Evaluation of Community Health Service Center Training Base by Shanghai Hospice Care Competent Nurse Trainees: A Qualitative Study

Evaluation of Community Health Service Center Training Base by Shanghai Hospice Care Competent Nurse Trainees: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Community Health Service Center Training Base by Shanghai Hospice Care Competent Nurse Trainees: A Qualitative Study Yanjun Huang, Gan Wang, Xinyu Li, Yuezhong Tang, Zhijie Yu, Wen Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5475575/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 May, 2026 Read the published version in BMC Palliative Care → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Enhancing the training of competent nurses in hospice care helps improve the quality of life for end-of-life care patients. This study aims to improve the effectiveness and quality of the training by exploring the attitudes of trained nurses in community health service centers towards the content and methods of the program. Methods: We conducted semi-structured interviews with 15 eligible nurses specializing in hospice care from seven administrative districts in Shanghai between September and November 2024, using Colaizzi 7 method for analysis. Results: The structure of the interview mainly revolves 4 topics, which are: Operational and Personalized Deficiencies in Course Content, Hospice Care Concept, Training Environment and Facilities, and Difficulties in Training Transfer for Hospice Care. The interviewee highlighted that while the project is practical and enhances professional competence and life values, it faces challenges in areas such as promotion opportunities, motivation mechanisms, implementation of humanistic care, nurses' willingness to learn about hospice care, salary adjustments, public awareness of hospice care, outpatient resource constraints, and the inclusion of emergency end-of-life care. These issues need to be addressed for improvement. Conclusions: This study delves into the perspectives and feedback of hospice care nursing trainees on the current training programs, offering insights into enhancing and optimizing end-of-life care training projects by analyzing the strengths and areas for improvement in teaching content, scheduling, and philosophies. The findings support driving improvements in end-of-life care-related programs, including curriculum optimization, skill enhancement, expanded training scope, and ongoing public education. Hospice Care Nurse Training Evaluation Qualitative Study Figures Figure 1 Background Hospice care is specialized, compassionate care, what addresses the needs of the patients and their families in the final stages of a terminal illness 1 . The founder of modern hospice care is Dame Cicely Saunders, a British nurse, social worker, and physician. She is credited with establishing the first modern hospice, St. Christopher's Hospice, in London in 1967. Saunders' work focused on providing compassionate care for terminally ill patients, addressing not only their physical symptoms but also their emotional, social, and spiritual needs 2 , 3 .As an emerging clinical discipline, over the past half-century, hospice care has seen significant development alongside hospice care in many countries. However, especially in comparison to developed countries, hospice care in China, starting relatively late, is still lags far behind 4 . To promote the development of hospice care, several documents related to hospice care were issued in mainland China in 2015, and the guidelines for hospice care and regulations for the management of hospice care centers were released by the government in 2017, However, hospice care in mainland China still lacks practical experience and systematic training programs. Previous literature has reported several factors contributing to the slow progress of hospice care in mainland China, including public misconceptions about end-of-life care based on traditional perceptions, a lack of systematic training, fear of medical disputes and legal actions, insufficient financial support and etc 5 – 7 . The rapid growth of the aging population and rising prevalence of chronic diseases in China are driving an accelerated demand for hospice care, posing substantial challenges to China's healthcare system. According to the data from the seventh national census of China, as of November 2020, the total population of mainland China was 141178 million people, with 19064 million people aged 65 and above, accounting for 13.5% of the total population 8 . Population aging leads to a rapid rise in demand for medical services, particularly for hospice care in terminal stages. Elderly people often face various symptoms such as pain, difficulty breathing, nausea, etc. in the final stages of their life, requiring specialized pain management and symptom control. Hospice care addresses these needs by prioritizing comprehensive pain and symptom control. Moreover, it gives emotional and psychological support, allowing patients to experience less distress in their final days and assists families in better planning for the future 3 , 9 .China now remains more than 200 hospitals and institutions providing hospice care services 10 . The growing aging population has further driven the demand for hospice care among geriatric patients 11 . The demand for hospice care in China is growing, yet the current development in this field remains insufficient and outdated. Therefore, first and foremost, it is crucial to cultivate professional and competent nurses in hospice care. To address the training demand, Shanghai