Identifying Enablers and Barriers of Palliative Care Learning in Undergraduate Nursing Education: Systematic Narrative Review
Hana Rizmadewi Agustina, Erna Rochmawati Rochmawati, Muhamad Zulfatul Ala, Siti Ulfah Rifaatul Fitri, Nahyeni Bassah Esoh, Putri Karisa Karisa, Oktaviani Fauziah Fauziah, Meideline Chyntia Chyntia
= http://dx.doi.org/10.24990/injec.v8i1.591 
Abstract views = 601 times
|
views = 309 times
Abstract
Introduction: The development of a structured curriculum, relevant teaching and learning methods, and support facilities and access is necessary to improve palliative care education by preparing nursing students as future professional nurses in the palliative care area. This review aims to synthesize available literature explaining the barriers and enablers in implementing palliative care education in undergraduate nursing students.
Method: This review uses a systematic narrative review approach. Studies were identified from the PubMed, Scopus, CINAHL, and ProQuest Nursing databases from January 2012 to August 2022 and then selected based on the inclusion criteria that had been set.
Results: The search results found that 23 of 890 studies were included. The findings were grouped into obstacles and enablers in four parts, namely curriculum and learning strategies, personal and professional competencies, relationships and enablers, and facilities and access.
Conclusions: Identifying barriers and enablers can help educational institutions to provide palliative care education according to the needs and expected developments in clinical practice. Collaboration and cooperation between stakeholders must be increased effectively to help provide maximum education.
Keywords
barriers, enablers, nursing students, palliative care education, undergraduate student
Keywords
References
Adesina, O., DeBellis, A. and Zannettino, L. (2014) ‘Third-year Australian nursing students’ attitudes, experiences, knowledge, and education concerning end-of-life care.’, International journal of palliative nursing, 20(8), pp. 395–401. doi: 10.12968/ijpn.2014.20.8.395.
Alfian Novanda Yosanto, Sufi Desrini and Wulandari Berliani Putri (2020) ‘The role of interprofessional education (IPE) for medical students in pharmacology subject’, Indonesian Journal of Pharmacology and Therapy, 1(2), pp. 72–78. doi: 10.22146/ijpther.710.
Ballesteros, M., Centeno, C. and Arantzamendi, M. (2014) ‘A qualitative exploratory study of nursing students’ assessment of the contribution of palliative care learning.’, Nurse education today, 34(6), pp. e1-6. doi: 10.1016/j.nedt.2013.12.010.
Bassah, N., Cox, K. and Seymour, J. (2016) ‘A qualitative evaluation of the impact of a palliative care course on preregistration nursing students’ practice in Cameroon.’, BMC palliative care, 15, p. 37. doi: 10.1186/s12904-016-0106-7.
Bassah, N., Cox, K. and Seymour, J. (2018) ‘Preregistration nursing students’ experiences of a palliative care course in a resource-poor setting.’, International Journal of Palliative Nursing, 24(8), pp. 388–397. doi: 10.12968/ijpn.2018.24.8.388.
Bassah, N., Seymour, J. and Cox, K. (2014) ‘A modified systematic review of research evidence about education for pre-registration nurses in palliative care’, BMC Palliative Care, 13(1). doi: 10.1186/1472-684X-13-56.
Bazrafkan, L. et al. (2019) ‘Clinical teachers as positive and negative role models: An explanatory sequential mixed method design’, Journal of Medical Ethics and History of Medicine, 12(11), pp. 1–15. doi: 10.18502/jmehm.v12i11.1448.
Brouwers, M. et al. (2020) ‘The impact of early breaking bad news education: a qualitative study into students’ self-reported take-home messages’, MedEdPublish, 9(February), p. 25. doi: 10.15694/mep.2020.000025.1.
Cao, W. et al. (2022) ‘Perceptions on the current content and pedagogical approaches used in end-of-life care education among undergraduate nursing students: a qualitative, descriptive study’, BMC Medical Education, 22(1), pp. 1–10. doi: 10.1186/s12909-022-03625-y.
Carrasco, J. M. et al. (2015) ‘Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development.’, Journal of pain and symptom management, 50(4), pp. 516–23.e2. doi: 10.1016/j.jpainsymman.2015.04.019.
