St Columba's Hospice EDINBURGH QUEEN MARGARET UNIVERSITY ST COLUMBA S HOSPICE MSc IN PALLIATIVE CARE For health and social care practitioners working with patients and families requiring palliative care Information for Students June 2009 St Columba s Hospice
MSc in Palliative Care An interdisciplinary programme for health and social care practitioners working with patients and families requiring palliative care Introduction The MSc in Palliative Care is a postgraduate, modular and interdisciplinary programme of studies at level 11 in the Scottish Credit and Qualification Framework. It is designed to prepare experienced practitioners from all disciplines involved in the care of patients and families in the palliative care phase of illness for advanced roles in specialist palliative care. These practitioners may be in posts involving clinical practice, research, management and/or education. The programme has been devised by an interdisciplinary planning team. Students may undertake the MSc in Palliative Care or exit with a Postgraduate Diploma in Palliative Care or Postgraduate Certificate in Palliative Care. Single modules may be taken as associate students for Continuing Professional Development. Within the programme there is an option to undertake modules in teaching and learning that meet the requirements for membership of the Higher Education Academy (HEA) and, in the case of nurses, the requirements for registration with the Nursing and Midwifery Council [NMC] as a nurse teacher. The programme is run in partnership with Queen Margaret University. The collaboration between the Hospice and QMU has lasted for more than a decade. 1
PROGRAMME PHILOSOPHY, AIMS AND OUTCOMES Programme Philosophy The philosophy is based on the following beliefs: Palliative care is: an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual (World Health Organisation cited in Sepulveda et al 2002). At its best palliative care is delivered through collaborative working, where the patient and family are part of the interdisciplinary team. Interdisciplinary education enables practitioners to learn with, from and about one another in a dynamic and interactive way that can be translated into collaborative working in practice. The programme encourages students from the various disciplines and care settings to make explicit their values and perspectives, enabling them to question and defend assumptions and to interpret and learn from experience. The student is at the centre of learning and the teacher acts as a facilitator and partner in learning. The mature practitioner brings to postgraduate study a wealth of knowledge, skills and experience that can be reflected upon, shared with peers and used as a basis for personal, professional and organisational development. Masters level study emphasises the strengthening of cognitive abilities and the critical understanding of the knowledge base for specialist palliative care. Masters level practitioners are able to practise in unpredictable professional contexts. They are able to participate and provide leadership in clinical and ethical decision-making where the issues are not always addressed by current protocols or professional codes. Learning/ teaching and assessment strategies should promote a critical approach to research and the capacity to reflect analytically on practice and integrate these, thus transforming professional practice. 2
Programme Aims: To facilitate experienced practitioners from all the disciplines involved in the interdisciplinary team to effectively and collaboratively apply research, theory, the principles of good practice and a specialist knowledge base to enhance the quality of care for patients and families with complex palliative care needs. To engage experienced palliative care practitioners of all disciplines in critical reflection on palliative care practice and in independent study for life long learning To advance specialist palliative care practice in the context of the practitioner s workplace and beyond Programme Outcomes MSc in Palliative Care Learning Outcomes On successful completion of the MSc in Palliative Care programme the practitioner will be able, through practice, to demonstrate: 1. A critical knowledge of the philosophy and principles of palliative care and a proactive approach to the political context in which it takes place 2. A critical knowledge of how strategies for research and enquiry are used to create an evidence base for palliative care practice 3. A creative and evidence-based contribution to the interdisciplinary team s response to the physical, psychological, social and spiritual issues experienced by patients and families in the palliative care phase of illness 4. Advanced communication skills for initiating, maintaining and concluding a therapeutic relationship with patients and families and for maximising effective team working 5. Critical reflection on practice as a means of life long learning and professional development 6. Facilitation of others to develop quality care for patients and families at the end of life through enhanced skills in key areas such as practice development, research, decision-making, education, leadership 7. The ability to plan and execute a significant work-based learning project relevant to the individual s palliative care context and which contributes to advancing palliative care practice 3
