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European Journal of Applied Sciences – Vol. 10, No. 3

Publication Date: June 25, 2022

DOI:10.14738/aivp.103.12368. Salminen-Tuomaala, M. (2022). Nursing Staff’s Experiences of Learning Palliative Care Through Simulation Coaching. European

Journal of Applied Sciences, 10(3). 186-200.

Services for Science and Education – United Kingdom

Nursing Staff’s Experiences of Learning Palliative Care Through

Simulation Coaching

Mari Salminen-Tuomaala

INTRODUCTION

Palliative care, as defined by the World Health Organization (WHO) is “an approach that

improves the quality of life of patients (adults and children) and their families who are facing

problems associated with life-threatening illness. It prevents and relieves suffering through the

early identification, correct assessment and treatment of pain and other problems, whether

physical, psychosocial or spiritual.” Good palliative care (PC) is person-centred, with special

attention paid to the individual’s needs and preferences [1]

, and it can be administered by a

multiprofessional (interdisciplinary) team of professionals and lay care providers [2]

. Palliative

care is recognized under the human right to health. Besides WHO, this view is endorsed by

many other national and international organizations, for example the World Palliative Care

Alliance or WPCA. [3,4,5] According to the national guidelines in Finland, for example, every

individual irrespective of age and diagnosis has the right to receive palliative care. [6,7]

In palliative care, the death of a terminally ill person is considered to be a natural process, and

no effort is made to prolong or shorten the person’s life. The aim is to support the individual to

live life as fully as possible until death, help family members adapt to the situation and support

the grieving. Palliative care incorporates symptomatic treatment and holistic treatment,

including end-of-life care as the last stage, during the person’s last days or weeks. [8]

According to estimates, between 40 and 57 million people, with approximately 80% of them

living in low or middle-income countries, are in need of palliative care annually. [1,9] The need

for palliative care is expected to grow as a result of the ageing population and the increasing

incident rates for cancers. [10] Other illnesses that are likely to increase the need for palliative

care include long-term cardiovascular, pulmonary, liver and kidney diseases, diabetes and

memory disorders. [11]

It has been estimated that up to over 80% of the world population do not receive appropriate

palliative care [12] due to lack of trained professionals, medicines or access to services. The

international challenge is to find ways to standardize palliative care services and integrate them

with basic health services, including prevention, early detection and treatment programmes. [1,4,5] The challenge needs to be tackled from three perspectives: Financing and structure of the

healthcare system; initial and continuing education; and pain medication policy. [1]

Palliative care is not confined to hospitals or professionals only. Besides hospital care

administered by multiprofessional teams, palliative care is commonly provided in other

healthcare settings or in the patient’s home, often with the help of volunteers or family

members. [13] Real-time remote counselling through telemedicine can be used to support

patients and their families and allow them to communicate with the palliative care team,

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Salminen-Tuomaala, M. (2022). Nursing Staff’s Experiences of Learning Palliative Care Through Simulation Coaching. European Journal of Applied

Sciences, 10(3). 186-200.

URL: http://dx.doi.org/10.14738/aivp.103.12368

irrespective of the location. [14] Regardless of where patients are cared for, it is important that

their wishes are respected through advance care planning (patients expressing their values and

care preferences should they lose capacity to communicate) and that their care is based on

ethical guidelines. [13]

Although the need for appropriate palliative care, including symptom management, meeting

psychosocial and spiritual needs [15] and resident involvement in decision-making [16]

, has been

discussed for years, there is still a relatively limited body of research on the effectiveness of the

interventions designed to improve palliative care for older people in care homes. A review of

three studies revealed little evidence for the effectiveness of the interventions, although they

seemed to have improved some of the ways in which care was given. Apart from residents with

dementia, who seemed have experience lower discomfort as a result of the interventions, it was

unclear if the changes had resulted in better outcomes for the residents. According to one study,

they seemed to have increased family members’ perceptions of the quality of care. [17] On the

other hand, an overview of 113 studies revealed that advance care planning had had a positive

effect on the quality of end-of-life care. [18] Another study, a systematic review of 13 studies,

showed that ACP decreased hospitalization, increased the number of residents dying in their

nursing home, and increased medical treatments being consistent with resident wishes. [19] In

light of these results, listening to patients’ wishes and needs seems one of the crucial aspects of

good palliative care. It has also been suggested that the development of palliative care practices

like advance care planning and symptom management could benefit all residents in care or

nursing homes. [20]

