Thursday, June 5, 2014

Palliative Education and Mentorship Needed for Clinicians

Changes are needed in how nurses and physicians are educated and trained about providing palliative care to older adults with serious illnesses, according to a Health Affairs blog written by Charles von Gunten and Betty Ferrell.

The authors contend that the fundamental approach to decision-making for elderly patients with serious illnesses should shift from the standard approach of “fixing” every biological issue, to the palliative care approach in which overall goals of care are established for the patient. However, for that to happen, clinicians need to start learning about palliative care early in their education and training. A clear standard and widely-adopted curricula for graduate and undergraduate training is needed, according to the blog:

“Although some medical schools have curricula on death and dying, the education is provided predominately through scattered didactic courses during the preclinical years. The effectiveness of the curricula is limited by the absence of immediate clinical application of the material, and hence, no opportunity to develop the necessary skills to alleviate the suffering of the patient and their loved ones.”

Efforts are underway to develop such materials, including some among nursing organizations and consortiums. The End-of-Life Nursing Education Consortium (ELNEC) project was formed to develop educational tools on core skills in palliative care. For the last 14 years the American Association of Colleges of Nursing has provided palliative care education through ELNEC, providing training to more than 17,500 nurses. However, this education needs to be reinforced in clinical settings with structured mentoring of nurses on palliative care, according to Gunten and Ferrell.

An INQRI study, Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice, explored the relationships between quality palliative nursing care delivered in intensive care units and patient and family outcomes. The study also explored how to measure and to improve these outcomes. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

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