Nursing Association launched the "Hospice Care Competent Nurse Practical Training Base Project" in 2023. On the one hand, it aims to identify professionals who can teach knowledge and skills in hospice care. On the other hand, through the construction of practical training bases, it aims to standardize teaching management and provide a comprehensive learning and development environment for competent nurses in hospice care, ensuring that they can acquire the necessary knowledge, skills, and experience to provide high-quality services. The Community Practical Training Base for Competent Nurses in Hospice Care based in Shanghai, where this research is located, was approved by the Shanghai Nursing Association in 2024 and has successfully completed two batches of four training sessions for competent nurses in hospice care. To improve the curriculum and enhance the quality of teaching at the training base, the research team conducted semi-structured interviews with 15 nurses who participated in the hospice care training at the base. The purpose of these interviews was to assess the quality of teaching at the community-based terminal care competent nurse practice training base, ensuring that the educational content and methods meet the specific needs of the trainees, thereby enhancing the effectiveness and quality of the training. Methods Settings and participants We conducted semi-structured interviews with 15 eligible nurses specializing in hospice care from seven administrative districts in Shanghai between September and November 2024. The criteria for being eligible for participation included: 1. had to be aged 18 years older; 2. undergraduate or master's degree students in nursing studies; 3. had at least 5 years clinical experience. Data Collection Semi-structured interviews were used for data collection. Based on a review of the literature and the research objectives, the research team developed an interview outline. Interviews were conducted in a conference room on the last day of the training. Before the interviews, participants were informed of the research purpose and discussion topics, adhering to confidentiality principles. Each interview was limited to 45 minutes. The interviews were recorded using a recording device, and two researchers took notes on the key points and non-verbal information (such as expressions, tone, and gestures). Interview Data Analysis and Quality Control Within 24 hours after the interviews, the recordings were transcribed into written data, and the interview records were coded. The Colaizzi 7 analysis method was used to analyze the interview data: carefully read all the materials; extract significant statements; code recurring viewpoints; aggregate the coded viewpoints; write a detailed, complete description; identify similar viewpoints; and return to participants for verification. To ensure the authenticity and reliability of the interview data, leading questions were avoided, interviewers refrained from expressing personal opinions, and participants were encouraged to provide details, with timely clarifications and confirmations of their viewpoints. Training Base and Project Introduction The Community Health Service Center of Xuhui District, Fudan University Shanghai Medical College (referred to as "the Center"), registered its hospice care department in March 2012 and began providing services.The Center adheres to a service philosophy that combines medical care with humanistic care, collaborating with multiple educational institutions and academic organizations. It has established several teaching and practice bases, including the Demonstration Base for hospice Care of the China Life Care Association, the National Caring Nursing Project Construction Base, the Medical Social Work Practice Base of the School of Social Development at Shanghai University, the Practice Base of the Shanghai Medical Ethics Association, and the Professional Nursing Master's Practice Base at Soochow University, among others. In 2023, the Center's Hospice Care Department became one of the first training bases for competent hospice nurses recognized by the Shanghai Nursing Association. The hospice care team at the center applied the multi-professional team service model to teaching. Courses were carefully designed based on the training outline from the Shanghai Nursing Society. The nursing department had established a specialized nurse training committee to formulate relevant management regulations and standards, teaching plans, and to review the qualifications of teaching staff. The training involved two full-time doctors, six full-time nurses, and one medical social worker from the hospice care team, along with instructors from the Wanqing Foundation and the Hand-in-Hand Life Care Development Center. In the practical training process, the base adopted various training methods such as core courses, special lectures, case analysis, group discussions, workshops, and hands-on practice. For example, simulated family meetings were conducted using a multi-team collaboration model involving family members, healthcare professionals, social workers, and ethicists to collectively discuss the patient's treatment and care plan. By simulating real scenarios, this approach helped trainees better prepare for and respond to actual family meetings, ensuring that patients and their families received appropriate support and decision-making guidance at critical moments. Building on the training provided by the Shanghai Nursing Association and integrating the base's unique characteristics, the curriculum included topics such as life