Shared Governance Through Bylaws: Transformation Within a College of Nursing.

BACKGROUND: Enhancing faculty voice and promoting shared governance within academia has long been called for but has not been well-reported. A college of nursing in the midwestern United States identified shortcomings in its organizational structure including lack of faculty voice, communication barriers, lack of faculty participation in decision making, and academic programs operating independently. METHOD: A workgroup was formed to transform the bylaws to promote shared governance, including faculty voice, equality, and engagement. RESULTS: The bylaws were revised and presented to faculty for discussion, further revisions, and vote. The revised bylaws were approved and implemented in August 2021. CONCLUSION: Through transformation of the bylaws, the college's 12-committee structure was reconceptualized to five standing committees and 13 subcommittees. Clear communication lines and cross-committee collaboration was established to break down the former academic program silos. Faculty with primary teaching assignments are equally represented throughout the structure with voice, vote, and responsibility. [J Nurs Educ. 2024;63(5):277-281.].

Top Ten Tips Palliative Clinicians Should Know About Rural Palliative Care in the United States.

Palliative care improves outcomes, yet rural residents often lack adequate and equitable access. This study provides practical tips to address palliative care (PC)-related challenges in rural communities. Strategies include engaging trusted community partners, addressing cultural factors, improving pediatric care, utilizing telehealth, networking with rural teams including caregivers, and expanding roles for nurses and advanced practice providers. Despite complex barriers to access, providers can tailor PC to be patient-centered, respect local values, and bridge gaps. The "Top 10" format emphasizes the relevant issues to enable clinicians to provide optimal care for people from rural areas.

Healthcare professionals' perspectives of barriers to cancer care delivery for American Indian, rural, and frontier populations.

Objective: This descriptive qualitative study sought to understand the barriers affecting cancer care delivery from the perspective of healthcare professionals (HCPs) serving American Indian (AI), rural, and frontier populations. Methods: One-on-one, semi-structured interviews with multidisciplinary HCPs (N = 18) who provide cancer care to AI, rural, and frontier populations were conducted between January and April 2022. Interviews were conducted via Zoom. Data were analyzed following thematic content analysis methodologies. Results: Thematic content analysis revealed three major themes: (a) Access, (b) Time, and (c) Isolation. The themes represent the HCP perspectives of the needs and barriers of persons with cancer to whom they provide cancer care. Furthermore, these themes also reflect the barriers HCPs experience while providing cancer care to AI, rural and frontier populations. Conclusions: This study provides preliminary evidence for the need and strong multidisciplinary support for an early palliative care intervention in rural and frontier South Dakota (SD). This intervention could support the needs of persons with advanced cancer as well as the HCPs delivering cancer care in rural settings. Innovation: This study is the initial step to develop the first culturally responsive, nurse-led, early palliative care intervention for AI, rural, and frontier persons with advanced cancer in SD.

Palliative Care Knowledge Following an Interdisciplinary Palliative Care Seminar.

BACKGROUND: The COVID-19 pandemic created a unique opportunity to evolve an interdisciplinary palliative care seminar (IPC) into a virtual platform. This seminar provides foundational palliative and hospice concepts, introductions into palliative care disciplines, integration of teamwork, and incorporates interdisciplinary student led patient encounters. Traditionally, this experience had been in person, however during the COVID-19 pandemic, healthcare restrictions transitioned the educational delivery to a virtual platform. METHODS: To assess the knowledge gained from this novel experience, the Palliative Care Knowledge Test (PCKT) was administered before and after the IPC Seminar. A 1-year follow up survey was also administered to evaluate how the IPC Seminar was applicable to the students' clinical experiences and practice. RESULTS: The virtual didactics and virtual student led patient encounters significantly improved learners understanding of palliative and hospice care. This gain of knowledge was noted across undergraduate and graduate programs, which highlights the need for and benefit from foundational concepts. Furthermore, a 1-year follow up survey noted the IPC seminar was applicable to their practices and suggests that this experience will impact future patients. DISCUSSION: Many of the students practice in rural areas where access to palliative care services is limited or non-existent. This experience exponentially impacts the growth of palliative and hospice care understanding and access to care across the region. CONCLUSION: Evolving our IPC Seminar has shown to significantly improve knowledge, foster collaboration of student led interdisciplinary teams, and increases capacity to meet the needs of more learners.

