Education that makes a difference to palliative and end of life care at the bedside in a resource-poor context: the situation of Cameroon

Background Current demographic trends giving rise to an ageing population worldwide, and changes in disease patterns, are increasing demands for palliative and end of life care. Nurses play a fundamental role in the care of patients with chronic and life-threatening illnesses, making it critical that nurses entering the profession should be competent and confident to provide palliative care. However, some preregistration nursing curricula, particularly those in resource-poor settings, do not include any palliative care content. Existing research identifies a lack of palliative care competencies among practising nurses, both newly graduated and student nurses. Aim The aim of this study was to develop, pilot and evaluate the impact of a palliative care course on Cameroonian preregistration nursing students’ palliative care knowledge and self-perceived competence and confidence in palliative care provision, using Kirkpatrick’s (1967) framework for training programme evaluation. Design This study is situated within the World Health Organisation’s public health model for palliative care as an overarching theoretical framework. It employed a longitudinal quasi-experimental pretest/posttest design, using both quantitative and qualitative methods. It was conducted in 3 phases. In the first phase, a 30 hours classroom based palliative care course, underpinned by experiential learning theory, was developed. In the second phase, the course was delivered to second and third year nursing students in one University in Cameroon, by nurse educators, a chaplain and palliative care trained nurses in Cameroon. In the third phase, an evaluation of the impact of the course on students’ palliative care knowledge, self-perceived competence and confidence in palliative care, and transfer of learning to practice was conducted. Course evaluation data was collected via a pretest/posttest survey, 3 focus groups and 10 individual critical incident interviews. Both descriptive and inferential statistics were used to analyse the quantitative data. The qualitative data was analysed thematically using the framework approach. Findings This study revealed a deficiency in the palliative care content of the pilot University’s preregistration nurse training curriculum, and very poor palliative care knowledge and self-perceived competence and confidence in palliative care provision, among preregistration nursing students of this University.A 30 hour classroom based palliative care course, delivered by nurse educators, palliative care nurses and a chaplain in Cameroon was found to statistically significantly improve students’ overall palliative care knowledge. In this study students’ also had improvements in their self-perceived competence and confidence in palliative care provision, though this was not statistically significant.Student nurses in receipt of palliative care education were able to transfer their learning to practice. They reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. Notwithstanding this positive finding, some factors, related to the student themselves, the qualified nurses, the practice setting or the patient and family, were found to negatively impact on the learning transfer process. The students generally felt that the course was an ‘eye opener’ and met with their expectations. They perceived the major strength of the course was the use of interactive and stimulating educational strategies, but felt that the absence of a supervised clinical practice component with dying patients was a major weakness of this course. Conclusion There is a need for a curriculum revision to include palliative care content in the preregistration nurse training curricula of the pilot University. This seems to reflect a general need by all preregistration nursing students in this country. This study’s findings reveal the need to advocate for palliative care education and practice policies, and for adequately preparing clinical placement sites for nursing students’ palliative care learning and transfer of learning in Cameroon, and possibly other resource poor settings