education, parallel medical record writing, the information technology development of hospice care centers, and aromatic care. At the end of the training, an assessment was conducted for the trainees, focusing on estimating survival time and relevant theoretical knowledge of hospice care. This assessment not only reinforced the trainees' professional skills but also deepened their understanding of the importance of dignity and the weight of life. The training was divided into four phases: 1. Core courses in hospice care; 2. Practical experience in hospice care wards; 3. Tours of the center's facilities; 4. Home-based hospice care practice (Supplementary material 1). Results Characteristics of participants The 15 selected participants are from various districts of Shanghai, and they participated in community hospice care base training. The selection criteria include: 1. Being at least 18 years old; 2. Holding a bachelor's degree or above in nursing; 3. Having at least 5 years of clinical experience; 4. Currently working in hospice care-related fields. Participants are aged 26–49, primarily 30–45, with work experience ranging from 5 to 30 years, mostly over 10 years, distributed across multiple districts in Shanghai, covering departments such as outpatient, geriatrics, and oncology, mostly as general nurses, with a few holding positions such as head nurse or higher, all with bachelor's degrees or above (Table 1 ). Table 1 Demographic information of the interviewee Number Gender Age Years of Experience Work District Department Title Position Education Level N1 Female 26 5 Huangpu District Outpatient Staff Nurse N/A Bachelor's Degree N2 Female 45 25 Xuhui District Outpatient Head Nurse N/A Bachelor's Degree N3 Female 27 5 Xuhui District Geriatrics Staff Nurse N/A Bachelor's Degree N4 Female 36 14 Xuhui District Geriatrics Staff Nurse N/A Bachelor's Degree N5 Female 39 18 Yangpu District Oncology Head Nurse Ward Nurse Bachelor's Degree N6 Female 46 26 Yangpu District High Cadre Ward Head Nurse Ward Nurse Bachelor's Degree N7 Female 37 16 Yangpu District Geriatrics Head Nurse N/A Bachelor's Degree N8 Female 32 12 Putuo District Geriatrics Staff Nurse N/A Bachelor's Degree N9 Female 43 18 Pudong New District Oncology Head Nurse Ward Nurse Graduate Degree N10 Female 32 10 Pudong New District Emergency Staff Nurse N/A Bachelor's Degree N11 Female 34 9 Pudong New District Geriatrics Staff Nurse N/A Bachelor's Degree N12 Female 27 5 Pudong New District Geriatrics Staff Nurse N/A Bachelor's Degree N13 Female 33 11 Pudong New District Geriatrics Staff Nurse N/A Bachelor's Degree N14 Female 32 11 Baoshan District Geriatrics Head Nurse N/A Bachelor's Degree N15 Female 49 30 Chongming District Department of Nursing Head Nurse Deputy Director of Nursing Bachelor's Degree Participants' evaluation of hospice care training The structure of the interview mainly revolves 4 topics, which are: Operational and Personalized Deficiencies in Course Content, Hospice Care Concept, Training Environment and Facilities, and Difficulties in Training Transfer for Hospice Care (Fig. 1 ). Topic 1: Operational and Personalized Deficiencies in Course Content The curriculum demonstrates shortcomings in practicality and personalization. Content should be updated to reflect the latest developments in end-of-life care, integrating theory with practice to facilitate a more intuitive understanding and mastery among trainees. N2: “ Some participants found the full-day presence at the training site inconvenient. It is suggested that lectures and ward visits be scheduled separately—theoretical learning in the morning and practical sessions in the afternoon. Additionally, courses should be tailored to meet individual learner needs.” N8: “ The family meeting and nursing document writing sections were overly theoretical. It is recommended to incorporate practical exercises or educational videos, using real-life cases to make the content more visually and easily comprehensible.” N9: “ To better evaluate learning outcomes, it is suggested that each participant submit a written report summarizing their learning insights and takeaways at the end of the course.” N10: “ Some course content overlapped with previous theoretical sessions. It is recommended that family meeting and parallel case record courses be integrated to enhance continuity and practicality.” N15: “ When launching hospice care in non-central urban areas such as Chongming, the course content may need to be adjusted and improved based on regional characteristics to better adapt to the local actual conditions and cultural background.” There is room for improvement in hospice care practice training in areas such as grief counseling, pain assessment procedures, the value manifestation of multidisciplinary teams, and the promotion of practical care tools. N1: “ Grief counseling courses are very helpful, especially in providing valuable guidance and methods on how to help patients and their families navigate difficult times.” N2: “ It is recommended to integrate continuous pain assessment into pain management, eliminating the need for a separate form, thus saving time on assessment and documentation.” N7: “ Multidisciplinary team members often take on multiple roles in their daily work but may struggle to demonstrate their value. By learning, we can document the details of our daily work in parallel medical records, thereby better showcasing our professional value.” N10: “ The oral brush mentioned in the comfort care course is very practical. I just tried it and felt great, and I recorded a video of its use, which I believe