In Finland, where this study was conducted, the median for adult palliative care services is 0.7

per 100,000 inhabitants. The services involve hospital PC support teams (5%), home PC teams

(59%), Inpatient PC units in hospitals (26%) and inpatient hospices (10%). [21] The need to

develop palliative care interventions also in care and nursing homes has been recognized. In

the private small and medium-sized care and nursing homes, however, resources may often be

limited and, compared to larger service providers, staff members have fewer opportunities to

participate in continuing education programmes. Simulation-based coaching in the facility has

been proposed as one solution to the problem. [22]

Some research has been conducted on nursing staff’s perceptions of palliative care and

palliative care training. A study conducted with Australian nurses and care assistants in

residential aged care facilities revealed strong relationships and genuine bonding with the

patients. The nurses and care assistants considered themselves to be “advocates” of residents,

with the responsibility to uphold their requests. Much of the nurses’ work, however, seemed to

consist of “battling and striving”, or attempting to deal with lack of staff, the diverse skills mix,

and regulatory requirements. The study revealed, among other things, that care assistants, who

were unregulated workers, had difficulty in documenting and communicating their

observations in the technical and scientific language used by professional nursing and medical

staff. [23]

A subsequent study by the same research team described the results of a multi-faceted training

intervention, based on the chronic care model and action research. The training intervention,

a combination of palliative care skill development workshops and field placements, had

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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 3, June-2022

Services for Science and Education – United Kingdom

resulted in a number of positive impacts for the participants, who were 28 aged nurses and care

assistants in residential aged care. It had increased their understanding of palliative care,

positively affecting learning and networking and reducing professional isolation through a

team approach. In addition, the introduction of validated assessment tools had enabled care

assistant to report their (frequently subtle) clinical observations. Learning the specialist

palliative care language had also increased participants’ confidence in communication with

medical staff. Based on these results, the researchers recommended multiprofessional teams

and commitment to ongoing learning and development interventions in palliative care. [24]

Ethical and interaction competence are considered essential for professionals working in

palliative care. [25,26] Learning needs reported in recent research involved learning to recognise

needs for palliative care and support in different patient groups, learning to encounter family

members and learning to ensure a dignified death. [27] Provision of individual support is a

challenge, because it depends on an open dialogue, which in turn requires time to develop. [28]

Although some aspects of palliative care education will necessarily remain discipline-specific,

interdisciplinary core competencies relevant to all professional groups involved in palliative

care have been formulated by the European Association for Palliative Care. They include

enhancing physical comfort, meeting the patient’s psychological, social and spiritual needs and

responding to the needs of family carers. In addition, interdisciplinary teamwork and

responding to the challenges of clinical and ethical decision-making are emphasized. The

competencies also involve the responsibility for developing one’s of self-awareness and

interpersonal and communication skills through continuing professional development. [29]

It has been suggested that many attributes required in multiprofessional palliative care –

communication, coordination and collaboration skills- can be effectively practised through

simulation-based education. [30,31,32] Besides practising interaction, simulated scenarios can be

useful in learning decision-making and problem-solving skills [33,34] as well as emotional

intelligence and situational awareness. [22] Simulation-based training can, for example, help

nurses encounter aggression and other, sometimes unexpected emotions in their patients. [30,35,36] Simulation training provides participants with an opportunity to “try out” strategies in

a risk-free environment. [37]

AIM

The aim of this qualitative study is to describe nursing home staff’s experiences of simulation

coaching in learning palliative care at their own workplaces. The knowledge produced can be

used to develop continuing education in palliative care.

The research question is: In their own assessment, what kind of competence did nursing home

staff develop through palliative care simulations?

METHODS

The qualitative research methodology was applied because it enhanced a profound data

concerning the nursing home staff’s experiences of simulation coaching in learning palliative

care. The participants took part in tailored simulation-based coaching on palliative care at their

own workplaces. After the educational intervention, they were requested to write essays on

their learning experiences. The material was analysed using inductive content analysis. The