Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Nurse Educ Today. 2023 Jul;126:105812. doi: 10.1016/j.nedt.2023.105812. Epub 2023 Apr 12.
Integrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap.
To establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools.
We used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen's EPA Quality rubric. Data analysis was performed via modes and quartile deviations.
The following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen's EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool.
The development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.
综合即时尸检和急性丧亲护理可以减轻失去亲人带来的情绪困扰，但有效的护理提供仍然不足。因此，在临终关怀教育中培养具备此类技能的护理学生至关重要，而可委托的专业活动（EPAs）提供了弥补这一差距的潜力。
建立与即时尸检和急性丧亲护理相关的 EPAs，并采用七类描述方法确定 EPAs、里程碑和评估工具。
我们使用改良德尔菲法和四步共识建立方法：i）根据文献回顾和临床经验，确定与即时尸检和急性丧亲护理相关的可能 EPA 项目清单；ii）选择专家小组；iii）汇总、审查和修改 EPA；iv）使用皇后 EPA 质量评估表评估 EPA 质量。数据分析采用模式和四分位偏差。
确定了以下四个主要的 EPA 组成部分：i）文化和宗教仪式评估；ii）死亡准备；iii）尸检护理；iv）急性丧亲护理。确定了三个高度相关的基本能力：一般临床技能、沟通和团队合作能力以及关怀。经过三轮调查达成共识。问卷回复率达到 100%。在第三轮中，所有项目都得到了>95%的小组成员的 4 或 5 分，并满足四分位偏差的截止分数<0.6，表明建立了高度共识。皇后 EPA 质量评估表的平均得分为 62.5，平均项目得分为 4.46，高于 4.07 的截止分数。制定了 EPA 的三个主要部分：任务描述、里程碑和评估工具。
即时尸检和急性丧亲护理的 EPA 评估的制定可能指导护理课程规划，以弥合能力与临床实践之间的差距。