can serve as a teaching resource.” The training schedule is reasonable, but some participants feel that the course content was not fully explored due to time constraints and hope for more opportunities to learn more knowledge and skills. N2: “ The training schedule is reasonable and relaxed, meeting the requirements of this training. There is good interaction between the teaching staff and participants, and an opportunity to reacquaint with each other, which helps to enhance the learning effect.” N7: “ Although the community has fewer medical resources compared to second and tertiary hospitals, we can focus more on humanistic care. The course content is good, but due to limited time, if it could be slightly expanded, we would have the opportunity to learn more knowledge and skills.” N8: “The course arrangement was very thoughtful, with a grand opening ceremony and everyone's name tags designed to add a formal touch to the learning. This format made the entire learning process feel ceremonial.” Topic 2: Hospice Care Concept The training deepened participants' understanding and perception of hospice care. However, some tertiary hospitals need to enhance their service content, particularly in terms of humanistic care and psychological support, and improve awareness of multi-professional team collaboration. N8: “ Due to personal experiences, I initially had a resistant attitude towards hospice care. Through the course, I gained a deeper understanding of life and death, no longer fearing to discuss the topic, and this transformation has had a profound impact on me.” N13: “ In tertiary hospitals, we focus more on symptom control, such as comfort care, with less emphasis on humanistic care and psychological support. Initially, I mistakenly thought that hospice care was just the job of nurses. Through learning, I realized that the team includes doctors, nurses, social workers, psychologists, volunteers, and other multi-professional personnel, which has changed my understanding.” Topic 3: Training Environment and Facilities The overall training environment is comfortable, but there are suggestions for improvements in small conference rooms and seating arrangements. Also, the convenience and functionality fineness of the nursing information system need to be enhanced, and can be learned from the higher-level training hospital's PAD login operation method. N5: “ The comfort of the environment is crucial, and I did not feel confined. Instead, the open and artistic space was refreshing and relaxing. Artworks combined with the theme of life showcased the sublimation of life. The humanistic atmosphere here makes one feel the dignity, peace, and serenity of life, perfectly aligned with respect for life. This experience made me reevaluate community hospitals.” N9: “ I think the training venue needs further improvement. If everyone sits closer in a smaller conference room, it will facilitate discussions and interactions, enhancing the learning effect. The convenience and functionality fineness of the nursing information system need to be improved: On one hand, the nursing information system can reduce the workload of nurses, and on the other hand, it can better meet the needs of patients. The information equipment in this base has room for improvement.” N10: “ In the higher-level training hospital, they use PAD login operations for all forms, with most of the programs on nurses' computers accessible via PAD. You can consider adopting this approach.” Topic 4: Difficulties in Training Transfer for hospice Care Lack of specific promotion opportunities and incentive mechanisms, making it difficult for tertiary hospitals to fully implement humanistic care in practice. While the nursing department has the willingness to learn and implement hospice care, it lacks comprehensive support, and the salary for hospice care nurses need to be adjusted to prevent staff turnover. N2: “ Promotion opportunities are crucial. If a job requires long-term commitment without discussing advancement, it will be difficult to sustain. Specific incentive mechanisms are needed. N6: “The practice of our tertiary hospital has both similarities and differences with other places. Here, we focus on patient comfort, while our unit emphasizes efficiency. Under the current workload, it is difficult for us to fully implement “humanistic” care.” N13: “ Currently, only the nursing department in our hospital has the willingness to learn and implement hospice care, but I know this is far from enough. Hospital leadership and department heads also need to pay high attention. Training nurses alone is not enough; comprehensive support is needed.” N14: “ The salary for hospice care nurses should be adjusted, or there may be low wages and staff turnover. Our hospital's training requires at least a college degree and stable emotions and compassion.” Public awareness and acceptance of hospice care still need gradual improvement. It is recommended to first popularize knowledge among general nurses and learn from the model of reproductive education by introducing basic education courses on life and death from elementary school, to facilitate the smoother implementation of hospice care work in the future. N9: “ It may still take a gradual process to popularize hospice care among the public. First, relevant knowledge should be popularized among general nurses, then gradually expanded to community residents. In the education system, we can follow the model of reproductive education and introduce education courses on life and death from elementary school. Such basic education will help in the