New ways to impact primary palliative care practices using online continuing education.

Background: Healthcare professionals trained in palliative care (PC) improve satisfaction and decrease healthcare overutilization for patients with serious illness and their families. A continuing education (CE) series on primary PC aligned to the National Clinical Practice Guidelines for Quality PC was developed by local, interdisciplinary experts for a target audience of rural, primary care healthcare professionals. The modules were accessed on an online learning management system platform. Objective: The study objectives were to assess differences in participants' knowledge, competence, performance, and ability to improve patient care as well as commitment to change practice after taking each of the CE modules. Design and Methods: To achieve these objectives, a descriptive design was used with a convenience sample of healthcare professionals who registered for the CE series and completed at least one module. Participants completed demographic questions and an evaluation survey after completing each module. Results: So far, 158 healthcare professionals have registered for the series with the majority being nurses and social workers. Although the professionals reported having extensive healthcare experience, they did not report having the same level of PC experience. The professionals represent nine different states. All the CE modules increased teamwork skills for most participants. The CE modules on cultural aspects and self-care had the biggest influence on participants' ability to improve patient outcomes. Cultural aspects, care of the actively dying, and advance care planning had the greatest impact on participants' knowledge, competence, and performance. Conclusion: The primary PC education series improved self-reported skills in teamwork, practice habits, and meeting goals of healthcare professionals from a variety of disciplines and settings. These enhanced primary PC skills will improve the incorporation of PC into a variety of practice settings, by multiple disciplines to enhance access to PC outside of, and potentially referrals to, specialty PC programs.Palliative care (PC) is an emerging field of healthcare aimed at positively affecting patients living with serious illness and their families. An important factor that influences a health professional's successful delivery of PC may be their knowledge, experiences, and confidence. PC training provided to healthcare professionals improves patients' and healthcare professionals' satisfaction and reduces healthcare expenditures through cost savings and cost avoidance.1,2.

Access to Palliative Care Services: Innovative Development of a Statewide Network.

In 2018, the Avera Sacred Heart Hospital and two partners were awarded a planning grant to improve palliative health care services in South Dakota (SD), United States, by assessing palliative care in rural SD communities. Through this effort, a newly formed South Dakota Palliative Care Network (SDPCN) convened statewide partners to develop a palliative care strategy for improving quality palliative care access for individuals with serious illness. Guided by a multidisciplinary governing board, the SDPCN completed needs assessments to (1) better understand the perception of palliative care in SD; (2) assess the palliative care landscape in the state; and (3) explore possible solutions to address the uneven access to palliative care. This article shares the process of network development, considers the future of the SDPCN, and provides a blueprint for improving palliative care in rural areas. The SDPCN sought first to inventory community-based palliative care resources and increase awareness of the need for services followed by addressing gaps identified through a comprehensive assessment. The SDPCN has engaged partners, captured data, and mapped a blueprint for sustaining accessible quality palliative care. Three years since its inception, the SDPCN secured additional funding to sustain the Network and to provide education on palliative care to providers and community members as a first strategic step toward improving overall palliative care in rural communities. The SDPCN currently serves rural SD patients by increasing knowledge of palliative care among health professionals (current and future), fostering Network member engagement, and maintaining an active governing board.

The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers.

