Evaluation of Self-efficacy and Confidence Levels Among Newly Graduated Nurses Exposed to an End-of-Life Simulation: A Comparison Study

Simulation, Storytelling, and Pediatric End-of-Life Care: A Continuing Professional Development Approach for Nurse Residents

Background: Providing end-of-life (EOL) care to pediatric patients and their families is challenging. Newly licensed nurses, especially those working with the hematology/oncology population, have little to no experience providing the specialized care needed for the dying child. An evidence-based continuing professional development activity provided a novel approach to improve the knowledge, attitudes, and comfort levels of nurse residents related to pediatric EOL care. Method: A high-fidelity simulation module of a pediatric oncology patient at the EOL was embedded into a 12-month nurse residency program. The module employed several teaching strategies including a storytelling approach. Results: Thirteen pediatric nurse residents participated in the program. While the evidence-based intervention increased participants' EOL care knowledge, their overall attitudes, and comfort levels remained unchanged. Discussion: EOL simulation with a storytelling approach is a highly valuable method of teaching new nurses how to care for a dying patient. Additional studies are needed to explore how to increase the comfort levels of new nurses in the delicate population of pediatric hematology/oncology.

Self-doubt in Nursing Students: An Evolutionary Concept Analysis

Self-doubt may negatively affect the development of prelicensure nursing students as they prepare to become practice-ready members of the workforce. Walker and Avant's method of analysis was used to explore generalized self-doubt as well as within the context of a contemporary nursing education framework: Aller's Development of Decision-Making and Self-Efficacy Model (ADD-SEM). Results indicate that several attributes of generalized self-doubt, as a form of low psychological capital, were consistent with this construct of the ADD-SEM and should be considered as nurse educators strive to ensure new nurses are prepared for the complexity of today's health care systems.

Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models

OBJECTIVES

The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data.

METHODS

Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points.

RESULTS

The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points.

SIGNIFICANCE OF RESULTS

Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.

Interdisciplinary simulation for nursing and medical students about final conversations: Catalyzing relationships at the end of life (CAREol)

OBJECTIVES

Final conversations (FCs) go beyond how patients want to be cared for at the end of life (EOL) and focus on messages of love, identity specific, and unique to an individual and relationship that requires self-examination, everyday talk that normalizes a difficult situation, religious/spiritual messages, and if needed, difficult relationship talk to heal broken relationships. The purpose of the Catalyzing Relationships at the End of Life (CAREol) program was to provide interdisciplinary education to nursing and medical students and clinical faculty about facilitating FCs among patients and families.

METHOD

This two-part, quasi-experimental program consisted of a cognitive (online) and experiential (live simulation) curriculum experience. Program curriculum, including video vignettes, readings, and live simulation (utilizing actors), was developed by the study team. Reflective journaling and researcher designed pre- and post-tests were used to assess comfort, confidence, importance, and distress regarding FCs and collaboration with other disciplines.

RESULTS

The pre-/post-test questions demonstrate statistical significance based on a paired t-test with effect sizes supporting the practical importance of the findings for effect size. Preliminary content and thematic analysis of qualitative responses describe categories of the mock team meeting experience and interaction with the actors to change patient and family outcomes.

SIGNIFICANCE OF RESULTS

Early intervention with the CAREol program provides a framework to help students and clinical faculty facilitate FCs that may result in peace and comfort for patients and families during a difficult time.