smoother implementation of hospice care work in the future.” Home-based hospice care relies on a scoring system, and those meeting the criteria can be included in the plan. Outpatient hospice care provides counseling services but has limited resources. In emergency situations, hospitals will also include them under hospice care, but this admission pathway needs further standardization and assessment of patient needs. N1: “ Our home-based hospice care is mainly based on a scoring system. As long as patients meet the intervention criteria of hospice care, they can be included in the home-based hospice care plan. Outpatient hospice care leans more towards providing counseling services, including physical care and life education, but due to resource limitations, the intervention scope is relatively limited.” N4: “ In cases where elderly patients with multiple chronic diseases face a sudden situation, such as being estimated to have two to three months of survival, we will also include them under hospice care. This is a pathway of admission for hospice care patients in our hospital.” Discussion From the results of the qualitative study on the 15 interviewees, this training program demonstrates several advantages: the content is practical, benefiting both the professional and personal lives of the participants. The training format and atmosphere are conducive to learning, broadening the participants' knowledge and perspectives, helping them face death with a deeper understanding of the value of life, and encouraging them to plan for the future while maximizing attention to the present. It also enhances understanding of community health service centers, and the humanistic care environment at the training base offers valuable reference for the development of humanistic care in other institutions. The program raises awareness about the low level of hospice care health literacy among the public and society, contributing to future efforts in promoting public education. The research findings provoke the following reflections and discussions. The integration of practice and theory is essential in hospice care training. The training curriculum could include more practical exercises, such as ward visits, conducting family meetings, drafting nursing documentation, applying nursing interventions tailored to patients' specific conditions, accompanying patients 12 . Equally critical are strategies for alleviating patients' negative emotions and managing pain. As well as the nursing staff, proper training is also crucial for volunteers, especially those providing direct patient support. Since most volunteers participate in multiple service areas, their training must be thorough and well-rounded 13 . In addition to physical, psychological, and social suffering, the World Health Organization (WHO) defines psychological suffering as one of the four specific areas of health concerns in its definition of total suffering 14 . However, it is widely reported that the nursing of patients' psychological suffering and needs is the least developed and most neglected aspect 15 . The 28-day mortality rate for critically ill patients in the intensive care unit was reported as 61.5% 16 . The severity of the illness causes immense suffering for patients, and the high mortality rate also places significant mental and psychological strain on healthcare staff. Both patients and healthcare workers may experience anxiety, depression, and grief 17 . Prolonged negative emotions can lead to burnout among frontline nurses, reducing their empathy and sense of self-efficacy, and causing resistance to hospice care work 18 . Effective pre-service training, shift rotations during the process, and ongoing support for frontline nurses in their daily work can help alleviate negative emotions 19 . Therefore, the training should not only strengthen the skills for emotional support of patients but also emphasize teaching nurses how to manage their own emotions, alleviate negative feelings, and maintain sustained empathy and a positive sense of self-efficacy. Non-pharmacological interventions, as a form of alternative therapy and an expression of humanistic care, have garnered widespread attention for their potential to enhance patient comfort. An increasing number of healthcare professionals recognize the significant benefits of complementary and alternative therapies, particularly for terminally ill or critically ill patients. These approaches can reduce the dosage of certain analgesics required by terminal patients, promote physical and emotional well-being, and improve overall quality of life 20 . The findings of several studies provided evidence that indoor therapeutical horticulture has a positive effect on mental health 21 . Interacting with nature or stay with elements of nature has been shown to enhance positive emotions, alleviate anxiety, and promote calmness 22 , 23 . Plants, as a key component of natural therapies, offer psychological comfort through touch, sight, and scent. Aromatic plants, in particular, have been demonstrated to play a role in the treatment of various mental health disorders 24 – 26 . Hospice care institutions are recommended to implement indoor therapeutic horticulture programs. For instance, the "Life Space" at this training base serves as a public indoor garden created by multidisciplinary artists for hospice care patients, which initiative significantly enhances the comfort of the living environment for patients at their terminal stage. Trainees commonly report that hospice care nurses face unsatisfactory salary and promotion opportunities. Research