BACKGROUND: Family caregivers play a vital, yet stressful role in managing the healthcare needs and optimizing the quality of life of patients with advanced cancer, from the time they are newly diagnosed until end of life. While early telehealth palliative care has been found to effectively support family caregivers, little work has focused on historically under-resourced populations, particularly African American and rural-dwelling individuals. To address this need, we developed and are currently testing Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African American and rural-dwelling patients with newly diagnosed advanced cancer. METHODS: This is a 2-site, single-blind, hybrid type I implementation-effectiveness trial of the Cornerstone intervention versus usual care. Cornerstone is a multicomponent intervention based on Pearlin's Stress-Health Process Model where African American and/or rural-dwelling family caregivers of patients with newly diagnosed advanced cancer (target sample size = 294 dyads) are paired with a lay navigator coach and receive a series of six, brief 20-60-min telehealth sessions focused on stress management and coping, caregiving skills, getting help, self-care, and preparing for the future/advance care planning. Subsequent to core sessions, caregivers receive monthly follow-up indefinitely until the patient's death. Caregiver and patient outcomes are collected at baseline and every 12 weeks until the patient's death (primary outcome: caregiver distress at 24 weeks; secondary outcomes: caregiver: quality of life and burden; patient: distress, quality of life, and healthcare utilization). Implementation costs and the intervention cost effectiveness are also being evaluated. DISCUSSION: Should this intervention demonstrate efficacy, it would yield an implementation-ready model of early palliative care support for under-resourced family caregivers. A key design principle that has centrally informed the Cornerstone intervention is that every caregiving situation is unique and each caregiver faces distinct challenges that cannot be addressed using a one-size-fits all approach. Hence, Cornerstone employs culturally savvy lay navigator coaches who are trained to establish a strong, therapeutic alliance with participants and tailor their coaching to a diverse range of individual circumstances. TRIAL REGISTRATION: ClinicalTrials.gov NCT04318886 . Registered on 20 March, 2020.

Perceptions of Palliative Care: Voices From Rural South Dakota.

OBJECTIVES: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. METHODS: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. RESULTS: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

Intentional learning: a student-centered pedagogy.

Objective The objective was to test the assumption that characteristics of intentional learning are not fixed and if an interview assignment enhanced intentional learning. Methods In order to meet the needs of practice, nursing educators have trialed student-centered pedagogies, often with resistance from students. Intentional learning appears to mirror the characteristics, such as autonomy, responsibility of one's own learning, self-regulation, and motivation, needed by students to be successful in student-centered pedagogies. Intentional learning had not been studied in nursing. A quasi-experimental pre/post-test design was used to test intentional learning in nursing students (N=92). Results While the interview assignment did not enhance intentional learning scores, intentional learning scores did significantly increase over the semester (p=0.039). Conclusion Intentional learning scores did increase, showing that students move along the intentional learning continuum depending on their learning experiences. Future research should include testing teaching strategies that foster intentional learning.

Intentional learning: A concept analysis.

AIM: To use a concept analysis to determine a clear definition of the term "intentional learning" for use in nursing. BACKGROUND: The term intentional learning has been used for years in educational, business, and even nursing literature. It has been used to denote processes leading to higher order thinking and the ability to use knowledge in new situations; both of which are important skills to develop in nursing students. But the lack of a common, accepted definition of the term makes it difficult for nurse educators to base instruction and learning experiences on or to evaluate its overall effectiveness in educating students for diverse, fast-paced clinical practices. DESIGN AND REVIEW METHODS: A concept analysis following the eight-step method developed by Walker and Avant (2011). DATA SOURCES: Empirical and descriptive literature. RESULTS:  Five defining attributes were identified: (1) self-efficacy for learning, (2) active, effortful, and engaged learning, (3) mastery of goals where learning is the goal, (4) self-directed learning, and (5) self-regulation of learning. CONCLUSION: Through this concept analysis, nursing will have a clear definition of intentional learning. This will enable nurse educators to generate, evaluate, and test learning experiences that promote further development of intentional learning in nursing students. Nurses in practice will also be able to evaluate if the stated benefits are demonstrated and how this impacts patient care and outcomes.