Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

Abstract

Background and objectives: Palliative care (PC) prevents and alleviates patients´ suffering to improve their quality of life in their last days. In recent years, there has been an increase in visits to the emergency services (ES) by patients who may need this type of care. The aims were to describe the training and capacitation of nurses from ES in PC. Accordingly, a systematic review was performed. Materials and Methods: Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used. The search equation was “Palliative care and nursing care and emergency room”. A total of 12 studies were selected. Results: The studies agree on the need for training professionals in PC to provide a higher quality care, better identification of patient needs and to avoid unnecessary invasive processes. Similarly, the implementation of a collaborative model between ES and PC, the existence of a PC specialized team in the ES or proper palliative care at home correspond to a decrease in emergency visits, a lower number of hospitalizations or days admitted, and a decrease in hospital deaths. Conclusions: The development of PC in the different areas of patient care is necessary. Better palliative care leads to a lower frequency of ES by terminal patients, which has a positive impact on their quality of life. Access to PC from the emergency unit should be one of the priority health objectives due to increment in the aged population susceptible to this type of care.

Registered nurses' experiences of caring for patients in hospitals transitioning from curative to palliative care: A qualitative study

“…The participants, especially in the ICU, experienced the period of transition of patients from curative intention of care to palliative care, and later end‐of‐life care, as stressful. This is in line with previous research (Thorn & Uhrenfeldt, 2017 ) and underscores the need for targeted education and training (Romero et al, 2020 ; Thorn & Uhrenfeldt, 2017 ). Definitions of palliative care (Radbruch et al, 2020 ; WHO, 2018 ) leave room for interpretation; the WHO emphasizes palliative care as an approach, early in a disease trajectory as well as at the end of life, whereas the International Association for Hospice and Palliative Care focuses on health‐related suffering related to persons with severe illness.…”

“…The discourse aiming to broaden the scope of palliative care for everyone, irrespective of diagnosis and disease trajectory, may lead to a shift in how palliative care is viewed. However, at present, the expectations are that RNs have a general knowledge of palliative care in different contexts and that they are able to instigate palliative care interventions according to patients' needs, is a previously identified challenge (Romero et al, 2020 ). The question of how to translate and operationalize palliative care into clinical practice remains unanswered, although it is obvious that to ensure care quality at the end of life in acute care settings, the RNs' needs for education and training must be addressed.…”

“…The question of how to translate and operationalize palliative care into clinical practice remains unanswered, although it is obvious that to ensure care quality at the end of life in acute care settings, the RNs' needs for education and training must be addressed. At the conclusion of a review, authors suggest that a way forward could be recruiting specialist palliative care nurses to work in emergency departments (Romero et al, 2020 ).…”

“…Palliative care can be differentiated between generalist palliative care and specialist palliative care, highlighting that everyone with palliative care needs, regardless of place of care, should be offered general palliative care. Consequently, healthcare professionals need a basic knowledge of palliative care, irrespective of care context; nonetheless, a systematic review has identified the lack of palliative care training for RNs in hospitals (Romero et al, 2020 ).…”

Training Proposal in Palliative Care for Primary Care Nurses in a Health Area in Spain

“…Additionally, it has been shown that some nurses possess theoretical knowledge in PC, but do not apply it in their clinical practice [10,27]. This justifies the recommendation for specific training for groups and specific health areas, aimed at the development of nursing competencies that will modify attitudes and favor the applicability of knowledge [12,28]. Furthermore, although the current trend is towards online training, some authors defend the need for face-to-face training, learning with simulation or case resolution, and discussion groups, which support the transfer of knowledge to behavior in care [11,27,27,29,30].…”