International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Managing pain in seriously ill patients with substance use disorders.

ABSTRACT: Managing pain can be challenging, especially in patients with serious illnesses and a history of substance use disorders. This article discusses the challenges of addressing pain in these patients and offers perspectives regarding their clinical management.

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers.

OBJECTIVE: To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. DESIGN: A single-group descriptive longitudinal correlational study. SETTING: Medical, surgical, and neurological ICUs in a large tertiary care university hospital. PATIENTS: Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p=0.01) and emotion-focused (p<0.01) coping decreased over time while avoidant coping (p=0.20) use remained stable. Coping strategies 30 days after hospitalization (R2=0.50, p<0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2=0.30, p=0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. CONCLUSIONS: Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

Preparing Trainees to Deliver Patient-Centered Care in an Ambulatory Cancer Clinic.

The purpose of this paper is to describe how an interprofessional cancer care clinic at the Cleveland Veteran's Affairs Medical Center (VAMC) is training health care professionals in patient-centered care. Teaching strategies included patient huddle discussions pre- and post-clinic, role-play, noon "lunch and learn" conferences, and, most importantly, patient interactions, which were evaluated with the patient perception of patient centeredness (PPPC) instrument. This instrument is designed to capture patient and provider perceptions of the provider's patient centeredness. Early findings demonstrated that patient responses were overwhelmingly positive and lacked variability. In response to the lack of variability, the educator in the clinic participated in the evaluation and patient, provider, and trainer responses were compared. Discussion of the weekly evaluations provided helpful formative feedback on patient centeredness to the trainees rotating through this specialty care clinic.

Updated palliative care competencies for entry-to-practice and advanced-level nursing students: New resources for nursing faculty.

American Association of Colleges of Nursing's Essentials: Core Concepts for Professional Nursing Education (2021) established four spheres of care across the lifespan with diverse populations, one of which is hospice/palliative/supportive care. A team of palliative nursing leaders and nurse educators sought to evaluate alignment of the new Essentials with existing palliative care competency statements. The rigorous process resulted in the revision of these palliative care competency statements to align with the new Essentials more accurately. The second edition of the Competencies And Recommendations for Educating nursing Students (CARES) reflect updated palliative care expectations for entry-to-practice nursing students. Similarly, second edition Graduate Competencies And Recommendations for Educating nursing Students (G-CARES) statements describe advanced-level student competency. The team also aligned CARES/G-CARES (2nd ed.) with the Domains, Competencies, Sub-Competencies, and Concepts of the new Essentials. The updated palliative care competency statements can guide faculty in integrating palliative care education into their programs and assessing alignment of programmatic outcomes with AACN's Essentials hospice/palliative/supportive care sphere of care.

Global Integration of Palliative Nursing Education to Improve Health Crisis Preparedness.

BACKGROUND: COVID-19 has highlighted the need for universal palliative care access. Nurses require palliative care education throughout the trajectory of professional training to effectively achieve this vision. METHOD: Review of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and use of educational exemplars highlight opportunities for improving palliative nursing education in academic and clinical settings. RESULTS: Consistently applying palliative care principles affects nursing outcomes across myriad domains of person-centered services. All nurses are responsible for delivering primary palliative care, but they cannot practice what they do not know. The End-of-Life Nursing Education Consortium Project offers evidence-based education for nursing students and practicing nurses nationally and globally. CONCLUSION: Equipping both nurses and nursing students with palliative care education is critical to improve the overall quality of health care throughout the continuum during COVID-19 and in the face of future health crises. [J Contin Educ Nurs. 2021;52(3):130-135.].

Preparing Advanced Practice Registered Nursing Students to Provide Primary Palliative Care.

BACKGROUND: Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care. PROBLEM: There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content. APPROACH: In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate-Competencies and Recommendations for Educating Nursing Students in primary palliative care for master's degree and doctor of nursing practice students. OUTCOMES: During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions. CONCLUSION: Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.

Integration of Palliative Care in the Role of the Oncology Advanced Practice Nurse.

Numerous organizations have cited the increasing demand for palliative care in oncology and the challenge of a limited workforce to deliver specialty palliative care. Advanced practitioners in oncology can provide generalist or primary palliative care to complement the care provided by specialists and enhance the overall provision of care. This article reports on a National Cancer Institute-funded training program to prepare advanced practice nurses to incorporate palliative care within their practice. One-year follow-up of the first three national cohorts (N = 276) included evaluation of goal achievement as these nurses integrated palliative care within their oncology practice. Goal analysis reported here demonstrates the success of the training program in impacting practice as well as the barriers to implementation efforts. The advanced practice registered nurses' implemented goals included extensive training of clinicians across disciplines and numerous systems changes to improve delivery of palliative care. Advanced practice nurses will continue to be a valuable source of extending palliative care into oncology care to support patients and families across the disease trajectory.

