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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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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
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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
researcher read through the material several times. She conducted the inductive content
analysis by picking out original utterances that represented an answer to the research
questions. These utterances, stored in Word files, were then reduced so that their original core
content was retained. Reduced utterances representing similar perspectives were grouped into
four generic categories, which were combined into one main category (Table 1). [38]
Participants
The 20 participants came from a large research and development project, carried out in private
care and welfare industries in one region of Finland between August 2017 and December 2019.
In all, 230 professionals participated in the project. They worked in child protection, mental
health services, and residential elderly care and nursing services in 20 private small or medium- sized social and healthcare enterprises (SMEs). The project aim was to increase staff’s
theoretical and practical competence through simulation-based coaching based on self- assessed learning needs.
This article reports the results of one sub-study of the overall research and development
project. The participants (n= 20) in the sub-study were employees in two enterprises providing
residential aged care and nursing services. The majority (12) of the participants were practical
(enrolled) nurses with an upper secondary level vocational education; six had a nursing degree
from a University of Applied Sciences or equivalent, and two had a degree in social services. All
participants were female. Their mean age was 32, with the age range 22-64 years. Most
participants had approximately 5 years’ experience of working in care and nursing homes
(range 2-25 years).
The Simulation Coaching Intervention
The educational intervention was based on participants’ self-assessed need to develop their
situational sensitivity, emotional intelligence, as well as interaction and client counselling skills
in supporting dying patients and families in palliative care. The training involved two 8-hour
days at the participants’ own workplaces. It was based on a coaching philosophy; the teachers
or facilitators assumed the role of coaches, whose task was to support professionals interested
in improving their non-technical palliative care competence. [39] The intervention was based on
the participants’ self-defined learning needs: How to support a dying patient and the patient’s
family members? How to provide high-quality palliative care based on patients’ and relatives’
needs? The participants had reported a need to develop their interaction and counselling skills;
situational sensitivity and emotional intelligence; management of palliative care situations;
management of acute situations, and coping with challenging behaviour of dying patients or
their family members. Based on these learning needs, the aim of the simulation coaching was
to help professionals recognise patients’ physical, psychological and social palliative care needs,
practise interaction and increase the professionals’ sensitivity and preparedness for holistic
care.
One of the teachers or facilitators assumed the role of a dying person or family member, while
another concentrated on facilitating the simulation process and feedback discussion. At each
workplace, the 10 participants were divided to two groups; actors and observers.
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The interventions consisted of three stages. First, the supervising facilitator described the
initial palliative care situation in a scenario and assigned actor and observer roles. The second
stage was the actual scenario of approximately 15 minutes, during which two professionals
acted the role of nurses. The rest of the participants were requested to make observations on
the verbal and non-verbal patient/family member-nurse interaction. The third stage involved
a feedback discussion. It started with the two actors allowed to have an opportunity to reflect
on their learning experience. This was followed by the observers’ comments. The feedback
included discussion on both successes and suggested improvements. For example, the
participants discussed whether a more dignified approach to a situation was available, based
on the core values of palliative care. The session ended with participants selecting key points,
which could be useful and put into daily practice of the workplace.
The simulated scenarios were constructed around challenging palliative care situations and
based on the following themes: the first encounter with the patient after the introduction of a
palliative care plan; recognition of the patients’ physical, psychological and social needs and
problems; interaction with an anxious patient; encountering fear of death; counselling and
supporting family members in palliative care; encountering demanding family members;
emotional support for patients in palliative care, and encountering grieving family members.
Data Collection and Analysis
Directly following the simulation coaching intervention, the participants were asked to write
essays (n=20) on the potential competence developed through the palliative care simulations.
They had 60 minutes time, and they wrote the essays in their work time at their workplaces.
The essays were analysed using inductive content analysis. The analysis stared with repeated
intensive reading of the transcribed material. Clauses, sentences or other meaningful
utterances, which appeared to answer the research question, were picked out and rewritten in
a reduced form while retaining their original core ideas. This was followed by grouping of the
reduced utterances into categories with similar contents (sub-categories), which were
combined into higher-order categories (generic categories), and finally collapsed into one main
category (Table 1). During this process, the researcher returned to the original material several
times.
ETHICS
Participation in the study was voluntary and anonymous.[40] National guidelines on research
ethics and good scientific practice were observed. [41] Study permission had been obtained
earlier from managers of the participating organizations for all sub-studies of the research and
development project, including this sub-study. The participants signed a consent form based on
verbal information about the study. This research topic was chosen, because few studies exist
on the use of simulation for gaining competence required in palliative care. The results can be
used in planning and implementing simulation-based continuing education for nursing
professionals. The researcher’s extensive experience of oncology care may have influenced her
views of palliative care. This may have affected the planning of the simulations, but it seems
less likely that it affected the data analysis. Original participant quotes are presented to
increase the credibility of the results.