Every Dying Patient Should Experience a Peaceful Death: A Mixed-Methods Approach to Assessing the Benefits of Palliative Care Training on Nursing Practice

Providing appropriate end-of-life care is not only a critical part of palliative care but a basic human right. Nurses are well positioned to perform this role; however, the delivery of end-of-life care is difficult. The purpose of this project was to prepare nurses to meet the challenges associated with end-of-life care and to optimize the opportunity for a peaceful death. The project comprised a mixed-methods design, analyzing a palliative care training program for a quantitative and qualitative impact on practice. Preintervention focus group discussions resulted in 6 primary themes concerning the care of these patients: ethical challenges, cultural/spiritual difficulties, troubling emotional aspects, communication challenges, frustrations, and basic unfamiliarity with end-of-life care. Nurses expressed uncertainties about their role in end-of-life care and how best to manage challenges within their scope of practice. There was a statistically significant increase in testing scores from pretraining to posttraining. Postintervention discussions identified changes within nursing practice expressed through 5 primary themes: enhanced communication, symptom management, improved emotional response, improved understanding of ethical principles, and the trajectory of death. Nurses need to receive education to understand their role within end-of-life care and effectively care for the dying patient when cure is no longer an option.

Factors associated with the decision to offer memory making in end-of-life: A survey of healthcare professionals in adult intensive care

AIM

Report experiences and behaviour influences with healthcare professionals' decision to and experiences of offering memory making during end-of-life care in the adult acute population.

BACKGROUND

Little is known about healthcare professionals' experiences offering memory making during adult acute end-of-life care.

DESIGN

Survey.

METHODS

Registered nurses, medical practitioners and social workers employed at a single tertiary referral adult intensive care, where memory making had been implemented nearly two years prior were invited to participate between June and August 2017. Reporting adheres to the STROBE checklist.

RESULTS

Ninety-six valid surveys (75% response rate: 75 registered nurses, 19 medical practitioners, and 2 social workers) were analysed with 67 participants reporting experience offering memory making. Highest overall agreement scores included believing families value memory making and the offer of memory making being beneficial. Enablers were described as organisational supports, personal qualities and good interpersonal relationships. Barriers identified included the intensive care environment, workload, inexperience offering/facilitating memory making, being afraid to offer, lack of resources and legality concerns. Compared with non-experienced participants, experienced participants reported higher level of confidence and comfort offering memory making, pride in their ability, ability to spend time supporting families and had observed colleagues offering memory making. Experienced participants were less likely to be afraid to offer, be limited by the family's behaviours, report lack of resources or be time limited to offer memory making.

CONCLUSION

Findings identify elements needed for the development and support for offering memory making to assist bereaved families in adult acute care including role modelling, support to reduce negative emotions, workload assistance and leadership/organisational support.

RELEVANCE TO CLINICAL PRACTICE

Discoveries have important implications in addressing evidence gaps regarding behaviour influences linked to the decision to offer memory making. Findings inform development and sustainability to integrate memory making as routine end-of-life care intervention in adult acute care.

From Development to Implementation: The Effectiveness of a High-Fidelity Simulation for Advance Care Planning for Undergraduate Nursing Students

This study describes the development and implementation of a high-fidelity simulation as the teaching strategy to enhance undergraduate nursing students' satisfaction, self-confidence, knowledge and learning, collaboration, and communication in providing advance care planning to a terminally ill patient. This original simulation was created using the Healthcare Simulation Standards of Best Practice to incorporate the CARES: Competencies And Recommendations for Educating Undergraduate Nursing Students Preparing Nurses to Care for the Seriously Ill and their Families into the nursing curriculum. A descriptive, quantitative study was conducted for 3 years, evaluating feasibility, sustainability, and student outcomes. Student outcomes were measured with the Frommelt Attitude toward the Care of the Dying Scale, the Student Satisfaction and Self-Confidence in Learning Scale, and Educational Practices Questionnaire. The findings showed the average global scores for the Student Satisfaction and Self-Confidence in Learning Scale (n = 174; mean [SD], 4.28 [0.86]) and for the Educational Practices Questionnaire (n = 164; mean [SD], 4.46 [0.7]), and item scores of each scale were heavily skewed toward the maximum score of 5. The high-fidelity simulation for advance care planning was demonstrated to be feasible and sustainable. As an investment in student learning, it increased the students' active learning, collaboration, communication, satisfaction, and self-confidence while learning how to conduct advance care planning for the terminally ill.