Exploring The Student Nurse Preparation Of Palliative And End-Of-Life Care

Research shows that six in ten Americans live with a chronic disease, significantly impacting their quality of life. That has led to the demand for nursing professionals in palliative care. However, research shows insufficient education and preparation for nurses to provide compassionate and competent care to dying patients.

Nurses must have adequate knowledge and skills to provide end-of-life care to dying patients. These professionals also need to understand how to communicate and handle the patients’ families.

Our detailed guide explores the student nurse’s initial experience caring for a dying patient. We also provide recommendations to prepare nursing students to provide palliative care.

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Palliative Care In The Nursing Profession

Palliative care is a subspecialty of nursing that’s becoming predominant. This type of care aims to relieve the pain and suffering of patients with life-threatening illnesses while improving their quality of life. Evidence shows that patients receiving palliative care over time experience a better quality of life and reduce their symptoms.

While hospice care shares some similarities with palliative care, the former handles patients in their final weeks or months of life. Palliative care addresses patients’ and their families’ social, psychosocial, physical, emotional, and spiritual needs.

Nurses need proper training in palliative care skills to help them care for patients with serious illnesses. They must adjust from regular nursing tasks like checking for vital signs and prescribing medication to providing comfort to patients, managing symptoms, and offering emotional and physical support.

Palliative nurses can work in different settings like acute-in-patient facilities, residential hospices, a patient’s home, or a long-term care facility.  Additionally, these nurses can be hospice nurses, acute care registered nurses, or advanced practice nurses with a higher degree and additional training.

Registered nurses wishing to specialize in adult-gerontology primary care need to enroll in the University of Indianapolis online agnp program. With the growing need for NPs in this primary care field, undertaking this program will equip you with skills to screen patients, order tests, analyze results, prescribe drugs, and offer treatment plans. You’ll also learn to manage transitions between care settings and provide caregiver education.

What Does The Palliative Nursing Curriculum Cover?

 Palliative care is all about combining the science of medicine with the art of caring. Being a palliative care nurse requires you to utilize palliative nursing skills, can exercise critical thinking, and provide individualized and compassionate care to patients. While the palliative care curriculum may vary, depending on where you study, most courses address the primary aspects of palliative care, which include:

Introduction To Palliative Nursing

Nursing students need to understand the basic concepts of palliative care to provide quality care to patients. Going through the introduction to palliative nursing allows nurses to define and characterize palliative care.

They also understand what this type of care pertains to and how to provide end-of-life care to patients. The course also introduces nurses to nursing interventions that help manage pain in a patient with a terminal illness.

Palliative care nurses learn how to provide emotional support for patients and utilize appropriate pain management tactics such as complementary therapies, pharmacological interventions, and non-pharmacological methods.

Nurses also become competent in promoting effective coping strategies. They may recommend helpful support groups, engage with patients to provide emotional support, or suggest stress management and relaxation techniques.

Communication In Serious Illness

Communication is a critical skill that every palliative care nurse needs to have.  As a care nurse, you must explain complex medical information in an easy-to-understand language. Patients need clarity on their disease progression, the medications they need to take, and information on the care plan a nurse will provide.

Nursing students go through communication classes to help patients and their families understand the condition, treatment goals, how to manage it, treatment outcomes, and more.

Additionally, communication skills allow palliative care nurses to work with the patients to understand their preferred options for care and make recommendations for changes if necessary.

Nursing communication is also vital during patient care transitions. Some patients have difficulty accepting their diagnosis or following up on a new treatment. Palliative care nurses communicate with patients and their families and help them navigate through end-of-life care with ease.

Communication as a palliative care nurse isn’t limited to one-on-one conversations with patients. Care providers undergo advocacy training to inform patients about advanced care options. These professionals also advocate for the patient’s wishes when making treatment decisions.

That is essential, especially when dealing with a patient suffering from chronic illness. Helping patients understand the available palliative care options and services raises awareness and allows them to open up about any concerns about the treatment plan.

Pain Assessment And Management

Research shows that pain assessment by knowledgeable and trained nurses can significantly reduce patient suffering. Student nurses are trained to assess and monitor pain levels. They get to identify different types of pain and gain a deeper understanding of pain anatomy and physiology.

As care providers, nurses also learn about how pain can affect a patient’s multiple aspects of life. For example, some people with chronic pain also suffer from mood disorders, which can reduce their quality of life.

Palliative care nurses also train to assess pain intensity and document it for future reference. Measuring pain through pain scales allows the care provider to determine the effectiveness of pain treatment and decide if modification is needed.

Nurses also need to provide patient education on pain assessment. Going through this training helps the palliative care nurse explain to a patient how pain is assessed during and after a procedure. The patient also gets to choose their preferred pain rating scale.