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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
RESULTS
General Observations
According to the participants, simulation coaching was a suitable method for learning palliative
care. The learning situations were considered to be “authentic”, similar to real-life work
situations and easy to identify with. The participants found that the scenarios had contained
elements that they had personally encountered at their work, but through the simulation
coaching, they had had an opportunity to share and examine their experiences and challenges
“more objectively” in a safe environment. The discussions had been “profound”; they had
included reflection on ethics and coping, and had also been useful as a form of work supervision.
More specifically, the results revealed four competence areas, for which the educational
intervention had been effective. They were: ethical competence, emotional intelligence,
situational awareness and counselling competence.
Ethical Competence
As regards the first area of competence, ethical competence, the participants first reported that
the simulated scenarios had made them better aware of ethically sensitive issues. The experience
had sparked much discussion. Second, based on the scenarios and feedback discussions, the
participants had come to reflect on the value foundation of palliative care more profoundly than
was typical of their daily work. Importantly, the scenarios had provided them with an
opportunity to examine the ethicality of palliative care from the perspectives of both patients,
their family members and the staff. This occurred for example when the facilitator, fully
immersed in the role of the client, demanded that the nurses consider her “as the person called
Wilhelmina, not as a bunch of diseases or symptoms”.
Third, the simulated scenarios had made the participants better aware of their clients’ needs for
individual and holistic attention. As one of the participants wrote,
”It was good to notice that Wilhelmina the patient said that she wanted to have a
bath in the evening as usual, she did not want to do it in the morning, because the
bathroom was humid and there was a smell of another patient’s sweat, so according
to the values of palliative care one must listen to her wishes and let her have her
bath in the evening.”
Fourth, ethical competence, as seen by the participants, also meant that they recognised the
prerequisites of high quality palliative care. In this context, the participants felt impelled to ask
if adherence to workplace routines and business models could sometimes actually prevent the
delivery of optimal palliative care. The participants simultaneously became aware of several
development needs in their work community. They said, for example, ”How much should you
change in the company operations, so that you could genuinely reach the goals as defined in the
values of palliative care? Is the number of staff sufficient?”
The participants reported having reflected on what high quality palliative care involved, and
whether it was similar when examined from the perspectives of patients, family members or
nursing staff. The participants had also discussed whether it was ethically appropriate to
encourage hope if the situation “actually seemed hopeless”. On the other hand, hope and
optimism were found to facilitate encounters with suffering.
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Emotional Intelligence
Emotional intelligence was another competence area that was found to have developed as a
result of the educational intervention in this study. It involved, first, the ability to take the
patient’s emotions into account. In other words, the participants paid attention to recognising
the patient’s emotions and reactions, and seeking to respond to them appropriately. The
participants found that they had improved in recognising and reflecting on patients’ and family
members’ emotions and “mood swings” during the palliative care process. The scenarios had
also helped them understand what affected patients’ emotions, and they felt better equipped
to objectively examine reasons and consequences of emotional outbursts. For example,
“In the scenario where Wilhelmina’s far-living daughter visited, the daughter
demanded that Wilhelmina’s hair should be permed and nails polished. She accused
the nursing staff of neglecting Wilhelmina’s beauty care. As the situation
progressed, it was discovered that underlying the daughter’s challenging
behaviour, there was guilt. These situations are quite common, the family member’s
distress in expressed as a critical or aggressive attitude. That scenario helped me
look at those situations from a distance in a way, in the daily life it can really bug
you and you may get provoked.”
The participants further wrote that their use of emotional intelligence skillsin palliative care had
improved as a result of the educational intervention. They felt more acutely aware of the need
for a compassionate and altruistic attitude and “genuine presence”. According to the
participants, to be able to recognise emotional needs and support the patient more genuinely,
it was important that they attempted to reach into the person’s experiential world and way of
thinking. In the words of one participant, “ It is important to identify yourself with the patient’s
situation and try to reach his or her emotions and experiences. Just to stay alongside the patient
for a while, give time and be present.”
Third, the participants reported that the simulations had made them better prepared to support
patients and family members emotionally. The participants felt that they were better able to
recognise needs for emotional support and more aware of the possibilities of providing such
support. Recognition of family members’ emotions or supporting seldom-seen family members
was considered to be demanding, but some long-term patients and their frequently visiting
families had become “almost like family members”. The death of such patients was experienced
as deeply touching. One of the participants described her emotions: ” When there is a death of
an aged patient, who has lived with us for a long time, I grieve as if I had lost a close relative.”
In this context it should be mentioned that the participants’ contributions also included
reflection on whether nurses were always able to adhere to their roles as empathic
professionals. It was suggested that the line between empathy and sympathy could occasionally
become blurred, and workers’ emotions could override their professionalism.
