Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School Center for Palliative Care, Boston, Massachusetts, USA.
J Palliat Med. 2021 Sep;24(10):1436-1442. doi: 10.1089/jpm.2021.0273. Epub 2021 Jul 9.
Opportunities for advanced practice registered nurses (APRNs) to train for specialty palliative care practice are insufficient to meet workforce needs. Graduate nursing programs in the United States do not have uniform or required curricula in palliative and end-of-life care of the seriously ill. In clinical practice, APRNs acquire palliative care skills by a mix of on-the-job experience, self-study, and continuing education. While physician colleagues can pursue post-residency training in one of 156 accredited hospice and palliative medicine fellowships, there are fewer than a dozen fellowships for APRNs, each training between one and three nurse fellows for specialty palliative care practice. This disparity slows the pipeline of palliative nursing experts and leaders, taxes employers with significant training duties, and results in an APRN workforce without uniform training. There are grass roots initiatives-often by non-nursing educators-to adapt existing physician and interprofessional fellowships for nurse learners, both in palliative care and other specialties. While these efforts help meet staffing needs and promote interprofessionalism, these programs are built upon medical curricula and competencies rather than grounding from a nursing framework. Nursing fellowship directors may not have the same administrative support, protected nonclinical time, funding, or access to nursing mentors and faculty afforded to their medical counterparts. This article provides a blueprint for clinician educators from nursing or non-nursing disciplines, who want to develop or refine training programs for APRNs that adhere to palliative nursing standards and offer a curriculum integrated with supervised practice and mentorship.
高级执业注册护士（APRNs）接受专业姑息治疗实践培训的机会不足，无法满足劳动力需求。美国的研究生护理课程在重病患者的姑息治疗和临终关怀方面没有统一或必需的课程。在临床实践中，APRNs 通过在职经验、自学和继续教育的混合方式获得姑息治疗技能。虽然医生同事可以在 156 个经认可的姑息治疗和临终关怀医学奖学金中的一个进行住院后培训，但只有不到十几个奖学金适用于 APRN，每个奖学金培训一到三名护士学员进行专业姑息治疗实践。这种差距减缓了姑息护理专家和领导者的培养速度，给雇主带来了巨大的培训负担，导致 APRN 劳动力没有统一的培训。有一些基层举措——通常是非护理教育者——旨在调整现有的医师和跨专业奖学金，以适应姑息治疗和其他专业的护士学习者。虽然这些努力有助于满足人员配备需求并促进跨专业主义，但这些计划是基于医学课程和能力构建的，而不是基于护理框架。护理奖学金主任可能没有与他们的医学同行相同的行政支持、受保护的非临床时间、资金或获得护理导师和教师的机会。本文为来自护理或非护理学科的临床教育者提供了蓝图，他们希望为 APRN 开发或完善培训计划，这些计划符合姑息护理标准，并提供与监督实践和指导相结合的课程。