Cavaye, J. and Watts, J. H. (2012) ‘End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives.’, Journal of Research in Nursing, 17(4), pp. 317–326. doi: 10.1177/1744987110379531.
Cavaye, J. and Watts, J. H. (2014) ‘An Integrated Literature Review of Death Education in Pre-Registration Nursing Curricula: Key Themes’, International Journal of Palliative Care, 2014, pp. 1–19. doi: 10.1155/2014/564619.
Chow, S. K. Y. et al. (2014) ‘The impact and importance of clinical learning experience in supporting nursing students in end-of-life care: cluster analysis.’, Nurse education in practice, 14(5), pp. 532–537. doi: 10.1016/j.nepr.2014.05.006.
Costa, Á. P., Poles, K. and Silva, A. E. (2016) ‘Formação em cuidados paliativos: Experiência de alunos de medicina e enfermagem’, Interface: Communication, Health, Education, 20(59), pp. 1041–1052. doi: 10.1590/1807-57622015.0774.
EA, K. et al. (2018) ‘The Effects of Simulation on Nursing Students Psychomotor Skills’, International Journal of Clinical Skills, 12(1), pp. 185–191. doi: 10.4172/clinical-skills.1000132.
Ek, K. et al. (2014) ‘Death and caring for dying patients: exploring first-year nursing students’ descriptive experiences.’, International Journal of Palliative Nursing, 20(10), pp. 509–515. doi: 10.12968/ijpn.2014.20.10.509.
Etkind, S. N. et al. (2017) ‘How many people will need palliative care in 2040? Past trends, future projections and implications for services’, BMC Medicine, 15(1), pp. 1–10. doi: 10.1186/s12916-017-0860-2.
Eyikara, E. et al. (2017) ‘The importance of simulation in nursing education’, World Journal on Educational Technology: Current Issues, 9(1), pp. 2–7.
Fajrin, A. M. et al. (2016) ‘Anita Megawati Fajrin : Pengaruh Peneraapan Model Pembelajaran Praktik Klinik Terhadap Peningkatan Kompetensi Asuhan Persalinan Anita Megawati Fajrin : Upaya Meningkatkan Kompetensi Mahasiswa Dalam Praktik Asuhan Persalinan melalui Model Pembelajarn Prakt’, Ijemc, 3(1), pp. 13–20.
Fauziningtyas, R. et al. (2020) ‘Determinants of Knowledge and Attitude related to Palliative Care Nurses’, International Journal of Psychosocial Rehabilitation, 24(7), pp. 7554–7562.
Fitch, M. I., Fliedner, M. C. and O’Connor, M. (2015) ‘Nursing perspectives on palliative care 2015.’, Annals of palliative medicine, 4(3), pp. 150–155. doi: 10.3978/j.issn.2224-5820.2015.07.04.
Gillan, P. C., Jeong, S. and van der Riet, P. (2021) ‘Undergraduate nursing students’ transformative learning through disorientating dilemmas associated with end-of-life care simulation: A narrative inquiry study.’, Nurse Education in Practice, 55, p. N.PAG-N.PAG. doi: 10.1016/j.nepr.2021.103174.
Gillan, P. C., van der Riet, P. J. and Jeong, S. (2014) ‘End of life care education, past and present: A review of the literature’, Nurse Education Today, 34(3), pp. 331–342. doi: 10.1016/j.nedt.2013.06.009.
Gillan, P. C., van der Riet, P. and Jeong, S. (2016) ‘Australian nursing students’ stories of end-of-life care simulation.’, Nursing & health sciences, 18(1), pp. 64–69. doi: 10.1111/nhs.12233.
Glover, T. L. et al. (2018) ‘Research Briefs Nursing Students’ Reactions to an Educational Experiential Immersion in Palliative Care’, 57(11), pp. 675–680. doi: 10.3928/01484834-20181022-08.
Glover, T. L. et al. (2019) ‘Experiential Palliative Care Immersion: Student Nurse’s Narratives Reflect Care Competencies’, Western Journal of Nursing Research, 41(10), pp. 1465–1480. doi: 10.1177/0193945919833061.
Hassankhani, H. et al. (2015) ‘The Relationship between Learning Motivation and Self Efficacy among Nursing Students’, Research and Development in Medical Education, 4(1), pp. 97–101. doi: 10.15171/rdme.2015.016.
