Gaps in Nursing Practice: Problem Statement and Recommendations Report

The Problem Statement in Nursing Education

The complexity of EOL care can take a heavy toll on unprepared nurses who are expected to be effective advocates of quality EOL service through direct inpatient care or referral. However, inadequate educational preparation, professional mentorship, and exposure to hospice practicum experiences have contributed to gaps in EOL care(Jackson & Motley, 2014). This issue is broad in scope, affecting the nurses’ decision-making and creating negative attitudes toward actual EOL practice. Specifically, symptom management, communication, and cultural sensitivity, which are critical competencies expected of nursing professionals, are lacking in new nurses.

Palliative/hospice nursing as a specialty practice is not a core focus of curricular development and standardization by most academic institutions. Further, opportunities and time for practical experience with a dying patient are lacking (Jackson & Motley, 2014). As a result, student nurses have entered practice without adequate professional training in this area, which is evidenced by moral distress when caring for terminally ill patients.

Another factor that could account for the gap in EOL practice skills among nursing students is inadequate communication practices to ensure shared decision-making and emotional balance. According to Jackson and Motley (2014), a nurse’s presence, active listening, and support are critical in advanced care planning. Part of nursing care involves taking care of the dying or those in critical care, and therefore, having the opportunity to see dying patients in any setting is imperative in preparation for practice. Access to EOL care for most people with terminal conditions is limited, despite 75% of US hospitals offering hospice programs (Jackson & Motley, 2014).

The growing demand for these services is an impetus for the adequate educational preparation of nurses to care for EOL patients and their families. Experiential training will ensure productive EOL conversations and manage patient/family anxiety that is often associated with dying.

Description of Course

The proposed EOL training program is designed to enhance the educational preparation of the nursing staff providing end-of-life care. It is expected that nursing students with no prior EOL training or experience will acquire practical skills in hospice care. The course, which is modeled around the End-of-Life Nursing Education Consortium (ELNEC) competency goals, will be delivered by nurse faculty and guest speakers at the facility’s nursing school through lectures and PowerPoint presentations.

The specific modules that will be covered include EOL nursing, communication, cultural/spiritual aspects, stages of the grieving process, ethical concerns, and preparing patients/families for imminent death (Jackson & Motley, 2014). Lectures will encompass a brief description of the philosophical foundations of palliative care and psychosocial aspects of EOL care. The course will also include experiential content; learning will involve interactive simulations and case studies. Students will also complete reflective journal activities, return demonstration, role play, and give presentations of their EOL experiences in class.

Furthermore, each learner will be assigned a hospice patient to care for as a part of his or her clinical experience. He or she will be required to spend 10 hours with the patient/family spread over the entire semester. The time spent per visit will depend on the patient’s state and integrated care needs. Learners will be allowed to make home and hospice center calls. They will then share their emotional experiences with EOL care and reflections weekly in class. Additionally, students will discuss how they addressed the psychosocial and spiritual needs of patients and families during each session.

The orientation of the learners to hospice experiences will be critical to achieving the learning outcomes of the EOL course. A case manager at our facility will orient them to the institution’s policies and their scope of practice, which will not include activities of daily living. He/she will also assign patients and arrange patient visits to allow students to apply classroom EOL knowledge in practice.

The proposed intervention (EOL course) will address the gap in end-of-life nursing care skills and competency. Through the clinical practicum, learners will spend time with individuals facing imminent death and develop their affective and emotional domains. In two-hour visits, they will learn to converse and empathize with terminally ill patients and their families. The goal is to develop competencies in therapeutic communication with people from different backgrounds, initiating discussions on spiritual matters, and navigating EOL care decisions to im