The feedback discussions had reminded the participants of the importance of regulating their
emotions. The regulation of emotions was considered essential for personal coping, but also for
the maintenance of a caring atmosphere. As one participant pointed out, the professional’s
ability to recognise their own and other people’s emotions could significantly affect the
patient’s care experience.
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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
A few participants reflected on how family members’ challenging behaviour or occasional
attempts to instil a sense of guilt in the nursing staff could negatively affect the patient’s mood,
emotions and coping. Challenging behaviour and emotional outbursts from family members
were reported to lead to distress and anxiety in nursing staff as well, and to affect staff’s coping
and the overall atmosphere in the nursing home. According to one participant, occasionally
encounters with family members required a great deal of “filtering of emotions”. As a
professional, it was important to learn to recognise and control one’s emotions. To quote a
participant,
“Family members may be demanding sometimes, then you just have to try and filter all those
expressions of hatred and blame, do not let it get under your skin, count to ten, do not get
provoked. Try to remember that these family members are in distress, scared, and there is guilt,
too.
Situational Awareness
According to the results, the participants’ ability to recognise problems in both verbal and non- verbal interaction had improved as a result of the educational intervention. They also felt that
they had become better equipped to support patient-family member interaction and to recognise
when to withdraw if families required time on their own.
The participants described how they had practised intervening in a neutral and general way, if
family members appeared to have problems addressing difficult issues. Situational sensitivity
and ability to choose an appropriate moment to intervene were required. The participants
wrote, for example, “ The scenario made it clear that as nurses we are sort of bridge builders,
we listen with a sensitive ear and verbalise difficult moments”, and “ Situational sensitivity, that
is like intuitive awareness that now the patient and family need help to talk about difficult
issues”.
The scenarios had also been helpful in practising to read non-verbal interaction or facial
expressions and gestures. One of the participants wrote, “The scenario involved a situation
where a family member had no words for the emotions, that helped me see the person’s need
for support”.
Counselling Competence
The last generic category that evolved in this study was counselling competence. The
participants had recognised an increase in their skills as regards the counselling of patients,
family members and colleagues in the multiprofessional team. They had, for example, become
more intensely aware of the need to encourage patients to report any changes in their
symptoms, so that appropriate symptomatic treatment could be secured. Some participants had
also discovered counselling on medication to be more crucial than they had previously believed.
One of them wrote, “The scenarios helped me realise that telling patients about medicines and
the option of increasing medication means respecting them as individuals until the very end,
and that can improve their life quality”.
Counselling family members on how to stand alongside patients was considered another
important part of palliative care. The participants reported that they had become more acutely
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conscious of the importance of informing family members, in more concrete terms, about the
palliative care objectives and available care options. The scenarios had also helped participants
realise the value of encouraging family members to become involved in the patient’s care. To
quote the participants, “ I learnt how important it was to tell them what palliative care involved
and what it did not”, and “ You have to explain the family members how they could get involved
in the patient’s care and life”.
Supporting family members’ coping was mentioned as an essential part of counselling,
especially when the client deteriorated and the end-of-life care stage was reached. Many
participants said that the scenarios had taught them to pay better attention to keeping family
members updated. One of the nurses wrote that counselling in palliative care involved
“coaching” family members and other close friends to face the impending death. To quote,
“I learnt through the scenario that you had to say out loud to the family members
that now the patient’s condition was deteriorating, especially when the end-of-life
care stage, the countdown started, you must not hide it, they have the right to know,
so that they can prepare themselves for the patient’s death.”
Last, the simulation-based education had reminded the participants of the importance of
supporting and counselling colleagues in multiprofessional teams. One participant described
how a scenario had affected her:
“In the scenario there was this social work professional, who did not know what the
physical signs of impending death were, and she was scared of staying awake alone
in the nursing home, someone had lost consciousness in the evening, and she had
never seen a dying person. That scenario made me realise that you can only give
appropriate palliative care if everyone in the nursing home knows the basic facts,
so you need counselling and support between colleagues.”
DISCUSSION
This qualitative study brings together the experiences of 20 employees of nursing homes, who
took part in a simulation coaching intervention in palliative care at their own workplaces. The
findings are based on an inductive content analysis of essays written by the participants to
describe competence developed through the simulated scenarios and subsequent feedback
discussions.
The participants found the simulations “authentic” and suitable for learning palliative care.
They appreciated the opportunity to share and examine their experiences “more objectively”
in a safe environment. The intervention had been particularly effective in the areas of ethical
competence, emotional intelligence, situational awareness and counselling competence. In
other words, it seems that the training had met the participants’ self-reported learning needs.
The need to increase palliative care training for both nursing and medical staff has been
emphasised in Finnish literature [42]
, and simulation-based training has been experienced as an
effective method of improving emotional intelligence, situational awareness [22] and interaction
and communication skills.[43,44]
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Sciences, 10(3). 186-200.
