pain and Symptom Management presenting empiric data specifically including findings about racial differences were examined independently by three reviewers using the rubric. RESULTS Fifty-seven articles met inclusion criteria. Articles that specifically described racial differences were common in the topic areas of quality (75% of articles), hospice (53%), palliative care services (40%) and spirituality/religion (40%). The top three reasons posited for racial differences were patient preference (26%), physician bias (23%), and cultural barriers (21%). Using the CRT rubric we found that 65% of articles posited that a racial difference was something that needed to be rectified, while articles rarely provided narrative (5%) or other data on perspectives of people of color (11%) to explain assumptions about differences. CONCLUSION Palliative care research frequently highlights racial differences in outcomes. Articles that examine racial differences often assume that differences need to be fixed but posit reasons for differences without the narratives of those most affected by them.
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Affiliation(s)
- Lawson Marcewicz
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA; Atlanta VA Health Care System (L.M.), Decatur, Georgia, USA.
| | - Susan K Kunihiro
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kimberly A Curseen
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Khaliah Johnson
- Division of Pediatric Palliative Medicine (K.J.), Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Jones KF, Laury E, Sanders JJ, Starr LT, Rosa WE, Booker SQ, Wachterman M, Jones CA, Hickman S, Merlin JS, Meghani SH. Top Ten Tips Palliative Care Clinicians Should Know About Delivering Antiracist Care to Black Americans. J Palliat Med 2022; 25:479-487. [PMID: 34788577 PMCID: PMC9022452 DOI: 10.1089/jpm.2021.0502] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Racial disparities, including decreased hospice utilization, lower quality symptom management, and poor-quality end-of-life care have been well documented in Black Americans. Improving health equity and access to high-quality serious illness care is a national palliative care (PC) priority. Accomplishing these goals requires clinician reflection, engagement, and large-scale change in clinical practice and health-related policies. In this article, we provide an overview of key concepts that underpin racism in health care, discuss common serious illness disparities in Black Americans, and propose steps to promote the delivery of antiracist PC.
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Affiliation(s)
| | - Esther Laury
- Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA.,Address correspondence to: Esther Laury, PhD, RN, Merck Sharp & Dohme Corp., US Outcomes Research, 351 N. Sumneytown Pike, North Wales, PA 19454, USA
| | - Justin J. Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren T. Starr
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Melissa Wachterman
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Christopher A. Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan Hickman
- Department of Community and Health Systems, Indiana University School of Nursing, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Salimah H. Meghani
- Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Bushunow V, Alamgir L, Arnold RM, Bell LF, Ivonye C, Johnson M, Kelsey R, Larbi D, Schenker Y. Palliative Care Attitudes and Experiences among Resident Physicians at Historically Black Colleges and Universities. J Pain Symptom Manage 2022; 63:106-111. [PMID: 34273523 DOI: 10.1016/j.jpainsymman.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Seriously ill Black patients receive lower quality palliative care than White patients. Equitable access requires palliative care skills training for all physicians. Historically Black Colleges and Universities (HBCUs) play a key role in educating Black physicians and have less access to palliative care resources. OBJECTIVE To investigate palliative care attitudes and experiences among primary care residents at HBCUs. METHODS Internal Medicine and Family Medicine residents at two HBCUs completed an online survey assessing attitudes towards palliative care and teaching and clinical experiences in palliative care. We performed a descriptive analysis of survey items. RESULTS Among 91 residents who completed the survey (response rate 48%), 65% were women and 68% Black. Most (96%) said that learning about palliative care was moderately/very important to their career; however, two-thirds of respondents considered care for dying patients to be depressing and half reported receiving negative messages about palliative care from other physicians. Residents reported receiving less teaching about providing palliative care (5.4 ± 2.3 on 10-point scale) than about managing sepsis (8.3 ± 1.8; P < 0.05). Fewer residents rated their palliative care education as "Excellent" or "Very Good" compared to their overall education (13% vs 70%; P < 0.05). CONCLUSION In the first survey exploring palliative care education at HBCUs, residents viewed palliative care as important but described the quality of their palliative care education as poor. This study highlights opportunities for improving palliative care education at HBCUs as a step toward addressing disparities in serious illness care.
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Affiliation(s)
- Vasilii Bushunow
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Laila Alamgir
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC
| | - Robert M Arnold
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA; Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
| | - Lindsay F Bell
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA; Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
| | - Chinedu Ivonye
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Mark Johnson
- Department of Community and Family Medicine, Howard University College of Medicine, Washington, DC
| | - Riba Kelsey
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Daniel Larbi
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC
| | - Yael Schenker
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA; Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
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