Academic journal article ABNF Journal

Transitioning RN to BSN Students from Acute Care to Hospice Care Nursing

Academic journal article ABNF Journal

Transitioning RN to BSN Students from Acute Care to Hospice Care Nursing

Article excerpt

In 2012, our registered nurse (RN) to Bachelor of Science in Nursing (BSN) program launched an educational initiative with a national Hospice organization to advance nursing education in Hospice and Palliative Care Nursing. To help prepare the BSN student for team-based interprofessional practice, that is cost-effective and meets patient, family, and community health care needs, students are taught skill development essential for collaborative care of the dying patient.

Prior to launching the Hospice course, there were two essential questions asked: 1) how many people die in America and 2) why teach hospice care to RN students? Here is the answer to our first question. In 2011, the average adjusted death rate for Americans was 740.6 per 100,000 populations, with a life expectancy of 78.7 years; and leading the list for all cause mortality was heart disease followed by cancer (Minino, 2013). Globally, the death rate is 7.9 deaths / 1,000 population, that results in approximately 107 deaths worldwide per minute or 1.8 deaths every second (World Fact Book, CIA, (2014). As a patient approaches the end of life's continuum, hospice care offers a respectable alternative that nurses and other healthcare professionals must learn to embrace.

Our second question was answered by simply observing the average acute care nurse in routine patient interactions. The current expectation of the acute care nurse is to save lives. Because of this expectation, there is limited focus on honoring "death" as a vital component to the end of life's continuum. Most healthcare professionals focus on a cure, while hospice care focuses on an empowering quality of life for those persons nearing end of life or experiencing a life-limiting illness. According to the National Hospice and Palliative Care Organization (NHPCO) "hospice provides expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes, as well as support to the patient's loved ones" (2012, p.3).The distressing reality is that most nurses are not taught the full scope of end of life care (EOL) in schools of nursing. Because of this educational deficit, a variance in care is created that may adversely affect the dying patient and his or her family's wishes.

Essential skills in hospice care must be developed and taught to decrease identified educational deficits. First, the hospice nurse must possess good communication skills to enhance patient and family dialogue regarding EOL issues. Second, the hospice nurse must be able to demonstrate compassionate care to the dying patient and family. Third, the hospice nurse must be able to perform advanced health assessment skills to quickly identify changes in the patient's condition. Fourth, the hospice nurse must understand the laws surrounding EOL care and advanced directives. The current RN-BSN curriculum infuses these four essential skills and aligns them with evidence-based practices in Hospice and Palliative Care Nursing Education (Ferrell & Colyle, 2010).

BSN End-of-Life Course

The EOL course is taught twice a year in eight-week sessions. The course consists of didactics, on-campus laboratory sessions and clinical field experiences. There are seven lectures presented by hospice staff that covers an introduction to hospice care, pain management, spiritual and cultural assessments, and patient / family communication. See Table 1 for the lecture outline.

The first three on-campus laboratory sessions are grounded in reality-based scenarios that focus on veterans across conflict eras, such as the Korean Conflict, Vietnam War, and the Iraq and Afghanistan Wars. At the end of each clinical simulated laboratory experience, there is a debriefing session conducted by the hospice clinical educator or liaison and nursing faculty. The different war era veterans were selected because they tend to respond differently to provider services and have unique health issues that must be understood by nurses, in order to provide high quality competent EOLcare. …

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