Rose Virani

Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference

A Consensus Conference sponsored by the Archstone Foundation of Long Beach, California, was held February 17-18, 2009, in Pasadena, California. The Conference was based on the belief that spiritual care is a fundamental component of quality palliative care. This document and the conference recommendations it includes builds upon prior literature, the National Consensus Project Guidelines, and the National Quality Forum Preferred Practices and Conference proceedings.

Strengthening nursing education to improve end-of-life care

The survey results provide future direction for nursing education. Results indicate an awareness in the nursing profession of the need for improved EOL care and identification of resources to achieve that goal. Many activities have been initiated within the nursing community, and the results of this project hopefully will stimulate additional activities. The imperative for improved EOL care will escalate in the future as our elderly population grows and a burdened health care system confronts the costs of chronic and terminal illness. Palliative care, which has traditionally been limited to hospice programs, must extend to other settings and be incorporated into the trajectory of care. The IOM report and other palliative care literature asserts that improved care for the dying will necessitate change at many levels. Patients and the general public must be educated to expect a higher standard of care at the EOL. Health care system changes are needed to improve access to care and to eliminate barriers such as regulatory constraints on prescribing opioids. However, central to all health care reform is the need for educated professionals to direct this change. As professionals dedicated to patient comfort and quality of life--even at the EOL, nurses should begin the revolution in EOL care by attending to the education of nurses.

Analysis of pain content in nursing textbooks

This paper reports on one goal of a project designed to improve end-of-life (EOL) care in nursing education. The goal was to improve the content regarding pain and EOL care included in major nursing textbooks. A descriptive study used content analysis of 50 textbooks selected from a potential of over 700 texts used in nursing education. The 50 texts included 45,683 pages. The text review was conducted using an analysis framework and included content analysis as well as quantification of the content present in the texts. While pain was the most common topic in the texts, the 248 pages of pain content represents only 0.5% of total text content. All nine areas of EOL content (902 pages) comprised only 2% of overall text. Particular weaknesses in the review of pain content were recognized in pharmacologic management of pain. In summary, nursing texts have limited content on pain. Increased attention to this area is essential to prepare nurses to care for patients at the end of life.

The Role of Oncology Nursing to Ensure Quality Care for Cancer Survivors: A Report Commissioned by the National Cancer Policy Board and Institute of Medicine

PURPOSE To examine the roles of oncology nurses in improving quality care for cancer survivors. DATA SOURCES A content analysis of textbooks, journals, and key documents; surveys of graduate oncology nursing programs and the Oncology Nursing Societys Survivorship Special Interest Group; review of the nursing licensure examination and oncology nursing certification; review of undergraduate and graduate nursing standards; and review of currently funded nursing research. DATA SYNTHESIS Ten critical content areas of cancer survivorship were used for the analysis: description of population of cancer survivors, primary care, short- and long-term complications, prevention of secondary cancer, detecting recurrent and secondary cancers, treatment of recurrent cancer, quality-of-life issues, rehabilitative services, palliative and end-of-life care, and quality of care. Although findings within each source indicated significant information related to the roles of nurses in caring for cancer survivors, deficits also were identified. CONCLUSIONS Review of key literature and resources suggests significant contributions by oncology nursing over the past two decades to the area of cancer survivorship. IMPLICATIONS FOR NURSING Support is needed to expand education and research to ensure quality care for future cancer survivors.

End-of-Life Nursing Education Consortium (ELNEC) training program: Improving palliative care in critical care

The integration of palliative care in critical care settings is essential to improve care of the dying, and critical care nurses are leaders in these efforts. However, lack of education in providing end-of-life (EOL) care is an obstacle to nurses and other healthcare professionals as they strive to deliver palliative care. Education regarding pain and symptom management, communication strategies, care at the end of life, ethics, and other aspects of palliative care are urgently needed. Efforts to increase EOL care education in most undergraduate and graduate nursing curricula are beginning; yet, most critical care nurses have not received formal training in palliative care. Moreover, educational resources such as critical care nursing textbooks often contain inadequate information on palliative care. The ELNEC-Critical Care program provides a comprehensive curriculum that concentrates on the requirements of those nurses who are working in areas of critical care. Extensive support materials include CD-ROM, binder, Web sites, newsletters, textbooks, and other supplemental items. The ultimate goal is to improve EOL care for patients in all critical care settings and enhance the experience of family members witnessing the dying process of their loved ones.

Evaluation of end-of-life nursing education for continuing education and clinical staff development educators.

This article presents data from the 1-year follow-up of the three conferences targeted toward continuing education (CE) providers and staff development (SD) educators and reviews the train-the-trainer model used in disseminating the End-of-Life Nursing Education Consortium (ELNEC) curriculum. The analysis has implications for educators to promote improved end-of-life (EOL) care in their own institutions.

