1. Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN

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In 1998, in recognition of the universal need for humane end-of-life care, the American Association of Colleges of Nursing, supported by the Robert Wood Johnson Foundation, convened a roundtable of expert nurses and other health care professionals to stimulate scholarly discourse on the care of patients at the end of life.


This group of experts developed the End-of-Life Educational Competency Statements, which every undergraduate nursing student should attain if patients were to achieve "a peaceful death." The group made recommendations concerning the content areas where these competencies could be addressed in undergraduate curricula. From the release of the American Association of Colleges of Nursing's Peaceful Death Document in 1998 to the present, this document has served as a valuable resource to guide nursing educators in preparing nurses to enter practice and competently care for patients at the end of life. This document has been a key foundation for the End-of-Life Nursing Education Consortium (ELNEC) project and has been cited extensively in the literature.


Now 17 years after the release of the Peaceful Death document, much work remains to be done to educate nurses to deliver primary palliative care. A new roundtable of national nursing faculty, nursing administration, and palliative care nursing experts was convened in the fall of 2015. This project is funded by the Cambia Foundation through a grant awarded to the ELNEC project and continues the collaboration with the American Association of Colleges of Nursing. The group discussed and revised the original document to expand the preparation of undergraduate nursing students beyond end-of-life care to include care for patients with serious illness and their families from the time of diagnosis, across the illness trajectory. Recommendations for innovative approaches to teach palliative nursing concepts and content were also a topic for this roundtable discussion. It is critical that undergraduate nursing education takes responsibility to improve care for seriously ill patients and their families across the lifespan in order to prepare the next generation of nurses. A complete summary of the work by this project will be available in early 2016.



Following is a summary of the key competencies identified in the document to be essential for future nurses to deliver palliative care.


Competencies needed by the nursing workforce are as follows:


1. Promote the need for palliative care for seriously ill patients and their families, from the time of diagnosis, as essential to quality care and an integral component of nursing care.


2. Identify the dynamic changes in population demographics, health care economics, service delivery, caregiving demands, and financial impact of serious illness on the patient and family that necessitate improved professional preparation for palliative care.


3. Recognize one'sown ethical, cultural and spiritual values and beliefs about serious illness and death.


4. Demonstrate respect for cultural, spiritual and other forms of diversity for patients and their families in the provision of palliative care services.


5. Educate and communicate effectively and compassionately with the patient, family, health care team members, and the public about palliative care issues.


6. Collaborate with members of the interprofessional team to improve palliative care for patients with serious illness, to enhance the experience and outcomes from palliative care for patients and their families and to ensure coordinated and efficient palliative care for the benefit of communities.


7. Elicit and demonstrate respect for the patient and family values, preferences, goals of care, and shared decision-making during serious illness and at end of life.


8. Apply ethical principles in the care of patients with serious illness and their families.


9. Know, apply and effectively communicate current state and federal legal guidelines relevant to the care of patients with serious illness and their families.


10. Performa comprehensive assessment of pain and symptoms common in serious illness, using valid, standardized assessment tools and strong interviewing and clinical examination skills.


11. Analyze and communicate with the interprofessional team in planning and intervening in pain and symptommanagement, using evidence-based pharmacologic and non-pharmacologic approaches.


12. Assess, plan, and treat patients' physical, psychological, social and spiritual needs to improve quality of life for patients with serious illness and their families.


13. Evaluate patient and family outcomes from palliative care within the context of patient goals of care, national quality standards, and value.


14. Provide competent, compassionate and culturally sensitive care for patients and their families at the time of diagnosis of a serious illness through the end of life.


15. Implement self-care strategies to support coping with suffering, loss, moral distress and compassion fatigue.


16. Assist the patient, family, informal caregivers and professional colleagues to cope with and build resilience for dealing with suffering, grief, loss, and bereavement associated with serious illness.


17. Recognize the need to seek consultation (i.e. from advanced practice nursing specialists, specialty palliative care teams, ethics consultants, etc.) for complex patient and family needs.



The Cambia Foundation-funded project will also provide support for an online palliative care curriculum for undergraduate nursing programs to be developed in 2016 and implemented in nursing schools in 2017. The project is intended to define the competencies needed by nurses and to provide faculty with the tools to make this vision possible.


These competencies identified for nursing practice reflect the solid foundation created by the pioneers of our field and nurses in the earliest hospices and palliative care programs who have demonstrated that "a peaceful death" is indeed possible and also that excellent care should begin at the time of diagnosis of serious illness.


As we start this new year in 2016, I hope that each of us can celebrate the work that has been done to advance palliative nursing and look forward to the work ahead. The education of our next generation of nurses will require all of us working together and is the most important work we can do.


Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN




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