Postgraduate Diploma in Palliative Care Learning Outcomes On successful completion of the Postgraduate Diploma in Palliative Care, the practitioner will be able to demonstrate achievement of learning outcomes 1-6. Postgraduate Certificate in Palliative Care Learning Outcomes On successful completion of the Postgraduate Certificate in Palliative Care, the practitioner will be able to demonstrate achievement of learning outcomes 1-5. 3. PROGRAMME STRUCTURE The structure of the Postgraduate Certificate The Postgraduate Certificate in Palliative Care is achieved by successful completion of the equivalent of 4 modules at M level (60 credits at SCQF 11). Table 1 sets out the structure for the Postgraduate Certificate. Table 1 : Postgraduate Certificate Structure All students do the three core specialist modules (Table 4) PLUS Students with a clinical role do one of the specialist symptom control modules (Table 6) Students with a non-clinical role do either: A core research module* (Table 5) or A non-specialist elective module* (Table 7) * Where core research or non-specialist modules are selected, the student must focus their assignment on a palliative care topic. 4
The structure of the Postgraduate Diploma The Postgraduate Diploma in Palliative Care is achieved by successful completion of the equivalent of 8 modules at M level (120 credits at SCQF 11). Within the Postgraduate Diploma students may opt to undertake as non-specialist electives a series of education modules imported from the MSc in Professional Education that meet the requirements for membership of the HEA and, in the case of nurses, the requirements for registration with the NMC as a nurse teacher. Table 2 sets out the Postgraduate Diploma structure. Table 2 : Postgraduate Diploma Structure All students do: the three core specialist modules (Table 4) one core research module * (but may choose to do two) (Table 5) Students with a clinical role do one of the specialist symptom control modules (but may choose to do two) (Table 6) Students with a non-clinical role All students choose modules from the non-specialist electives to complete their 8 modules for the Postgraduate Diploma level (Table 7) * Where core research or non-specialist modules are selected, the student must focus their assignment on a palliative care topic. 5
The structure of the MSc in Palliative Care The MSc in Palliative Care will be attained by successful completion of the equivalent of 12 M level modules (180 credits at SCQF 11). Within the MSc programme students may opt to undertake as non-specialist electives a series of education modules imported from the MSc in Professional Education that meet the requirements for membership of the HEA and, in the case of nurses, the requirements for registration with the NMC as a nurse teacher. The structure of the MSc is set out in Table 3 Table 3 : MSc in Palliative Care Structure All students do the three core specialist modules (Table 4) one core research module * (but may choose to do two) (Table 5) Students with a clinical role do one of the specialist symptom control modules (but may choose to do two) (Table 6) Students with a non-clinical role All students choose modules from the non-specialist electives to complete the 8 modules of the Postgraduate Diploma level (Table 7) All students complete the 4 specialist work-based learning project modules Advancing Palliative Care Practice: Work Based Learning. This may not be submitted until all other components of the programme are successfully completed. * Where core research or non-specialist modules are selected, the student must focus their assignment on a palliative care topic. 6
Table 4: Core Specialist Modules The Core Specialist Modules Shadows & Horizons: Advancing Palliative Care Practice Supporting Patients and Families in Palliative Care: A Team Approach Developing Advanced Communication Skills for Palliative Care Table 5: Core Research Modules Core Research Module (from QMU array) Evidence-based Health and Social Care 1 and 2 Research Methods 1 (Delivered on Web-CT) NB There may be some changes to this for 2009/10 Table 6: Specialist Symptom Control Modules Specialist Symptom Control Modules An Integrated Approach to Breathlessness in Palliative Care Working with People with Complex Pain and Symptoms 7
Specialist Modules (Core, Symptom Control): The specialist modules reflect the key topic areas of palliative care pain and symptom control, psychosocial and spiritual care, communication and ethical issues at the end of life. The ability to critique current practice and to continuously scan the horizons for innovation and change are also viewed as integral to a palliative care curriculum. The listed specialist modules address these issues. Ethics are addressed in relation to each module. There is one area of the programme where a distinction is drawn between students with a clinical and non-clinical role. Only those with a clinical role are required to do a symptom control module. The topic of suffering/ total pain encompassing the physical, psychological, social and spiritual aspects of pain, however, is included in the core module Supporting Patients and Families in Palliative Care: A Team Approach. Core Research Modules: It is a requirement that students do one research module, but students may opt to do two research modules. A range of appropriate research methods modules are presented to increase student choice in this area in relation to module content, mode of delivery, location and timetabling. The modules entitled Research Methods (1) and Evidence Based Health & Social Care-1 are designed to provide students with a broad understanding of a range of research methodologies and their use. They also provide opportunities to enhance IT and bibliographic skills and skills in the critical appraisal of published research. Students may opt to do Evidence-based Health & Social Care-2 which further addresses data collection and analysis. Non-Specialist Elective Modules from the QMU Array: As well as the key palliative