Nursing students also prepare to provide compassionate palliative care by understanding how to manage a patient’s pain. By listening to the patients, nurses help alleviate anxiety, fear, and isolation, which are common in patients with chronic pain.

Nursing education also enlightens the students that pain management provides physical pain relief and improves physical functioning, quality of life, and enhanced ability to function. To manage pain, palliative care nurses can recommend non-pharmacological therapies like massage, physical therapy, acupuncture, and chiropractic manipulation.

Symptom Assessment And Management

Nursing students need to learn how to identify a patient’s symptoms and can improve these symptoms. Palliative care education aims to proactively equip nurses with skills to manage symptoms using quality and comprehensive treatments.

Student nurses learn about the common symptoms that patients experience in palliative care. Those include nausea, vomiting, delirium, and pain. Nurses must be able to choose the right screening tools to determine the cause and severity of symptoms. They also need to conduct a thorough assessment, which includes reviewing medical records/history and assessing any social and cultural health factors.

Palliative care nurses train to identify the appropriate pharmacological management strategies to evaluate the cause and severity of these symptoms.  Nurses also go through non-pharmacological strategies.

Undertaking this course, nurses also learn and explain the complexities of pain management and other symptoms that a patient with renal disease may be suffering from. They learn which medication to avoid when working with this patient population. Under symptom assessment and management, nurses also learn different ways to teach family members how to care for their loved ones and handle these symptoms.

Nurses need to understand that not all symptoms will be physical. Some could be spiritual, psychological, or social. Going through symptom assessment and management, you’ll be able to identify other symptoms that aren’t physical.

Nursing students learn to have a holistic approach to pain and all symptoms that a person with a life-limiting illness may experience. Symptom management aims to improve the patient’s quality of life, functionality, and overall physical well-being.

Loss, Grief, And Bereavement

Palliative care nurses need to support patients and their families when they’re going through grief and loss. The nursing curriculum shows student nurses how to provide compassionate care to patients and their loved ones. They also learn that the care they offer differs from one person to another.

Some patients experience anticipatory grief, where the loved one learns about a patient’s terminal illness. The grieving process is different as they go through the emotions and feelings together. Nurses learn how to provide support through this period and help them express their feelings to reclaim a sense of acceptance.

Nurses study the different stages of grief and help patients navigate through each stage with empathy and compassion. Being in this profession also means respecting the patient’s spiritual and cultural beliefs when they’re experiencing loss.

Knowing how to maintain emotional resiliency is also part of the curriculum. As a nurse, you need to stay strong, be attentive to the patient, and provide the best care for those experiencing loss and grief. It’s also essential to encourage patients to be open about their feelings without being judgmental.

Furthermore, as a palliative nurse, you need to provide the resources needed during each stage of grief. Sometimes, you may need to recommend counseling and therapy sessions, spiritual support, or community peer support groups.

Final Hours

Nursing students also go through end-of-life care to help patients navigate the last hours, days, or months of their lives. You learn how to help patients live comfortably until their final hours and be attentive to their needs while considering their wishes. Understanding your patient’s preferences is also essential, as you’re in charge of their health management and daily routines.

As a nurse, you must anticipate all aspects of nursing care, including ethical and legal challenges that may arise in end-of-life care. Understanding your patient’s autonomy and being able to render the best care possible within their preferences is paramount.

Additionally, nurses must assess the treatment methods and ensure that a drug’s benefit outweighs the side effect. Ensuring that there’s a drug-symptom balance can help avoid any legal issues.

Sometimes a nurse will have to intervene when a patient’s loved one tries to ignore or challenge the patient’s wishes.  In this case, you may need to advocate for the patient’s will through a living will or medical power of attorney.

In extreme cases, a nurse must enforce physician orders for life-sustaining treatment to respect the patient’s wishes. Another hurdle nurses face is broken communication. Some patients and their families may be indecisive and not know what they want.

A good example is when a patient is put on life support with no chance of survival, and the family can’t decide whether to remove him from life support or wait a little longer. As a nursing student, you’re informed of all possible challenges in end-of-life care. That way, you’re better prepared to handle them and still provide the best possible care.

Nursing And The Future Of Palliative And End-Of-Life Care

 Multiple studies reveal a shortage of skilled nurses who can provide palliative and end-of-life care. However, more nurses specialize in this field and acquire skills in handling and caring for patients and their families.

By incorporating experiential teaching approaches, tweaking the curriculum to address palliative care more, and consistently evaluating nursing students’ competencies, nurses will be better prepared and equipped to provide the best care.

It’s expected that in the years to come, the number of palliative care nurses who are skilled and confident will rise to accommodate the need for quality patient-centered care.

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