Ever since Dame Cicely Saunders founded the modern hospice movement, nurses have always been an essential part of palliative care. The palliative care nurse role is evolving, and part of this evolution has been in regulation, education and in establishing core competencies for what a nurse needs to demonstrate to effectively carry out this role. Not all European countries have these competencies though, and it is always good news when they are adopted by countries for the first time. Today, Marisa de la Rica Escuín, Doctor of Nursing Practice at the University of Zaragoza, announces a significant development in Spain.
Early in 2006, nurses who were members of the multidisciplinary Spanish society of Palliative Care (SECPAL) identified the importance of promoting the development and visibility of the role of the palliative care nursing professional. This was particularly important as there was no specific competency framework or formal regulated training for palliative care nurses in Spain, unlike countries such as the United Kingdom, Canada, the United States and Australia. As a result of this effort to develop this area of knowledge and training, the Spanish Association of Palliative Care Nursing (AECPAL) was founded in 2006, federated with SECPAL, maintaining the autonomous nature of the nursing profession as well as the interdisciplinary nature that characterises palliative care.
In 2001, the Spanish National Palliative Care Plan defined for the first time the basis for the palliative care model. This plan included general principles for public programmes of palliative care to be implemented into the different regions of Spain. After this, since 2007, the Palliative Care Strategy of the National Health System stated, among other recommendations, which level of competencies were needed for future nurses to work in this field, including basic into undergraduate in nursing and advanced into postgraduate specific training in palliative care. However, to date, there is no consensus on the roadmap to implement such specialised training.
One of the essential objectives declared by AECPAL was to develop its own competencies framework  which includes a specific training program for general competencies (for a basic understanding of palliative care) and then specific competencies for advanced level of intervention. These two levels offer a training trajectory for palliative care nurses, which should connect to the corresponding accreditation of these healthcare professionals, as a path to excellence in the professional practice of palliative care nursing. In the search for a competency framework based on professional consensus, the research project which served as the basis for this framework was published in 2021[2,3].
As a result of all this work, we are pleased to present the Framework of Action for Nurses in the field of Palliative Care, a consensus document led by AECPAL and the General Council of Nursing of Spain. This framework facilitates the standardisation of the body of knowledge in nursing palliative care in Spain, both in undergraduate and postgraduate education; it advocates for patients to have equity of access to high quality palliative care; and it promotes the development of nursing ‘quality of care’ indicators for the continuing assessment and improvement of the healthcare system.
Moreover, this framework for palliative care nurses should be incorporated into academic, institutional, and organisational settings in accordance with social care and healthcare needs of patients with advanced chronic diseases and their families. The competency framework will allow:
- academic and government programs to have a roadmap to certify nurses who meet these palliative care nursing competencies
- guidance for education programmes and a reference for educators
- enhancement of the competency profile in the palliative care nursing profession.
We hope that this framework will improve the experience of all patients who are facing their last phase of life, and their families. We believe it will also help palliative care nurses, and all the team, to feel more satisfied and safer as practitioners due to having these competencies while working in complex situations in palliative care. We know there is much work to do to improve access to and quality of palliative care in Spain and we feel our consensus document is a very significant step forward.
1 AECPAL. ‘Competencias enfermeras en Cuidados Paliativos’, 2013.
2 ‘Recommendations about training in palliative care in nursing degree of the Spanish PC Nurses Association’, 2019.
3 Guanter-Peris,L et al. ‘Spanish Palliative Care Nurses’ Degree of Acceptance of a Proposal for Nursing Competencies in Palliative Care’.Journal of Palliative Care, 2021.
4 ‘Marco de Actuación de las enfermeras en el ambito de CP’, 2022.
Links and resources
- Read the Spanish Framework of Action for Nurses in the field of Palliative Care framework here (English version) or Spanish version here.
- Find out more about the ‘Training recommendations for palliative care in nursing degrees’ from the Spanish Palliative Care Nurses Association’ here.
- The EAPC has a Task Force on Innovation in Nurse Education – find out more here.
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