care topics identified, research, education, management, teamwork are highlighted as curriculum areas for advanced practice. It is through teaching, research dissemination and change management that specialist and advanced practitioners influence practice. Students can select optional modules from the QMU Postgraduate portfolio subject to approval by the Programme Leader. Examples of the elective modules are set out by themes in table 7. The elective modules allow the student to develop their palliative care practice in one or more of these themes. The electives are offered in line with the intention to increase flexibility as the programme progresses. Within the electives there is the possibility beyond postgraduate certificate level of developing a theme. For example in terms of clinical practice development, students may opt to do a double module in pain assessment and/ or pain management. Alternatively the student may elect to do some education modules. It is possible in this programme to build in education modules from the MSc in Professional Education that meet the requirements for membership of the HEA and, in the case of nurses, the 8
requirements for registration with the NMC as a nurse teacher. A student, however, may wish to choose modules from a number of different themes. Table 7: Examples of Non Specialist Electives from the QMU array Clinical Practice Education Leadership/ Management Approaches to Evaluation and Support of Clinical Judgement Developing Professional Practice: Work-Based Learning (single or double) Perspectives in Family and Community Health Measurement and Assessment of Pain and its Effects (double) Practice Development* Primary Care Working Together Creatively Working Together in the Management of Chronic Pain (double) Within the education theme, students may elect to do the double module on Education in Action (double) Following that, if they wish to be accredited with the Higher Education Academy they need to do 2 further modules: Developing Professional Education Work-based Learning OR Curriculum Development PLUS An elective module from the MSc in Professional Education array Developing Professional Practice: Work-Based Learning (single or double) Managing Change in Health Care (delivered by Web- CT) Practice Development Quality in Health Care (delivered by Web-CT) Primary Care Working Together Creatively NB There may be some changes to this list of electives for 2009/10 Specialist Work-based Learning Project Modules: The specialist work-based learning project is the culmination of the programme and is designed to promote the integration and synthesis of theory with practice. The project aims to: enable the student to claim academic credit for planning, implementing, evaluating and disseminating an original and significant work-based project which contributes to advancing palliative care engage the student in study which demands a professional and interdisciplinary approach, academic rigour, independence and self direction. 9
This approach to the final project ensures that the focus is on the learner at the hub of a process of work-based learning that involves employers, practitioners and education providers in a tripartite partnership. This approach is intended to maximise opportunities for learning and professional development in the workplace that can be accredited academically. Work-based learning enables different students to take different pathways depending on the context in which they practise palliative care and the discipline they represent. It also ensures that the context of study is the interdisciplinary team and promotes the affective dimension of learning in palliative care through interaction with patients and carers. All of this is crucial to ensuring that practitioners are offered a learning experience that facilitates the development of the cognitive, affective and psychomotor skills and knowledge needed to advance palliative care practice. The Student Experience of Programme Structure Tables and text on programme structure do not always give a real sense of the student experience. Therefore some possible student experiences are indicated below as case studies. Case Study 1 Alison is a specialist physiotherapist, educated to degree level. She works full time in an Oncology Unit. She is keen to study at masters level and applies for the MSc in Palliative Care. In years 1 and 2 she studies the three core specialist modules Shadows and Horizons: Advancing Palliative Care Practice, Developing Advanced Communication Skills in Palliative Care and Supporting the Patient and Family in Palliative Care: A Team Approach and she opts to do the specialist symptom control module An Integrated Approach to Breathlessness in Palliative Care. In year 3 Alison does a core Research Methods 1 module and the Practice Development module from the QMU array, focussing her assignments on topics relevant to palliative care. In year 4, continuing with a clinical practice theme, she does the double module Working Together in the Management of Chronic Pain, doing an assignment on the use of TENS in palliative care. Her academic progress has been excellent and Alison is encouraged by the teaching team and her manager to complete the work-based learning project for the MSc in Palliative Care. For this she builds in depth and breadth on work started on TENS in palliative care in an earlier module. 10
