Palliative care in undergraduate curricula : Results of a national scoping study

Background: We wished to explore the ways in which palliative care is included in undergraduate health services curricula in Australia and the barriers to, and opportunities for, such inclusion. Methods: A scoping study of current Australian undergraduate health care curricula, using an email survey of deans (or equivalent) of health faculties was designed utilising all Australian undergraduate courses that prepare medicine, nursing and allied health professionals for entry to practice. Participants were deans or faculty heads from health and related faculties which offered courses relevant to the project, identified from the Australian Government Department of Education, Science and Training website. Sixty-two deans (or equivalent) from 41 Australian universities were surveyed. A total of 42 completed surveys were returned (68% of deans). Main outcome measures were total hours, content, teaching and learning strategies and resources for palliative care education in undergraduate curricula; perceived gaps, barriers, and opportunities to support the inclusion of palliative care education in undergraduate curricula. Results: Forty-five percent of respondents reported the content of current curricula reflected the palliative approach to a large degree. More than half of the respondents reported that their course had palliative care components integrated to a minor degree and a further third to a moderate degree. The number of hours dedicated to palliative care and teaching and learning strategies varied across all respondents, although there was a high degree of commonality in content areas taught. Conclusion: Current Australian undergraduate courses vary widely in the nature and extent to which they provide education in palliative care.

Bridging the Gap: Developing a Palliative Approach to Care for Young Adults with Life Limiting Conditions

Bridging the Gap: Developing a Palliative Approach to Care for Young Adults with Life Limiting Conditions

More young adults (YAs) with life limiting conditions (LLC) are surviving into adulthood as earlier diagnosis and improved medical management in pediatric care lead to higher rates of survival for cancer, congenital heart and neuromuscular conditions. When these YAs leave pediatric care, they leave behind comprehensive and coordinated health, social and education services for uncoordinated adult systems, with limited access to palliative services they received in pediatric care.

YAs with LLCs will benefit from a public health palliative approach to care. This approach better matches their chronic disease trajectories of a series of declining plateaus over a period of months to years, punctuated by unpredictable periodic crises. Public health palliative care is a blended provision of health care and community services based on evidence that health care is most effective and least expensive when offered in conjunction with a complement of services that reflects social determinants of health and well-being. For YAs with LLCs, these resources will support their health, social, vocational, independent living, and educational goals to maximize their opportunities in an abbreviated time frame.


The objectives of this workshop are to:

1. Provide an overview of the young adult population with palliative care needs.
2. Discuss current care of this population.
3. Highlight results from three recent projects to examine and address needs of this population.
4. Dialogue with audience about other programs, initiatives, or ideas to address the needs of this population.

We look forward to robust conversations and ideas from your practice and research.

Providing 'best practice' placements begins with mentoring skills : overview of the Program of Experience in the Palliative Approach (PEPA) quality improvement initiatives for mentors

Objectives PEPA is funded by the Department of Health and Ageing and aims to further improve the skill and confidence of the generalist workforce to work with people with palliative care needs. Recent quality improvement initiatives to promote transfer of learning into practice include appointment of a clinical educator, implementation of an online module for mentors and delivery of a mentoring workshop (collaborating with NSAP and PCC4U). This paper presents an overview of outcomes from these quality improvement initiatives. Methods PEPA host sites are selected based on their specialist palliative care level. Host site managers are surveyed six-monthly and participants are surveyed pre and three months post-placement to collect open and fixed response data on their experience of the program. Participants in the mentoring workshop (n=39) were asked to respond to a survey regarding the workshop outcomes. Results The percentage of placement participants who strongly agreed they ‘have the ability to implement the interventions required for people who have a life-limiting illness’ increased from 35% in 2011 (n=34) to 51% in 2012 (n=91) post-placement. Responses from mentor workshop participants indicated that 76% of respondents (n=25) agreed that they were able to identify principles for mentoring in the context of palliative care. In 2012, 61% of host site managers (n=54) strongly agreed that PEPA supports clinician working with people with a life-limiting illness. Conclusion Strategies to build the capabilities of palliative care professionals to mentor and support the learning experience of PEPA participants are critical to ongoing improvements of the program.

