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Background: Virtual reality immersive environments have been shown to be effective in medical teaching. Our university hospital received funding from our deanery to film teaching videos with a 360 degree camera. Aims: Evaluate whether Virtual Reality is an effective teaching environment. Virtual Reality headsets were set up for medical students who rotated through Velindre Cancer Hospital’s Palliative Care department. Methods: Students watched a 27 minute video on nausea & vomiting in palliative care settings in a virtual tutorial space. They subsequently viewed a radiotherapy treatment experience. Results: Of the 72 medical students who participated, 70 found the experience comfortable, with 2 students stating they found it uncomfortable (tight headset, blurry visuals). Numerical scoring on ability to concentrate in VR from 0-10 (0=worst, 10=best) scored an average of 8.44 (range 7-10). Asked whether this format suited their learning style, average score was 8.31 (range 6-10). 97.2% (n=70) students stated that they would recommend this form of learning to a colleague, with 1 student saying he/she would not recommend and 1 student stating he/she was unsure. Students left positive & negative free text comments which helped frame future needs in this emerging area and will be presented. Discussion: This study indicates that there is room for exploring new ways of delivering teaching and expanding it more widely in palliative care, but also provides feedback on areas that need further careful attention. Comments from students included: “Might have been the novelty factor but I learned more from this 20 minute VR thing than I have from many lectures” Summary: The project has proved so popular in medical student feedback that the VR experience is now available on Youtube & has been expanded to routine teaching. It has been viewed worldwide incl Africa, so this format of teaching could prove valuable and promising in its potential for global reach.

Background: Palliative care exists in diverse healthcare settings. Nurses play a crucial role in its provision. Different levels of palliative care provision and education have been recognized in the literature. Therefore, nurses need a set of various competencies to provide high-quality palliative care. Aims: To systematically synthesize the empirical evidence of (1) nursing competencies needed in palliative care and (2) whether these competencies differ across the level of palliative care. Design: Systematic integrative review with thematic synthesis. Prospero: CRD42018114869. Data sources: CINAHL, PubMed, Academic Search Premier, Scopus and Medic databases. Studies on nursing competencies linked to palliative care reported in English, Swedish, Finnish, Spanish, Portuguese or German were considered. Search terms: ‘palliative care or hospice care or end-of-life care’, ‘competency or professional competence or skills’ and ‘nursing’. Articles were independently screened and reviewed by two researchers. Quality appraisal was conducted following Hawker’s criteria. Results: A total of 7454 articles were retrieved, 21 articles were included in the analysis. Six diverse nursing competencies dimensions, namely leadership, communication, collaboration, clinical, ethico-legal and psycho-social and spiritual were identified. The reports rarely defined the level of palliative care and covered a wide array of healthcare settings. Conclusion: Nurses need a wide range of competencies to provide quality palliative care. Few studies focused on which competencies are relevant to a specific level of palliative care. Further research is needed to systematize the nursing competencies and define which nursing competencies are central for different levels of palliative care to enhance palliative care development, education and practice.

Background: Communication is present in all encounters in care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not lea ...

Introduction Antimicrobial resistance (AMR) is a challenging global and public health issue, raising bioethical challenges, considerations and strategies. Objectives This research protocol presents a conceptual model leading to formulating an empirically based bioethics framework for antibiotic use, AMR and designing ethically robust strategies to protect human health. Methods Mixed methods research will be used and operationalized into five substudies. The bioethical framework will encompass and integrate two theoretical models: global bioethics and ethical decision-making. Results Being a study protocol, this article reports on planned and ongoing research. Conclusions Based on data collection, future findings and using a comprehensive, integrative, evidence-based approach, a step-by-step bioethical framework will be developed for (i) responsible use of antibiotics in healthcare and (ii) design of strategies to decrease AMR. This will entail the analysis and interpretation of approaches from several bioethical theories, including deontological and consequentialist approaches, and the implications of uncertainty to these approaches.

Objective: The Bioethics Teaching in Secondary Education (Project BEST) aims to promote the teaching of bioethics in secondary schools. This paper describes the development and implementation of the programme in Portugal. Design: Programme development involved two main tasks: (1) using the learning tools previously developed by the US Northwest Association of Biomedical Research and the Council of Europe and (2) applying the project in classrooms, conducting lectures on bioethics for students and teachers, and then using the previously developed learning tools. Setting: 32 schools representing the most densely populated regions of Portugal. Methods: Two surveys, based on previously validated measures, were used to evaluate the project. Results: The surveys were answered by the 179 students and 16 teachers attending a conference held by the project, which concluded the project’s implementation phase. The findings point to the positive impact of this project. Conclusion: Based on evidence collected to date, it is clear that (1) students can develop reflective skills using this kind of an approach, (2) the project is well suited to secondary school syllabuses and to the age range of students from secondary schools, and (3) the teaching of values should start earlier at school, thereby helping young people develop a critical perspective on problems linked to scientific development and its implications on human health.

Background: Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care. Aim: To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration. Design: A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676). Data sources: Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.’s tool was used for quality appraisal. Results: A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients’ comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units. Conclusion: This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.

Background: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations” (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. Objectives: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses’ current end-of-life care practices. Design: Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. Findings: All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Discussion: Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients’ preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. Conclusion: While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses’ involvement and practices in end-of-life decision-making.

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