Future palliative competence needs – a qualitative study of physicians’ and registered nurses’ views

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Abstract

Background

Globally, the need for palliative care will increase as a result of the ageing of populations and the rising burden of cancer, non-communicable diseases as well as some communicable diseases. Physicians and registered nurses working in palliative care should have a sufficient level of education and competence in managing the changing needs and requirements of palliative care. There is, however, need for evidence-based palliative care training and education of physicians and registered nurses. The purpose of this study was to describe the views of physicians and registered nurses regarding future competence needs within palliative care.

Methods

The study was conducted through use of a cross-sectional qualitative design. A total of 54 physicians and 110 registered nurses completed an open-ended questionnaire about the future competence needs of palliative care. The data were analyzed using inductive content analysis.

Results

The results revealed four main competence needs within palliative care for the coming decade: palliative care competence at all levels within healthcare and social welfare services; individualized palliative care competence; person-centered encounters competence; and systematic competence development within palliative care.

Conclusions

The results offer cues for education and professional development, which can be used to support physicians and registered nurses when future palliative care competences are included in educational programs. Seamless cooperation between palliative care services and educational institutions is recommended to ensure that undergraduate and postgraduate education is based on a continuous assessment of competence requirements within the field of palliative care. Therefore, online multi-professional simulations, for example, could be used to enhance future competencies within palliative care; undergraduate medical, nursing and allied healthcare students as well as postgraduate palliative care professionals and experts of experience could work together during simulations.

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Most cited references 30

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Integration of oncology and palliative care: a Lancet Oncology Commission

Stein Kaasa, Jon H Loge, Matti Aapro … (2018)

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.

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Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Linda Aiken, Douglas Sloane, Peter Griffiths … (2016)

Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80

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Education and training to support the use of clinical telehealth: A review of the literature.

S. Edirippulige, N Armfield (2017)

Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

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Author and article information

Contributors

Arja Suikkala:

ORCID: https://orcid.org/0000-0001-5957-0479

arja.suikkala@diak.fi

Anniina Tohmola:

ORCID: https://orcid.org/0000-0001-6463-0536

anniina.tohmola@lapinamk.fi

Eeva K. Rahko: eeva.rahko@ppshp.fi

Minna Hökkä:

ORCID: https://orcid.org/0000-0002-3343-4839

minna.hokka@kamk.fi

Journal

Journal ID (nlm-ta): BMC Med Educ

Journal ID (iso-abbrev): BMC Med Educ

Title: BMC Medical Education

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6920

Publication date (Electronic): 17 November 2021

Publication date PMC-release: 17 November 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 585

Affiliations

[1 ]GRID grid.449075.b, ISNI 0000 0000 8880 8274, Diaconia University of Applied Sciences, ; Kyläsaarenkuja 2, FI- 00580 Helsinki, Finland

[2 ]GRID grid.448926.5, ISNI 0000 0004 4649 1976, Lapland University of Applied Sciences, ; Kemi, Finland

[3 ]GRID grid.412326.0, ISNI 0000 0004 4685 4917, Department of Clinical Oncology, , Oulu University Hospital, ; Oulu, Finland

[4 ]GRID grid.449529.7, ISNI 0000 0004 0414 9419, Kajaani University Applied Sciences, ; Kajaani, Finland

Author information

Arja Suikkala https://orcid.org/0000-0001-5957-0479

Anniina Tohmola https://orcid.org/0000-0001-6463-0536

Minna Hökkä https://orcid.org/0000-0002-3343-4839

Article

Publisher ID: 2949

DOI: 10.1186/s12909-021-02949-5

PMC ID: 8597871

PubMed ID: 34789216

SO-VID: 2f22b96f-d556-4004-af1a-1e675c01ff33

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 11 May 2021

Date accepted : 2 September 2021

Custom metadata

ScienceOpen disciplines: Education

Keywords: palliative care,palliative medicine,palliative nursing,professional competence,qualitative research

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ScienceOpen disciplines: Education

Keywords: palliative care, palliative medicine, palliative nursing, professional competence, qualitative research

Future palliative competence needs – a qualitative study of physicians’ and registered nurses’ views

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Abstract

Background

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Results

Conclusions

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Special feature: Methodological Innovations in Qualitative Educational Research

Most cited references 30

Integration of oncology and palliative care: a Lancet Oncology Commission

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Education and training to support the use of clinical telehealth: A review of the literature.

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