A peaking and tailing approach to education and curriculum renewal for sustainable development

Contextual factors for sustainable development such as population growth, energy, and resource availability and consumption levels, food production yield, and growth in pollution, provide numerous complex and rapidly changing education and training requirements for a variety of professions including engineering. Furthermore, these requirements may not be clearly understood or expressed by designers, governments, professional bodies or the industry. Within this context, this paper focuses on one priority area for greening the economy through sustainable development—improving energy efficiency—and discusses the complexity of capacity building needs for professionals. The paper begins by acknowledging the historical evolution of sustainability considerations, and the complexity embedded in built environment solutions. The authors propose a dual-track approach to building capacity building, with a short-term focus on improvement (i.e., making peaking challenges a priority for postgraduate education), and a long-term focus on transformational innovation (i.e., making tailing challenges a priority for undergraduate education). A case study is provided, of Australian experiences over the last decade with regard to the topic area of energy efficiency. The authors conclude with reflections on implications for the approach.

A study to evaluate the introduction of simulation as a teaching strategy for the mental health and learning disability fields of nursing, in an undergraduate nursing curriculum within one higher education institution

High Fidelity Simulation or Human Patient Simulation is an educational strategy embedded within nursing curricula throughout many healthcare educational institutions. This paper reports on an evaluative study that investigated the views of a group of Year 2 undergraduate nursing students from the mental health and the learning disability fields of nursing (n = 75) in relation to simulation as a teaching pedagogy. The study took place in the simulation suite within a School of Nursing and Midwifery in the UK. Two patient scenarios were used for the session and participants completed a 22-item questionnaire consisting of three biographical information questions and a 19-item Likert scale. Descriptive statistics were employed to illustrate the data and non-parametric testing (Mann-Whitney U test) was employed to test a number of hypotheses. Overall students were positive about the introduction of patient scenarios using the human patient simulator into the undergraduate nursing curriculum. This study used a small, convenience sample in one institution and therefore the results obtained cannot be generalised to nursing education before further research can be conducted with larger samples and a mixed-method research approach. However these results provide encouraging evidence to support the use of simulation within the mental health and the learning disability fields of nursing, and the development and implementation of further simulations to complement the students’ practicum.

Acute care teaching in the undergraduate nursing curriculum

AIM: To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
BACKGROUND: Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
PRACTICE DEVELOPMENT INITIATIVE: An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
CONCLUSIONS: Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
RELEVANCE TO CLINICAL PRACTICE: The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.

Wellness as higher education curriculum: A comprehensive framework for health education and promotion

A number of studies in relation to the place, impact and purpose of Wellness curricula provide insight into the perceived benefits of Wellness education in university environments. Of particular note is the recommendation by many authors that curriculum design fosters personal experiences, reflective practice and active self-managed learning approaches in order to legitimise (give permission for) the adoption of wellness as a personal lifestyle approach in the frenetic pace of student life. From a broader educational perspective, Wellness education provides opportunities for students to engage in learning self regulation skills both within and beyond the context of the Wellness construct.To realise the suggested potential of Wellness education in higher learning, it is necessary that curricula overlay the principles from the domains of both self-regulation and Wellness, to highlight authentic learning as a means to lifelong approaches. Currently, however, systematic development and empirical examination of the Wellness construct have received limited academic investigation. Despite having a multitude of intended purposes from the educative to the therapy oriented goals of the original authors, most wellness models appear to be limited to the “what” of Wellness. Investigations of the “how” and “why” aspects of Wellness may serve to enhance currently existing models by incorporating behaviour modification and learning approaches in order to create more comprehensive frameworks for health education and promotion.It is also important to note that none of the current Wellness models actually address the educative framework necessary for an individual to learn and thus become aware or understand and make choices about their own Wellness.The literature reviewed within this paper would suggest that learner success is optimised by giving learners authentic opportunities to develop and practice self regulation strategies. Such opportunities include learning experiences that: provide options for self determined outcomes; require skills development; recognise principles of successful learning as outlined by the APA; and are scaffolded according to learner needs rather than in generic ways. Thus, configuring a learner centred curriculum in Wellness Education would potentially benefit from overlaying principles from the domains of both SRL and Wellness to highlight authentic learning as a means to lifelong approaches, triggered by undergraduate experiences.Student perceptions are a rich and significant data base for the measurement of their experiences, activities, practices and behaviours. Wellness undergraduate education, such as the “Fitness, Health and Wellness” unit offered by Queensland University of Technology, offers a context in which to confirm possibilities suggested by the literature reviewed in this paper in a practical, Australian context.

How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom?

Background

Although the General Medical Council recommends that United Kingdom medical students are taught ‘whole person medicine’, spiritual care is variably recognised within the curriculum. Data on teaching delivery and attainment of learning outcomes is lacking. This study ascertained views of Faculty and students about spiritual care and how to teach and assess competence in delivering such care.