Hökkä, M., Lehto, J. T., et al. (2022) ‘Finnish nursing students’ perceptions of the development needs in palliative care education and factors influencing learning in undergraduate nursing studies – a qualitative study.’, BMC Palliative Care, 21(1), pp. 1–15. doi: 10.1186/s12904-022-00915-6.
Hökkä, M., Rajala, M., et al. (2022) ‘The effect of teaching methods in palliative care education for undergraduate nursing and medical students: a systematic review.’, International Journal of Palliative Nursing, 28(6), pp. 245–253. doi: 10.12968/ijpn.2022.28.6.245.
Hökkä, M., Pölkki, T. and Lehto, J. T. (2022) ‘Nursing Students’ Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence—A Nationwide Cross-sectional Study’, Journal of Palliative Care. doi: 10.1177/08258597221084445.
Hold, J. L., Blake, B. J. and Ward, E. N. (2015) ‘Perceptions and experiences of nursing students enrolled in a palliative and end-of-life nursing elective: A qualitative study.’, Nurse education today, 35(6), pp. 777–781. doi: 10.1016/j.nedt.2015.02.011.
Jerry Dale, J. and Catherine Elise, B. (2017) ‘Simulation as a Classroom Teaching Method’, Journal on School Educational Technology, 12(4), p. 49. doi: 10.26634/jsch.12.4.13551.
Knopp de Carvalho, K. et al. (2017) ‘Educational process in palliative care and the thought reform.’, Investigacion y educacion en enfermeria, 35(1), pp. 17–25. doi: 10.17533/udea.iee.v35n1a03.
Kuraoka, Y. (2018) ‘Effect of an experiential learning-based programme to foster competence among nurse managers’, Journal of Nursing Management, 26(8), pp. 1015–1023. doi: 10.1111/jonm.12628.
Laranjeira, C., Afonso, C. and Querido, A. I. (2021) ‘Communicating Bad News : Using Role-Play to Teach Nursing Students’. doi: 10.1177/23779608211044589.
Lewis, C. et al. (2016) ‘The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision.’, BMC palliative care, 15, p. 67. doi: 10.1186/s12904-016-0143-2.
Lewis, E.G. et al. (2018) ‘We never speak about death. Healthcare professionals’ views on palliative care for inpatients in Tanzania: A qualitative study’, Palliative and Supportive Care, 16(5), pp. 566–579. doi: 10.1017/S1478951517000748.
Lewis, E G et al. (2018) ‘We never speak about death. Healthcare professionals’ views on palliative care for inpatients in Tanzania: A qualitative study’, Palliative and Supportive Care, 16(5), pp. 566–579. doi: 10.1017/S1478951517000748.
Li RN, J. M. S. N. et al. (2019) ‘Undergraduate Nursing Students’ Perception of End-of-Life Care Education Placement in the Nursing Curriculum.’, Journal of Hospice & Palliative Nursing, 21(5), pp. E12–E18. doi: 10.1097/NJH.0000000000000533.
Lian, Z. et al. (2019) ‘Nurse Education in Practice Nursing students ’ re fl ections on caring for end-of-life patients in a youth volunteer association’, Nurse Education in Practice, 34(June 2017), pp. 204–209. doi: 10.1016/j.nepr.2018.12.006.
Lin, W. C. and Fan, S. Y. (2020) ‘Emotional and cognitive barriers of bereavement care among clinical staff in hospice palliative care’, Palliative and Supportive Care, 18(6), pp. 676–682. doi: 10.1017/S147895152000022X.
Lippe, M. P. and Carter, P. (2015) ‘End-of-life care teaching strategies in prelicensure nursing education: An integrative review’, Journal of Hospice and Palliative Nursing, 17(1), pp. 31–39. doi: 10.1097/NJH.0000000000000118.
Lundberg, K. M. (2008) ‘Promoting self-confidence in clinical nursing students.’, Nurse educator, 33(2), pp. 86–89. doi: 10.1097/01.NNE.0000299512.78270.d0.
Mastroianni, C. et al. (2019) ‘Palliative Care Education in Undergraduate Nursing Curriculum in Italy.’, Journal of Hospice & Palliative Nursing, 21(1), pp. 96–106. doi: 10.1097/NJH.0000000000000515.
