In order to deliver quality palliative care it is essential to develop research guided and evidence-based palliative care nursing education.
The ageing world population, the increase in non-communicable diseases and the emergence of novel viruses — recently highlighted by the Covid -19 pandemic — demonstrate the need for palliative care services. It is expected that the demand for these services will double by 2060 (Connor et al., 2020). In order to deliver quality palliative care, it is essential that all health professionals receive proper education and training in palliative care (Council of Europe, 2018). Palliative care education for nurses has been developed in Finland over the last eight years. This development has been systematically guided by research.
The EduPal project (2018–2021) was one of the key milestones in the development of palliative care education and related research in Finland. Based on data collected in the project, over twenty peer-reviewed papers have been published. The project’s work also led to the development of a national curriculum recommendation for palliative care education at undergraduate level, as well as a specialisation program and a master’s degree program. The development of palliative care education has continued in NursEduPal@Euro project through international collaboration between several organisations. NursEduPal@Impact builds on this work and is developing new evidence-based educational tools.
Evidence-based development of palliative care education
The NursEduPal@IMPACT project aims to strengthen the self-efficacy and leadership skills of nurses working in palliative care. To achieve this, two studies will be conducted as part of the project, and the results will be used in the design and development of new innovative teaching methods and materials.
The first study aims to highlight the experiences of nurses working in palliative care with moral and ethical dilemmas and to examine how they act in these situations. The survey data was collected using a cross-sectional design from European nurses (n=247) in spring 2024 via an electronic questionnaire on the website of the European Association for Palliative Care and will be analysed using inductive content analysis. The survey could be answered in 12 different languages.
The first study aims to highlight the experiences of nurses working in palliative care with moral and ethical dilemmas and to examine how they act in these situations.
The second study of the NursEduPal@IMPACT project was designed to complement the data from the first study. The aim of the study is to describe nurses’ perceptions of self-efficacy and leadership skills in palliative care and to examine their views on how nurses can be taught to act in morally and ethically challenging situations. The research data was collected through focus group interviews (6) and analysed systematically using framework analysis. The participants were nurses from Finland, Belgium, and Romania, and one group was international, with participants from around the world.
In nursing, ethical dilemmas are usually related to end-of-life issues (Rainer et al., 2018), where nurses have to choose between two or more tasks that they perceive as ethically wrong (Karlsson et al., 2010). Ethical dilemmas tend to increase nurses’ feelings of powerlessness, concern, or frustration (Karlsson et al., 2010). Ethical decision-making can cause a moral conflict in nurses, which is described as an internal conflict, but it is considered an inevitable part of end-of-life care (De Panfilis et al., 2019). The moral conflicts described by nurses are used in a variety of ways in the training materials developed for the project. The results of the studies serve, among other things, as real-life descriptions in the learning materials, and as guidelines for the type of learning content to be developed in the project and the learning methods to be used.
Next steps
Progress has been made in the development of palliative care services and education in Finland. However, there is still a need for further development in both areas. Data needs to be collected on how the situation evolves nationally. There is also a need to assess the effect of education on students’ competencies and patient care. To do these, collaborative approaches is needed. An example of this kind of activity is PallEduXRSim (Palliative Education with eXtended Reality Simulation) research project. The aim with this is to continue the findings on competence perceptions in palliative care nursing (Hökkä et al., 2020; 2021; 2022) and NursEduPal@EURO’s development of a national curriculum recommendation for palliative care education at undergraduate level (Hökkä et al., 2024). An educational intervention will be developed with extended reality (XR) simulation, and its effects will be evaluated on undergraduate nursing students’ competence in delivering palliative care. XR is an umbrella term for immersive simulation including virtual reality (VR), augmented reality (AR) and mixed reality (MR). This research will explore the effectiveness of a palliative care education module based on the curriculum recommendations (Hökkä et al., 2024) and students’ wishes for palliative care education to be well structured, led by professionals in the field and based on real experiences (Hökkä et al., 2022).
To ensure competent nurses and quality education, systematic research approaches are needed in collaboration between universities of applied sciences, universities and the professional field. During the last eight years a lot has been done, but still there is a demand to further develop the education, teaching methods and systematic research related to this subject. This requires collaboration between national and international researchers.
Lähteet
Connor, S. (2020). Global Atlas of Palliative Care, 2nd. Worldwide Palliative Care Alliance and World Health organization. http:// www.thewh pca. org/ resou rces/ global- atlas- on- end- of- life- care.
Council of Europe. (2018). The provision of palliative care in Europe. Parliamentary assembly. Council of Europe. Resolution 2249. http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=25214&lang=en
De Panfilis, L., Di Leo, S., Peruselli, C., Ghirotto, L., & Tanzi, S. (2019). “I go into crisis when …”: ethics of care and moral dilemmas in palliative care. BMC Palliative Care, 18:70.
Hökkä, M., Martins Pereira, S., Pölkki, T., Kyngäs, H., & Hernández-Marrero, P. (2020). Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis. Palliative medicine, 34(7), pp.851–870.
Hökkä, M., Melender, H.L., Lehto, J.T., & Kaakinen, P. (2021). Palliative nursing competencies required for different levels of palliative care provision: A qualitative analysis of health care professionals’ perspectives. Journal of palliative medicine, 24(10), pp.1516–1524.
Hökkä, M., Pölkki, T., &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, 37(3), pp.434–442.
Hökkä, M., Ravelin, T., Coupez, V., Vereecke, D., Brennan, J., Mathe, T., Brandstötter, C., Paal, P., Spanu, D.E., &Mitrea, N. (2024). Core palliative care competencies for undergraduate nursing education: international multisite research using online nominal group technique. Journal of Palliative Care, 39(3), pp.217–226.
Karlsson, M., Roxberg, A., Barbosa da Silva, A., & Berggen, I. (2010). Community nurses´experiences of ethical dilemmas in palliative care: a Swedish study. International Journal of Palliative Nursing, 16(5).
Rainer, J., Scneider, J.K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27:3446–3461.
Permanen address: http://urn.fi/URN_NBN:fi-fe2025100199113
