What is a compassionate response in the emergency department? Learner evaluation of an End-of-Life Essentials online education module

Are We Stepping Back? Findings From an Italian Study on Post-Pandemic Changes in Nursing Education

AIM

To describe (a) recommended changes implemented and their perceived effectiveness at the country level, (b) changes discontinued in the post-pandemic era with reasons, and (c) research priorities in nursing education for the next five years.

BACKGROUND/INTRODUCTION

The COVID-19 pandemic has pushed several nursing education transformations. However, no studies have documented changes still prevalent in the post-pandemic era.

DESIGN

A national cross-sectional study following the STROBE guidelines.

METHODS

All Italian nursing programs (n = 241) were targeted. Eight major and 21 subrecommendations indicating changes expected were included in the online survey to measure their implementation, their perceived effectiveness and status at the time of the survey, discontinuation reasons, and the research priorities. Descriptive and content analyses were used.

RESULTS

113 (45.5%) nursing programs participated reflecting the education received by >70% of Italian nursing students. All recommended changes have been implemented from 60.2% to 100% nursing programs, resulting in a perceived effectiveness from 4.29 (confidence interval [CI] 95%, 4.07-4.51) to 6.37 (CI 95%, 6.19-6.56) out of 7. A few recommendations were still applied at the time of the survey, while several were discontinued (from 4.8% to 61.9%) because, in order, of concern regarding their effectiveness, university/law dispositions, traditional methods reimplemented, technical/logistic difficulties and students' requests. Digital solutions' impact on nursing education was identified as a research priority.

CONCLUSION

After the multifaced changes triggered by the pandemic, the pace of transformation of nursing education seems to have been decelerated.

IMPLICATIONS FOR NURSING

The potential regressive pattern that has emerged, wherein the previous model of nursing education is repristinated, calls for immediate action, which is also in line with the research priorities.

Development and implementation of the Compassionate 1 Curriculum: an educational initiative to improve the delivery of care to patients receiving involuntary orders for mental health emergencies

Compassion is an indispensable attribute of quality healthcare, but enhancing compassion is seldom the focus of emergency healthcare improvement. The Compassionate 1 Project was launched in the St. Joseph's Emergency Department, Toronto, with a goal of reducing critical agitation events among patients receiving involuntary orders for mental health emergencies. This initiative sought to enhance compassion by improving the quality of communication and material comfort for this patient group. Here, we describe the first component of this project, a novel, whole-of-department educational initiative to teach the delivery of compassionate care to patients with mental health presentations. The second component of this project will evaluate the impact of this initiative in reducing critical agitation events.

Desire to Die Communication Training for Professionals: Developing Online Formats

Background

Severely ill patients often express a desire to die, which can turn into suicidality. To support health professionals in managing this issue, we initially created a two-day face-to-face training to enhance self-confidence, knowledge, attitudes, and skills. Due to the increasing need for more accessible formats, we aimed to transition this training online and develop a complementary website.

Methods

Multimethod approach to develop and evaluate an online training and a website on dealing with the desire to die in palliative care in Germany. This involved: (1) reviewing literature on effective didactic elements, (2) digitalizing the face-to-face training and creating the website with ongoing expert feedback, and (3) piloting and evaluating these resources through online surveys.

Results

We retrieved suggestions for the development of online trainings and websites from n = 39 publications. Through these results and expert discussion, an online version of our training and a website were developed. For evaluation, we conducted two trainings (face-to-face (n = 8) and online (n = 19)) with multiprofessional participants. All improved significantly in self-confidence after the training without differences between online and face-to-face training. Website evaluation of usability, comprehension, information quality, presentation, and sustainability by n = 71 users yielded favorable feedback with improvement suggestions for structure and plain language.

Conclusions

Dealing with the desire to die can be taught not only face to face but also through online training and an educational website. This can ensure low-threshold access to scientifically sound information and training units for those health professionals confronted with the desire to die.

The Impact of Palliative and End-of-Life Care Educational Intervention in Emergency Departments in Singapore: An Interrupted Time Series Analysis

Background and Objectives: The increasing prevalence of end-of-life care needs in the emergency department necessitates training for emergency staff in managing terminal symptoms, facilitating serious illness conversations and ensuring goal-concordant interventions. This study aims to evaluate the longitudinal effects of an end-of-life care educational intervention on various emergency professionals. Materials and Methods: An interrupted time series study was conducted among emergency physicians and nurses at three public healthcare institutions over two-and-a-half years. The study had three phases: Phase 1-5 pre-intervention surveys, Phase 2-intervention with an online training course, and Phase 3-5 post-intervention surveys. The impact of the intervention was scored based on staff perceptions of end-of-life care in 3 domains: 1. Knowledge of palliative care (Knowledge), 2. Quality of end-of-life care provided (Care), and 3. Ability to communicate with patients and families (Communication). Results: There were 990 participants with 6450 questionnaires distributed and an 87% response rate of completed questionnaires. Phase 3 had generally higher levels of agreement in all 3 domains compared to Phase 1, with a continued upward trend in Knowledge scores. Upward trends in the Care and Communication domains were less pronounced. Among the 631 (out of 990) participants who completed the training, test scores showed a median improvement of 37.5% (p < 0.001). Conclusions: This study supports the feasibility of online end-of-life care training tailored specifically for emergency professionals, with promising results in the Knowledge, Care, and Communication domains. The findings can help guide the further development of training programs or the adoption of similar interventions for basic palliative care training for emergency physicians and nurses.