A questionnaire comprising 28 questions exploring attitudes to whole person medicine, spirituality and illness, and training of healthcare staff in providing spiritual care was designed using a five-point Likert scale. Free text comments were studied by thematic analysis. The questionnaire was distributed to 1300 students and 106 Faculty at Queen’s University Belfast Medical School.

351 responses (54 staff, 287 students; 25 %) were obtained. >90 % agreed that whole person medicine included physical, psychological and social components; 60 % supported inclusion of a spiritual component within the definition. Most supported availability of spiritual interventions for patients, including access to chaplains (71 %), counsellors (62 %), or members of the patient’s faith community (59 %). 90 % felt that personal faith/spirituality was important to some patients and 60 % agreed that this influenced health. However 80 % felt that doctors should never/rarely share their own spiritual beliefs with patients and 67 % felt they should only do so when specifically invited. Most supported including training on provision of spiritual care within the curriculum; 40-50 % felt this should be optional and 40 % mandatory. Small group teaching was the favoured delivery method. 64 % felt that teaching should not be assessed, but among assessment methods, reflective portfolios were most favoured (30 %). Students tended to hold more polarised viewpoints but generally were more favourably disposed towards spiritual care than Faculty. Respecting patients’ values and beliefs and the need for guidance in provision of spiritual care were identified in the free-text comments.

Students and Faculty generally recognise a spiritual dimension to health and support provision of spiritual care to appropriate patients. There is lack of consensus whether this should be delivered by doctors or left to others. Spiritual issues impacting patient management should be included in the curriculum; agreement is lacking about how to deliver and assess.

An Activity Theoretical Approach to Designing Curriculum and Instruction That Shift the Means and Ends of History Education

Reformers want history education to help students learn to engage in historical inquiry, read critically across conflicting sources, and engage in civil discussion of controversial issues. How can we help teachers and students shift the roles, norms, and activity in history classrooms to achieve these aims? An activity-theoretical framework suggests the value of explicitly attending to multiple aspects of human activity when designing and presenting reform-oriented pedagogies or curricula. Such attention increases the odds that teachers who implement new approaches or curriculum will achieve significant shifts in the means and ends of history education.

Guidelines for a K-12 traffic safety education curriculum. Volume II: curriculum content and instructional approach. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Evaluation of a six-week professional education curriculum designed to retain registered psychiatric nurses

During the past few years there has been a drastic shortage of registered nurses in the field. The shortage appears to have affected the field of psychiatric mental health nursing most intensely. The psychiatric nursing shortage is a multifaceted problem grounded in decreasing federal funds for advanced clinical training, inadequate undergraduate psychiatric experiences, lack of a well prepared articulate role model, the integrated curriculum and the confusion and blurring associated with the roles and functions of the psychiatric mental health nurse.^ This dissertation will describe the current nursing shortage; the decline in enrollment to nursing programs; the history of psychiatric nursing as a discipline; the shortage of psychiatric mental health nurses; factors contributing to the psychiatric nursing shortage and a plan for a solution to the nursing shortage in psychiatry.^ The paper focuses on an evaluation conducted on an internship curriculum designed to facilitate effective nursing care in the treatment of clients who exhibit emotional problems. The purpose of this study was to attract and retain nurses to employment opportunities in four Hospital Corporation of America (HCA) facilities, using a six week internship program.^ The study will yield an analysis of the effect of combining psychodynamic principles and knowledge with skills in the clinical area. The demands of educational practice have been merged with the discipline of psychiatric nursing in the development of this curriculum. ^

Embedding environmental sustainability in the undergraduate chemistry curriculum : a case study

In spite of increasing attention devoted to the importance of embedding sustainability in university curricula, few Australian universities include specific green chemistry units, and there is no mention of green or sustainable chemistry concepts in the majority of units. In this paper, an argument is posited that all universities should embed sustainable chemistry within all Chemistry courses because it is the morally correct stance to minimise the harm of climate change. Attitudes of chemistry lecturers towards integrating sustainability into their teaching have been probed and it was found, using an established model, that personal environmental perspectives are critical to their attitude. Importantly, academic staff whose research has an environmental component were more likely to incorporate sustainability into their teaching while others struggled to find ways to do so even when they believed it to be important. This paper will recommend that resources are required to assist academic staff without a green chemistry research program to incorporate sustainability into their teaching and several suggestions are provided.