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned.

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.

Videoconference Intervention for Distance Caregivers of Patients With Cancer: A Randomized Controlled Trial.

PURPOSE: Approximately 20% of caregivers (CGs) live > 1 hour away from the patient and are considered distance caregivers (DCGs) who often report higher distress and anxiety than local CGs. The purpose of this study was to test the effectiveness of an intervention aimed at reducing anxiety and distress in DCGs of patients with cancer. METHODS: This randomized controlled trial enrolled DCGs of patients with all cancer types who were being seen monthly by oncologists in outpatient clinics. There were three arms of the intervention delivered over a 4-month period: arm 1 (a) received 4 monthly videoconference-tailored coaching sessions with an advanced practice nurse or social worker focused on information and support, (b) participated in patient's appointments with the oncologist via videoconference over the 4-month study period, and (c) had access to a website designed for DCGs. Arm 2 did not receive the coaching sessions but received the other two components, and arm 3 received access to the DCG website only. RESULTS: There were 302 DCGs who provided pre- and postintervention data. There were significant anxiety by group (P = .028 and r = 0.16) and distress by group interactions (P = .014 and r = 0.17). Arm 1 had the greatest percentage of DCGs who demonstrated improvement in anxiety (18.6%) and distress (25.2%). CONCLUSION: Coaching and use of videoconference technology (to join the DCG into the patient-oncologist office visit) were effective in reducing both anxiety and distress for DCGs. These components could be considered for local CGs who-with COVID-19-are unable to accompany the patient to oncologist visits.

Preparing Oncology Advanced Practice RNs as Generalists in Palliative Care.

OBJECTIVES: To train and support oncology advanced practice RNs (APRNs) to become generalist providers of palliative care. SAMPLE & SETTING: APRNs with master's or doctor of nursing practice degrees and at least five years of experience in oncology (N = 165) attended a National Cancer Institute-funded national training course and participated in ongoing support and education. METHODS & VARIABLES: Course participants completed a precourse, postcourse, and six-month follow-up evaluation regarding palliative care practices in their settings, course evaluation, and their perceived effectiveness in applying course content in their practice. RESULTS: The precourse results showed deficiencies in current practice, with a low percentage of patients having palliative care as part of their oncology care. Barriers included lack of triggers that could assist in identifying patients who could benefit from palliative care. Six-month postcourse data showed more APRNs participating in family meetings, recommending palliative care consultations, speaking with family members regarding bereavement services, and preparing clinical staff for impending patient deaths. IMPLICATIONS FOR NURSING: APRNs require palliative care training to integrate this care within their role. APRNs can influence practice change and improve care for patients in their settings.

Preparing New Graduate RNs to Provide Primary Palliative Care.

BACKGROUND: More than 90 million Americans are struggling to live with serious illness and are in need of palliative and end-of-life care. Yet, many novice RNs have not been adequately prepared during their undergraduate programs to care for them. METHOD: A large southwestern Magnet comprehensive cancer center piloted integrating the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum into their nurse residency program during 2018 with 55 new RNs. RESULTS: A pre-and posteducation evaluation questionnaire measured comfort with caring for patients with serious illness, competence, and knowledge in six areas of palliative care. All eight evaluation questions demonstrated statistically significant improvement posteducational intervention. Many nurse residents reported a change in clinical practice 1 month posteducation. CONCLUSION: The nurse residency is an opportune training time to prepare novice nurses to provide primary palliative care for all patients with serious illness and their families. [J Contin Educ Nurs. 2020;51(6):280-286.].

Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises.

With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.

The Need for Cultural Inclusivity in Global Palliative Nursing: Caring for Selected Underserved Populations in the United States.

It is estimated that 11.1 million people in the United States are living with serious illness, and most people with serious illness need palliative care. Quality palliative care incorporates culturally sensitive care, and with the increasing diversity in the United States, it has become even more critical that nurses and health care professionals be prepared to meet the unique needs of those living within the diverse and underserved populations of this country. Advocating for access to palliative care for the seriously ill, culturally respectful care at the end of life, and honoring values, practices, and beliefs are essential roles of the nurse. This article presents 4 examples of individuals from diverse and potentially vulnerable US populations who face unique challenges as they deal with their life-limiting diseases and face end of life.

Online End-of-Life Nursing Education Consortium Core Curriculum for Staff Nurses: An Education Strategy to Improve Clinical Practice.