Teaching empathy and compassion to healthcare providers in palliative care: a scoping review

Empathy and compassion are core competencies that healthcare providers (HCPs) require when caring for patients and families with life-threatening illnesses like cancer. These constructs are often challenging to define and generalise and are often used interchangeably. Medical education has evolved from the traditional curriculum-based approach to a more eclectic competency-based approach. The purpose of this review is to explore the current evidence on teaching compassionate care for palliative care issues in cancer settings in lower-middle-income countries. A preliminary search of the Scopus database from 2,000 until now identified 1,502 records, of which 54 peer-reviewed articles were included in this review. Training in compassion and empathy was delivered in three formats: online, face-to-face and blended learning or hybrid. The training modalities were didactic, experiential and reflective, with many educational interventions using a multimodal approach. The educational interventions reported a positive outcome and improvement in empathetic and compassionate behaviours. However, they were limited due to inadequately defined constructs, use of self-reported outcome measures and difficulty in ascertaining if these skills were retained long-term and were translated into the clinical settings. Given that compassion and empathy are multidimensional constructs, it is imperative that educational interventions be multimodal and learner-centred, focusing on developing the knowledge, attitudes, skills and behaviours of the HCP in providing compassionate care while aiming for conceptual clarity regarding definition and more robust validated outcome measures.

Person-centred care and online pedagogy in nursing education: a discussion paper

AIM

To discuss person-centred care in nursing education and the role of online pedagogy to facilitate meaninful learning.

BACKGROUND

The core principles and values of person-centred care are at the centre of national and international healthcare education. Person-centred care recognises partnerships and relationships between nurses, healthcare practitioners and individual patients, carers and their families and part of the training of healthcare professionals. However, the literature on how person-centred care is taught to facilitate meaningful learning in nursing education particularly in the context of online pedagogy is limited.

DESIGN

A critical discussion paper.

METHODS

A critical discussion of person-centred care and online pedagogy that can facilitate teaching practices are presented, drawing on authors' positionality and case exemplars.

RESULTS

Teaching person-centred care using online pedagogy appears to have a promising impact on undergraduate and postgraduate nursing students' experiences. Engaging students in critical examination and reflection on the complexities of person-centred care in practice creates meaningful experiential learning for both students and educators.

CONCLUSION

Evidence suggests that the use of online pedagogy is a beneficial and effective way to incorporate the teaching of person-centred care into nursing education, yet more evidence is needed to evaluate its impact on nursing practice.

"Holding back my own emotions": Evaluation of an online education module in pediatric end-of-life care

Providing quality end-of-life care to a child who is dying in hospital can be stressful and challenging, and health professionals often feel ill-prepared and require additional support. End-of-Life Essentials offers online education modules for health professionals working in acute hospitals, including one on end-of-life care in pediatric settings. This study aimed to evaluate this module and explore learners' views on challenges faced when caring for a dying child and their family in a hospital setting. Learners comprised nurses, doctors, and allied health professionals. A quantitative pre-/post-evaluation analysis was conducted using learner data (n = 552) on knowledge and skills gained from engagement with the module, along with a qualitative thematic content analysis on learner responses (n = 395) to a post-evaluation free-text response question, between May 2019 and May 2020. Learners' post-evaluation ranks of perceived knowledge, skill, attitude, and confidence were significantly higher than pre-evaluation ranks (p < 0.001). Effect sizes were small to medium, ranging from 0.31 to 0.38 (95% confidence intervals from 0.23 to 0.45). Emerging themes from the qualitative data were dealing with emotions, and communicating effectively. This evaluation suggests that the Pediatrics module could be a useful online learning resource for health professionals. A planned longitudinal study will further investigate practice change.

"We are Human too.": The Challenges of Being an End-of-Life Doula

End-of-life (EOL) doulas are emerging professionals who provide an intimate approach to the death process by focusing on the psychological, social, spiritual, and emotional needs of dying individuals. EOL doula work is stressful; it exposes individuals to recurring stressors such as suffering and grief. Trained professionals are needed to help advocate for the dying individual and their families. Despite the growing literature on EOL doulas, information regarding the challenges of being an EOL doula is underrepresented in the literature. This paper is one of the first to address this concept. Twelve in-depth, semi-structured interviews regarding the EOL doula experience were conducted as a part of a larger exploratory study. Three overarching themes emerged from the larger project: motivations to become an EOL doula, roles of an EOL doula, and challenges of an EOL doula. In this article, only challenges of EOL are discussed, along with subsequent subordinate themes.

Aotearoa New Zealand emergency medicine specialists on the provision of care at or near the end of life: A survey

OBJECTIVES

The ED is an increasingly important venue for the initiation of palliative care. We sought to characterise the opinions, experience, training and education of ED staff in Aotearoa/New Zealand (NZ) with regard to specific aspects of palliative care in the NZ ED setting.

METHODS

All NZ FACEMs were personally emailed a simple unstructured 16-part survey asking questions about initiating palliative care, goals of care, initiation and availability of advance care plans, frailty screening, availability of palliative expertise, training and education, cultural safety and pastoral care of staff. All EDs were contacted and a link provided for non-FACEM ED staff who wished to participate. Free-text comments were analysed for dominant themes.

RESULTS

All NZ EDs had at least one participant. There was a high level of senior medical staff engagement with 60% of NZ FACEMs participating. More than 300 free-text comments from this group were available for theme analysis. A total of 93% of NZ FACEM respondents agree that palliative care should be able to be initiated in the ED. Only 25% of this group knew of training in serious illness conversations in the ED while only 34% felt culturally competent when providing end-of-life care for Māori and their whanau (family). Pastoral care for ED staff appears to be ad hoc. Time and privacy limitations were common themes.

CONCLUSIONS

There is significant opportunity for quality improvement in the initiation and provision of palliative care from the ED. Attention to how departments provide pastoral care to their staff is needed.