‘What matters most to you?’

A fresh focus on training for nurses

She enrolled online in the End-of-Life Nursing Education Consortium, an education initiative to improve palliative care, where she learned more about how to have tough end-of-life conversations – both about death itself and about the patient’s hopes and goals. The curriculum provides training in palliative care geared toward nursing students and practicing nurses, including undergraduate and graduate nursing faculty, continuing education providers, staff development educators, specialty nurses in pediatrics, oncology, critical care, geriatrics, and advanced practice nurses.

The Massachusetts Coalition for Serious Illness Care aims to bring that education to more nurses in the Commonwealth, after a recently published survey of undergraduate Massachusetts nursing programs found a dearth of formal end-of-life training.

The survey, conducted by the coalition’s Nursing Taskforce, found that only four of the 21 nursing programs that responded reported having an independent course related to palliative care.

“It's a long-standing problem: there is not enough emphasis in nursing curriculums or any curriculums on palliative care,” said Priscilla Gazarian, co-chair of the coalition’s Nursing Taskforce. “They’re dictated by regulatory content that has to be covered, so topics like this don't get the attention they need.”

The consortium’s training includes portions on communication skills, pain management, symptom management, and grief and bereavement. There is content on end-of-life care across cultures, as well as information on physiological processes of declining health.

“With communication, it’s a lot about assessing where patients are at in their understanding of prognosis, what they know about their condition, and how to communicate what you're observing at the bedside from patient and family to the rest of the team” Gazarian said.

The Massachusetts Coalition for Serious Illness Care, which is funded by the nonprofit Blue Cross Blue Shield of Massachusetts and other organizations, set its sights on the issue even before the survey was published: the coalition’s two-day Train-the-Trainer event provided participants with 14 hours of training as well as an Oxford Textbook of Palliative Nursing and a flash drive containing over 1,500 pages of palliative care resources. Gazarian, chair for the Department of Nursing at the Manning College of Nursing and Health Sciences at UMass Boston, was among the training faculty.

Vital conversations

The central piece to furthering palliative care education, Gazarian said, is helping nurses get more comfortable engaging in conversation with their patients, and becoming more involved in the end-of-life process.

“In general, I think getting people more engaged in these concepts helps empower nurses to feel like they can ask patients, ‘What do you understand about your health condition?’” Gazarian said.

“This kind of support and encouragement is critical,” said Anna Gosline, the coalition’s executive director, because far too often patients and families don’t truly understand the full clinical picture, limiting their ability to make the choices that are right for them in that moment.

“Supporting patients in gaining a holistic understanding of their prognosis is one of many areas where nurses are uniquely well-positioned to help improve serious illness care,” Gosline said. “Nurses are critical parts of the care team and have the potential to support so much of the care, communication and empathy when it really matters. It’s important to improve critical skills and knowledge to help our nurses care for people with serious illness here in Massachusetts.”