Case Study 2 David is an experienced Social Worker, educated to degree level, who works part time in a Hospice. As well as his social work role, he is asked regularly to teach about palliative care on degree level programmes in the local University and at the Hospice. He sometimes has social work students placed with him. This is a role that he enjoys. He wishes to study at postgraduate level and applies for this programme. In his first year David does 2 core specialist modules (Shadows and Horizons: Advancing Palliative Care Practice and Supporting the Patient and Family in Palliative Care: A Team Approach). The following year he undertakes the third core specialist module on Developing Advanced Communication Skills in Palliative Care and does a core research module, tailoring his assignment to a palliative care topic. Although David could exit at Postgraduate Certificate level he decides to proceed developing an education theme. Over the next two years he does four modules from the MSc in Professional Education. Again he focuses his assignments on palliative care teaching and learning. This allows him to exit with a Postgraduate Diploma in Palliative Care and can apply for HEA membership. Case Study 3 Fiona is an experienced district nurse, who undertook a degree in community nursing some years ago. She wishes to do a postgraduate level module for CPD. She does the Working with People with Complex Pain and Symptoms. On completion of this and having put her toe in the water she does the Developing Advanced Communication Skills in Palliative Care module the following semester. Having come this far she enrols on the masters programme and completes the other two core specialist modules. Although she has plans to continue, family circumstances are such that she decides to exit with a Postgraduate Certificate in Palliative Care. Case Study 4 Simon is a GP and is studying for the MSc in Primary Care. Recently he has had some particularly complex palliative care patients and opts to do the module on Working with People with Complex Pain and Other Symptoms as an elective within his programme. 11
Mode of Study and Programme Length The programme is offered part-time. Modules are offered in a variety of ways: In a series of study days in normal working hours on week-days In concentrated blocks of full time study By work-based learning By Web-CT The minimum time to complete the programme is two years, the maximum 7 years. Students taking the Postgraduate Certificate part-time will normally do so over 2 years. Module Availability and Viability Modules are offered subject to demand and viability. They are not, therefore, necessarily offered every year. Progress through Programme The programme leader advises all students regarding their module choices as they progress through their programme of study 4. TEACHING, LEARNING and ASSESSMENT APPROACHES Teaching approaches will include group-focused discussions, challenge and debate, collaborative case study analysis, reflective debriefings, skills rehearsal, simulated role play, interactive lectures and independent study. Interactive learning methods, based around each individual s knowledge and experience, contribute to the development of an integrated, interdisciplinary and reflective approach to solving complex problems. The sharing of knowledge by participants from their diverse professional perspectives throughout the programme aims to focus and extend experience and understanding of palliative care practice and of postgraduate level study. In addition to traditional teaching and learning strategies, Web CT is being introduced into some modules, usually as a component within a blended model. Assessment methods include critical commentary and reflection on practice, selfand tutor- assessment of taped interviews, case study analyses, poster presentations, portfolios, use of reflective diary. 5. SUPPORT FOR STUDENTS AND THEIR LEARNING The postgraduate nature of the programme demands that the student s work is predominantly independent. The programme team, however, fully appreciate the importance of a strong support structure. The Hospice lecturers ensure that students are informed of that structure and encourage them to use it. Students are allocated one of the Hospice lecturers as personal academic tutor for ongoing 12
academic support and to discuss any issues likely to affect academic progress. Students undertaking the final work-based learning project have both an academic supervisor and a work-place mentor. 6. ARRANGEMENTS FOR ADMISSION These are set out in more detail in the programme documents, but in general terms these are: Degree/ professional equivalent. Evidence of recent academic study. 2 years post qualification/ registration experience Access to a learning environment that offers experience of working with palliative care patients and families Individual prospective students may wish to discuss these with the programme leader. 7. RESOURCES The programme is organised so that specialist modules are taught at St Columba s Hospice and non-specialist modules are taught at QMU. The Hospice has a senior nurse lecturer and a nurse lecturer. Many members of the interdisciplinary team contribute to the teaching team for specialist modules. Non-specialist modules are taught and assessed by QMU staff. The Hospice lecturers are supported by a dedicated personal assistant. St Columba s Hospice has excellent teaching and learning accommodation and equipment. There is a large purpose built lecture theatre and two newly built seminar rooms (with sea-views!) Multi media projection is available in all of these. There is a well-stocked specialist palliative care library, which houses up-to-date books, reference material and an excellent range of relevant journals and, in particular, specialist palliative care journals. Reference Sepulveda C Marlin A Yoshida T et al (2002) Palliative Care: The World Health Organisation s Global Perspective Journal of Pain and Symptom Management 24 (2) 91-96 13