URL: http://dx.doi.org/10.14738/aivp.103.12368
The participants reported increased awareness of ethical issues and the need to respect
patients’ wishes. Professionals working in palliative care might find systematic advance care
planning helpful; a considerable body of research has confirmed the positive effect of ACP on
the quality of end-of-life care.
[18,20] However, as in earlier literature [23]
, the participants
expressed concern over the lack of staff required to ensure high quality palliative care.
Adequate human resources and well-trained staff have been found to be a prerequisite of high
standard palliative care.
[29,45] Importantly, the provision of individual support, which is based
on open dialogue, requires time and resources.[28]
The participants in this study also described how they had managed to facilitate simulated
interaction situations between patients and families by prompting communication or by sheer
presence. With impending death, the social relationships between patients and family members
may change and new challenges evolve.
[28] Dealing with the situation calls for strong emotional
intelligence and situational awareness. It is also useful to examine the patients’ social
relationships individually from the perspective of their life courses.
[46] The more meaningful
the social relationships have been to the patient, the greater the effect of being deprived of them
can be on their wellbeing.
[28]
Learning methods, which foster creativity and experimentation, and allow “failures” and
mistakes, are required in continuing education.[47] Simulation-based learning has proved to be
an effective way of sharing best practices and improving collaboration and communication in
aged care.[48] At best, simulations can help integrate different kinds of knowledge and construct
solid competence.
[49]
The study has some limitations. The sample was small, limited to a single region in Finland. One
researcher collected and analysed the data. Despite this, the findings can be useful both
nationally and internationally in planning palliative care training for aged care and services. In
general, large samples are not necessary in qualitative research. The data was well saturated;
the same themes started to recur.
CONCLUSION
Simulation-based coaching can be recommended for learning palliative care in both initial and
continuing education programmes. It allows participants to practice, in a safe environment,
how to deal with situations calling for profound emotional intelligence and situational
awareness.
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Sciences, 10(3). 186-200.
URL: http://dx.doi.org/10.14738/aivp.103.12368
Table 1. Palliative care competence gained through simulation-based coaching
Reduced expressions Sub-categories Generic
category
Main category
Recognition of ethically
sensitive issues and situations
Awareness of ethical issues
in palliative care
Ethical
competence
Palliative care
competence
Reflection of palliative care
values
Examination of ethicality from
the client’s perspective
Reflection on the ethicality
of palliative care
Examination of ethicality from
the professional’s perspective
Taking the client’s individuality
into account
Individual and holistic
attention given to the client
Taking the client’s needs into
account holistically
Taking the client’s wishes
comprehensively into account
Recognition and attention
given to the client’s suffering
Recognition and attention
given to factors that affect the
client’s life quality
Recognition of challenges to the
implementation of palliative
care Recognition of the
prerequisites of high quality
palliative care
Recognition of risks and threats
to the quality of palliative care
Recognition of the routines and
resources that affect the quality
of palliative care
Recognition and responding to
the client’s emotions and
reactions
Taking the client’s emotions
into account
Emotional
intelligence
Understanding what affects the
client’s emotions
Understanding the client’s
thinking and experiential world
Recognition of the importance
of a compassionate and
altruistic attitude
Use of emotional
intelligence skills to support
Compassion and presence the client
Understanding the importance
of empathy skills
Recognition of the client’s need
for emotional support
Emotional support to clients
and family members
Supporting the client
emotionally
Distinguishing between
empathy and sympathy at one’s
work
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Emotional and psychosocial
support to family members
Recognising one’s emotions
The importance of
regulating one’s emotions
Recognising the effect of one’s
and others’ emotions on client
care and coping experiences
Encountering blaming or
challenging behaviour in family
members
Regulation and control of one’s
emotions
Filtering and dealing with
expression of emotions
Recognition of challenges in
client-family member
interaction
Recognition of problems
and facilitation of verbal
interaction
Situational
awareness
Verbalising difficult issues
Recognition of the optimal
timing intervening
Recognizing situations with no
words and offering support
Recognition of non-verbal
interaction and respect for
the family’s time alone
Recognizing the client’s and
spouse’s or other family
member’s need for time alone
Reading the client’s facial
expressions and gestures
Counselling on client’s
symptoms and pharmaceutical
care Counselling on symptomatic
treatment
Counselling
competence
Counselling on symptomatic
treatment
Counselling family members on
care options and objectives Counselling family members
Counselling family members on standing alongside clients
their involvement in the client’s
care
Counselling to support family
member’s coping
Informing family members of
changes in care for a
deteriorating client
Counselling to support
multiprofessional work
Enabling multiprofessional
palliative care
Counselling to support
collaboration between
professions