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.

Nurse Researchers Provide Guidance for Conducting Research in Clinical Setting

Two nurse researchers are providing practical advice that other nurses can use to develop and strengthen their own research skills in a clinical setting,  Advanced Health Care Network for Nurses reports.

The guide, Anatomy of Research for Nurses by Christine Hedges and Barbara Williams, was written for nurse researchers early in their careers. It takes readers step-by-step through the research process, providing information on how to formulate a hypothesis, and the legal and ethical issues involved in conducting a research study. Obtaining research grants is also covered.

By conducting research in the clinical setting, nurse researchers are generating evidence for high quality, safe nursing practice, the authors write. Hedges is the director of nursing quality and research at University of North Carolina Health Care and Williams is a nurse scientist at Meridian Health Ann May Center for Nursing and Allied Health in New Jersey.

Anatomy of Research for Nurses is available for purchase at: http://www.nursingknowledge.org/anatomy-of-research-for-nurses.html.

The Importance of Nursing in Achieving the "Best Care at Lower Cost"

by Richard C Lindrooth and Olga Yakusheva

The Institute of Medicine (IOM) released the findings of its Committee on the Learning Health Care System in America in a report entitled "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America"[1] in early September, 2013.  The report recognized that the complexity of clinical decision-making is rapidly increasing and that clinicians need to continuously update their skills in order to keep up with:

(1) rapidly expanding diagnostic and treatment options; and
(2) the increasingly complex and chronic clinical condition of patients.

Given the growing external demands placed on nurses, the IOM reports that a critical determinant of the success of an organization in dealing with these demands is how "a learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations."   Nurses in particular are in an excellent position to play a central role in creating a virtuous feedback loop such that it is feasible to continuously adjust and incrementally improve systems in response to rapidly changing external demands.  The report, supported by the results of a growing and increasingly robust body of academic research, stresses the important role of leadership and management in fostering and maintaining an environment within which continuous learning could take hold.

The recommendations highlight the critical importance of continuing investments in the human capital necessary to enable clinicians' (nurses) to thrive in the dynamic health care market.  Bachelors of Science in Nursing (BSN) programs teach nurses the critical communication skills and analytical tools and that can be harnessed by a well-managed organization in creating an environment that fosters and rewards continuous learning. 

The good news is that employers will increasingly recognize the value of a BSN and reward staff for the additional cost and effort required for the degree.  The IOM Future of Nursing report documents the value of an advanced degree and knowledge of the value of a BSN is reflected in recent hiring trends.  Standard economic theory predicts that the value of a BSN - and human capital in general - depends upon the ability of an organization to put those skills to productive use.  Well-managed organizations will be apt to reward advanced training precisely because the organization can harness the human capital to increase productivity. 

The IOM report documents the experiences of many organizations that have successfully fostered the skills and experience if their staff to improve outcomes and productivity.  While the case studies are encouraging, there are even more organizations that still have not adopted the management practices necessary to facilitate continuous learning.  An organization's future success hinges on its ability to keep up with rapidly changing treatments and the increasingly complex needs of patients. Those organizations that are successful in doing so will thrive and grow market share at the expense of organizations that fail to keep up. 

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[1] Smith, M; R. Saunders, L. Stuckhardt, and J.M. McGinnis, Editors. 2013. ""Best Care at Lower Cost: The Path to Continuously Learning Health Care in America." Available at: http://www.nap.edu/catalog.php?record_id=13444, accessed on September 20, 2013.