Oncology End-of-Life Nursing Education Consortium training program: improving palliative care in cancer.

PURPOSE/OBJECTIVES To describe an evaluation of the oncology version of the End-of-Life Nursing Education Consortium (ELNEC-Oncology) training program, which is designed to provide oncology nurses with the knowledge and materials necessary to disseminate palliative care information to their colleagues in local chapters of the Oncology Nursing Society (ONS). DATA SOURCES Participant reports. DATA SYNTHESIS 124 nurses representing 74 ONS chapters attended the first two courses. Dyads of ONS members from local chapters applied to attend ELNEC and completed surveys regarding their goals and expectations for implementing end-of-life (EOL) education and training after completion of the program. Participants educated more than 26,000 nurses after attending the program, including 7,593 nurses within their ONS chapters and 18,517 colleagues within their workplaces. Barriers to implementation included a lack of funding and time constraints. Participants sought additional palliative care learning opportunities, including attending other workshops, subscribing to palliative care journals, and becoming involved in committees focused on palliative care. CONCLUSION The ELNEC-Oncology program is a national collaboration with ONS that provides oncology nurses with the tools and expertise to effectively disseminate palliative care content to colleagues within their local chapters and work settings. IMPLICATIONS FOR NURSING EOL care information remains critical to the science of oncology nursing, and ELNEC-Oncology provides an effective strategy for disseminating the information.

End-of-Life Nursing Education Consortium: 5 Years of Educating Graduate Nursing Faculty in Excellent Palliative Care

Since January 2001, over 4,500 nurses, representing all 50 U.S. states and the District of Columbia, have attended 1 of 50 national End-of-Life Nursing Education Consortium (ELNEC) train-the-trainer courses. Of the 4,500 nurses who have attended a national ELNEC course, 300 graduate nursing faculty members participated in one of four National Cancer Institute (NCI) grant-funded courses, ELNEC-Graduate, that focused on the needs of faculty teaching graduate nursing students. These nursing faculty members represent every state in the United States and 278 (63%) out of 438 graduate nursing programs. The final NCI-funded ELNEC-Graduate course took place in June 2006. Due to the continued need for this education, additional courses were offered at the 2007 American Association of Colleges of Nursing (AACN) masters conference, and another course was presented in February 2008 at the same AACN meeting. The purpose of this paper is to describe the history of the ELNEC-Graduate project and to demonstrate its impact in empowering graduate nursing faculty members to improve their teaching methods and strategies regarding end-of-life (EOL)/palliative care education. Because of ELNEC-Graduate, graduate nursing faculty members are better equipped to provide this education to their students so that these students are prepared to care for patients and their families experiencing EOL/palliative care issues.

Evaluation of palliative care nursing education seminars

PURPOSE More than 50 million people die each year around the world. Nurses are crucial in providing care to these individuals and their families as they spend the most time at the bedside with patients and families. Yet many nurses have received little or no education about palliative care. METHODS/SAMPLE The Open Society Institute (OSI) and the Open Medical Institute (OMI) partnered with End-of-Life Nursing Education Consortium (ELNEC) to develop an international nursing palliative care curriculum. This international curriculum was implemented with two training courses held in Salzburg, Austria in October 2006 (n=38) and April 2008 (n=39) representing 22 Eastern European/Central Asian countries. Participants were asked to establish goals in disseminating the palliative care information when they returned to their country. The participants were mentored/followed for a 12-month period to evaluate their palliative care knowledge as well as challenges encountered. KEY RESULTS The participants provided excellent ratings for the training courses indicating that the courses were stimulating and met their expectations. The 12-month follow-up demonstrated many challenges (i.e., lack of funds, institutional support, fear of death), in advancing palliative care within each participants setting/country as well as many examples of successful implementation. CONCLUSIONS There is an urgent need for improved palliative care throughout the world. The ELNEC-International curriculum is designed to address the need for increased palliative care education in nursing. In order to improve the quality of life for those facing life-threatening illnesses around the world, ongoing support is needed for world-wide palliative care educational efforts.

Appraisal of the Pediatric End-of-Life Nursing Education Consortium Training Program

Major deficiencies continue to exist in pediatric palliative and end-of-life nursing education. The End-of-Life Nursing Education Consortium (ELNEC)-Pediatric Palliative Care (PPC) train-the-trainer curriculum was developed to create a nursing education program to improve care for children and their families confronted with life-threatening illnesses (www.aacn.nche.edu/ELNEC). Two ELNEC-PPC training programs were held in August 2005 and August 2006. The purpose of this article is to present data from the precourse and 12-month postcourse follow-up of participants who attended the two courses. Findings from these assessments demonstrate a positive link between educational initiatives and clinical outcomes.