Because of the growing population of patients with serious illness, the demand for specialty palliative care exceeds the resources available. Nurses must be prepared to provide primary palliative care to fill the gap in the availability of specialized palliative care providers. However, meeting the educational needs of a vast number of practicing nurses poses a significant challenge. Often, institutions are limited in the financial and staffing support that they can contribute for continuing nursing education, especially when the training requires staff to spend substantial time away from work. In order to address this issue, one large medical center conducted a study to examine the educational and clinical practice outcomes of offering an online version of the End-of-Life Nursing Education Consortium Core Curriculum to nearly 100 nurses. The participants were divided into 2 groups. Group 1 received online education only, whereas the other group received the online education plus a 3-hour face-to-face training session. Both groups reported statistically significant improvements in symptom management and communication skills, with no significant difference between the pedagogical approaches. Most importantly, the education resulted in a statistically significant impact on the nurses' clinical practice. The results of this study demonstrate that online education can be used as an effective and efficient strategy to provide primary palliative care education to a large number of nurses.

An Innovative End-of-Life Nursing Education Consortium Curriculum That Prepares Nursing Students to Provide Primary Palliative Care.

Research has demonstrated that patients facing serious, life-limiting illnesses and their families benefit from receiving palliative care. Increasingly, however, specialty palliative care has limited resources. Prelicensure nursing students who are educated to provide primary palliative care to patients with serious illness and at the end of life can fill that gap. This article describes the development and implementation of an innovative online nursing curriculum that prepares students with essential primary palliative nursing knowledge and skills.

Promoting Palliative Care Internationally: Building Leaders to Promote Education, Practice, and Advocacy.

In February 2000, nine nursing educators, practitioners, and researchers met in Nashville, Tennessee, to develop a palliative care curriculum specifically for nurses. The following month, 22 advisors from nursing organizations across the United States convened in Washington, DC to review the recommended curriculum development and dissemination plans for end-of-life care throughout nursing schools, hospitals, hospices, home care, and geriatric settings. The Robert Wood Johnson Foundation provided funding for curriculum and competency development and for six national train-the-trainer courses to be held from 2001 to 2003. The curriculum entitled the End-of-Life Nursing Education Consortium was designed to meet the needs of nurses caring for patients with serious and complex illnesses at the end of their lives. This work, beginning in 2000 with the development of the End-of-Life Nursing Education Consortium curriculum, has been taught in every state across America and in 91 countries around the world and has been translated into eight languages. Over 21,400 trainers have returned to their institutions and educated over 642,000 colleagues.

Palliative Nursing Summit: Nurses Leading Change and Transforming Care: The Nurse's Role in Coordination of Care and Transition Management.

The Hospice and Palliative Nurses Association Palliative Nursing Summit (Summit) "Nurses Leading Change and Transforming Care" brought nurses from numerous specialties together to discuss collaboration in advancing primary palliative nursing. Nursing leadership was highlighted, and the future of integrating primary palliative care was emphasized. Three workshop groups held discussions on key collaborative topics of communication/advance care planning, pain and symptom management, and coordination of care/transition management (CCTM). Nursing has historically led the way in CCTM, especially in acute- and long-term-care settings. The philosophy and principles of CCTM are in direct alignment with the values and guidelines for quality palliative care. Goals of CCTM include the achievement of optimal health, equal access to care, and appropriate utilization of health care resources, balanced with the patient's right to self-determination. This article presents an overview of the patient and family outcomes and nursing actions identified by the group regarding CCTM.

Palliative Nursing Summit: Nurses Leading Change and Transforming Care: The Nurse's Role in Communication and Advance Care Planning.

Advance care planning (ACP) is an essential component of quality palliative care that requires expert communication skills. Nurses are often the health care provider patients and families rely on when exploring their values and preferences and making treatment decisions. Therefore, communication and ACP was one of the 3 areas of practice addressed during the Palliative Nursing Summit. This article summarizes patient outcomes and nursing actions recommended by summit participants related to communication and ACP. Areas addressed included education, clinical care, research, and policy/regulation. Recommended patient outcomes included the honoring of patient/family preferences and the inclusion of ACP discussions during routine care and across the life span. Recommended nursing actions included the following: (1) nursing education (both undergraduates and practicing nurses) and competencies related to communication and ACP be developed and implemented; (2) primary palliative care, including communication and ACP, be included in the practice standards of all nursing specialties; (3) health care systems support conversations about ACP and related documentation; (4) research be conducted related to the implementation of patient/family preferences and related health care utilization; and (5) regulation and reimbursement be crafted to support nursing practice related to ACP and related conversations at the nurses' full level of expertise.