Meier, D. E. (2011) ‘Increased access to palliative care and hospice services: opportunities to improve value in health care.’, The Milbank quarterly, 89(3), pp. 343–380. doi: 10.1111/j.1468-0009.2011.00632.x.
Menekli, T. et al. (2021) ‘Effect of educational intervention on nurses knowledge about palliative care: Quasi-experimental study’, Nurse Education in Practice, 51(February). doi: 10.1016/j.nepr.2021.102991.
Minosso, J. S. M., Martins, M. M. F. P. da S. and de Campos Oliveira, M. A. (2022) ‘Palliative care in undergraduate nursing education: A mixed-methods study.’, Revista de Enfermagem Referência, (1), pp. 1–8. doi: 10.12707/RV21060.
Munawaroh (2017) ‘The Influence of Teaching Methods and Learning Environment to the Student’s Learning Achievement of Craft and Entrepreneurship Subjects at Vocational High School’, International Journal of Environmental & Science Education, 12(4), pp. 665–678. Available at: https://files.eric.ed.gov/fulltext/EJ1144859.pdf.
Munkombwe, W. M., Petersson, K. and Elgán, C. (2020) ‘Nurses’ experiences of providing nonpharmacological pain management in palliative care: A qualitative study’, Journal of Clinical Nursing, 29(9–10), pp. 1643–1652. doi: 10.1111/jocn.15232.
Murray, R. (2018) ‘An Overview of Experiential Learning in Nursing Education’, Advances in Social Sciences Research Journal, 5(1), pp. 1–6. doi: 10.14738/assrj.51.4102.
Özveren, H. and Kırca, K. (2019) ‘Influence of Palliative Care Training on Last-Year Nursing Department Students’ Perception on Regarding Spirituality and Spiritual Care: A Single-Group Pretest-Posttest Intervention Study.’, Journal of religion and health, 58(3), pp. 860–869. doi: 10.1007/s10943-018-0701-4.
Permana, R. H. (2020) ‘Persepsi mahasiswa tentang efektivitas pembimbing klinik’, NURSCOPE: Jurnal Penelitian dan Pemikiran Ilmiah Keperawatan, 6(2), p. 66. doi: 10.30659/nurscope.6.2.66-73.
Pieters, J. et al. (2019) ‘Palliative care education in the undergraduate medical curricula: students’ views on the importance of, their confidence in, and knowledge of palliative care’, BMC Palliative Care, 18(72), pp. 1–7.
Pivač, S. et al. (2021) ‘Implementation of active learning methods by nurse educators in undergraduate nursing students’ programs – a group interview’, BMC Nursing, 20(1), pp. 1–10. doi: 10.1186/s12912-021-00688-y.
Polat, Ü. and Karataş, T. (2018) ‘Nursing students’ knowledge of palliative care at a university in Turkey’, Research and Theory for Nursing Practice, 32(3), pp. 276–295. doi: 10.1891/1541-6577.32.3.276.
Porter, J. et al. (2013) ‘Preparation for high-acuity clinical placement: Confidence levels of final-year nursing students’, Advances in Medical Education and Practice, 4, pp. 83–89. doi: 10.2147/AMEP.S42157.
Price, D. M. et al. (2017) ‘Palliative and End-of-Life Care Education Needs of Nurses Across Inpatient Care Settings.’, Journal of continuing education in nursing, 48(7), pp. 329–336. doi: 10.3928/00220124-20170616-10.
Price, J. et al. (2014) ‘Perspectives of an international education initiative in children’s palliative care.’, International Journal of Palliative Nursing, 20(11), pp. 542–548. Available at:https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103921111&site=ehost-live.
Price, J., Dornan, J. and Quail, L. (2013) ‘Seeing is believing -- Reducing misconceptions about children’s hospice care through effective teaching with undergraduate nursing students.’, Nurse Education in Practice, 13(5), pp. 361–365. doi: 10.1016/j.nepr.2012.09.013.
Price, J. E. et al. (2019) ‘Perinatal/neonatal palliative care: Effecting improved knowledge and multi-professional practice of midwifery and children’s nursing students through an inter-professional education initiative.’, Nurse education in practice, 40, p. 102611. doi: 10.1016/j.nepr.2019.08.005.
Putra, K. R., Hany, A. and Ariningpraja, R. T. (2021) ‘The Effect of Clinical Learning Environment on Nursing Student Satisfaction in East Java Province.’, Sohag University International Journal of Educational Research, 6(1), pp. 64–71. doi: 10.24990/injecv6i1.393.
Putranto, R. et al. (2017) ‘Development and challenges of palliative care in Indonesia: role of psychosomatic medicine.’, BioPsychoSocial medicine, 11, p. 29. doi: 10.1186/s13030-017-0114-8.
Roberts, H. et al. (no date) ‘Guidance on the Conduct of Narrative Synthesis in Systematic Reviews A Product from the ESRC Methods Programme with’, (April 2006), pp. 1–92.
Russell, E., Durepos, P. and Kaasalainen, S. (2018) ‘Initial Experience With Palliative Care: A Nursing Student’s Perspective.’, Perspectives: The Journal of the Gerontological Nursing Association, 40(1), pp. 28–34. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=131537416&site=ehost-live.
Sapeta, P. et al. (2022) ‘Adaptation and continuous learning: integrative review of coping strategies of palliative care professionals’, Palliative Medicine, 36(1), pp. 15–29. doi: 10.1177/02692163211047149.
Shabiralyani, G. et al. (2015) ‘Impact of Visual Aids in Enhancing the Learning Process Case Research: District Dera Ghazi Khan.’, Journal of Education and Practice, 6(19), pp. 226–233.
Silveira, N. R. et al. (2016) ‘Palliative care and the intensive care nurses: feelings that endure.’, Revista brasileira de enfermagem, 69(6), pp. 1074–1081. doi: 10.1590/0034-7167-2016-0267.
Strang, S. et al. (2014) ‘Swedish nursing students’ reasoning about emotionally demanding issues in caring for dying patients.’, International journal of palliative nursing, 20(4), pp. 194–200. doi: 10.12968/ijpn.2014.20.4.194.
Valen, K., Simonsen, M., Holm, A. L., et al. (2021) ‘Impact of palliative care simulation on nursing students’ learning outcomes and reported use in hospital placement’, Nursing Open, (March), pp. 1–11. doi: 10.1002/nop2.991.
Valen, K., Simonsen, M., Lise, A., et al. (2021) ‘Impact of palliative care simulation on nursing students ’ learning outcomes and reported use in hospital placement’, (June), pp. 1–11. doi: 10.1002/nop2.991.
van der Wath, A. E. and du Toit, P. H. (2015) ‘Learning end-of-life care within a constructivist model: Undergraduate nursing students’ experiences.’, Curationis, 38(2), p. 1537. doi: 10.4102/curationis.v38i2.1537.
Watts, T. (2014) ‘Final-year nursing undergraduates’ understandings of palliative care: a qualitative study in Wales, UK.’, International Journal of Palliative Nursing, 20(6), pp. 285–293. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103974469&site=ehost-live.
Weurlander, M. et al. (2018) ‘How do medical and nursing students experience emotional challenges during clinical placements?’, International journal of medical education, 9, pp. 74–82. doi: 10.5116/ijme.5a88.1f80.
WHO (2014) Strengthening of palliative care as a component of comprehensive care throughout the life course.
WHO (2018) Integrating Palliative Care and Symptom Relief Into Primary Health Care.
WHO (2020) Palliative Care. Available at: https://www.who.int/news-room/fact-sheets/detail/palliative-care#:~:text=Palliative care is an approach, associated with life-threatening illness.
Zahran, Z. et al. (2022) ‘Nursing students’ attitudes towards death and caring for dying patients’, Nursing Open, 9(1), pp. 614–623. doi: 10.1002/nop2.1107.
Zelko, E., Pajk, J. R. and 30, N. K. S. (2021) ‘Interprofessional collaboration in palliative care - pilot testing of a communication tool developed in Public Health Centre Ljubljana’, International scientific conference of primary care, (February).
Zhou, Y., Li, Q. and Zhang, W. (2021) ‘Undergraduate nursing students’ knowledge, attitudes and self-efficacy regarding palliative care in China: A descriptive correlational study.’, Nursing open, 8(1), pp. 343–353. doi: 10.1002/nop2.635.
Refbacks
This work is licensed under a Creative Commons Attribution 4.0 International License.
This journal is indexed by:
Copyright of Indonesian Nursing Journal of Education and Clinic (INJEC) (e-ISSN:2527-8819, p-ISSN:2527-8800).