shows a clear correlation between overall job satisfaction and turnover intention, with significant positive correlations between salary and overall job satisfaction, relationships with the organization, professional pride, autonomy, and control 27 – 29 . To strengthen the professional hospice care workforce in response to the growing demand, it is essential for employers to enhance recognition and salaries, create a more positive work environment, reduce workload, and focus on patient needs rather than profit. Moreover, modern facilities, such as the use of smart healthcare technologies, including electronic medical records, remote visits, automated alarms, and smart prescriptions, play a crucial role in improving the efficiency of healthcare services, reducing the workload of healthcare professionals, allowing to focus more on patient care, and enhancing the overall patient sense 30 , 31 . Conclusion This research has been conducted for better understanding of the perceptions and feedback of nursing trainees regarding the current training program. By analyzing the strengths and areas for improvement in the teaching content, arrangement, and philosophy, the study was sought to provide insights for enhancing and refining hospice care training programs. Future improvements include continuous curriculum optimization, skill enhancement in end-of-life care, expanded training reach, and continued public education efforts. These findings support advancing hospice care initiatives. Declarations Acknowledgements We would like to extend our gratitude to all the nurses who participated in the interviews, as well as the instructors at the hospice care training base, and we also thank the organization's management for their support in terms of personnel, materials, and venues. Data availability statement Data available on request from the authors. The data that support the findings of this study are available from the corresponding author upon reasonable request. Conflict of interests The authors declare that they have no conflicts of interest. Author's Contributions YJH: Participated in data collection and manuscript drafting. GW: Participated in study concept and design, data collection, data analysis and interpretation, and manuscript drafting and revision. XYL: Participated in manuscript drafting and revision. YZT, ZJY, and WC: Participated in data collection, data proofreading, and manuscript revision. All authors read and approved the final manuscript. Ethics Statement The Medical Research Ethics Committee of the School of Public Health at Fudan University approved Professor Luo Li's ethics application for the study titled "Investigation on the Development of Nursing Talent in Xuhui District" on September 19, 2024. The approval number is IRB#2024-09-1161. 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Relationships between social work involvement and hospice outcomes: results of the national hospice social work survey. Soc Work . 2004;49(3):415-422. doi:10.1093/sw/49.3.415 Wojciechowska W, Malecka B, Suchorska L. The level of occupational burnout among nurses working in hospice home care. Med Paliatywna . 2022;14(1):41-47. doi:10.5114/pm.2022.118723 Cai X. Development and optimization of platforms of wise information technology of med based on medical internet of things and blockchain technology. Internet Technol Lett . Published online December 12, 2023. doi:10.1002/itl2.482 Zanotto BS, Beck da Silva Etges AP, dal Bosco A, et al. Stroke Outcome Measurements From Electronic Medical Records: Cross-sectional Study on the Effectiveness of Neural and Nonneural Classifiers. JMIR Med Inf . 2021;9(11):e29120. doi:10.2196/29120 Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1TrainingProgramforQualifiedNursesinPalliativeCareattheKangjianCommunityHealthServiceCenterShanghai2024.xlsx Cite Share Download PDF Status: Published Journal Publication published 20 May, 2026 Read the published version in BMC Palliative Care → Version 1 posted Editorial decision: Revision requested 21 Nov, 2024 Editor assigned by journal 19 Nov, 2024 Submission checks completed at journal 19 Nov, 2024 First submitted to journal 18 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5475575","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":380862282,"identity":"7446bddc-382f-43c1-80bf-c17eb179b726","order_by":0,"name":"Yanjun Huang","email":"","orcid":"","institution":"KangJian Community Health Service Center","correspondingAuthor":false,"prefix":"","firstName":"Yanjun","middleName":"","lastName":"Huang","suffix":""},{"id":380862283,"identity":"b0a88608-06a3-4bd0-94d5-60bca84605a5","order_by":1,"name":"Gan Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYBADOTb2BgaGCgZmME+CGC3GfDwHGBjOkKIlcZ5EApFa5N3PHpP4uaOWsU3ydQLDwTZreXMG5oO3eRjs8nBpMTyTlybZe+Y4M5t07gaglnTDnQ1sydY8DMnFOLU05Jjd4G07xgbSwvyx7TDjhgM8ZtI8DAcSG3Bp6X9jdvNv2zEeNsmzIFsO2284wP8NrxZ5iRyz27xtNRJsErxgLYlAW9jwajGQeGP+W7btgAEbT+6GAwfOpSdvOMxmbDnHIBm3Lf05xoZv2+rq57ef3fjgQJm17YbjzQ9vvKmww23LATB1GExC2OCoMcChHmQLxKw63CpGwSgYBaNgFAAArbxaPsZmU0cAAAAASUVORK5CYII=","orcid":"","institution":"Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China","correspondingAuthor":true,"prefix":"","firstName":"Gan","middleName":"","lastName":"Wang","suffix":""},{"id":380862284,"identity":"31c88a93-0315-46b0-87e6-4ea6f46473f8","order_by":2,"name":"Xinyu Li","email":"","orcid":"","institution":"School of Public Health, Fudan University, Shanghai, 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Xinyu","middleName":"","lastName":"Li","suffix":""},{"id":380862285,"identity":"d62e9a1e-f919-4b01-8e77-c54877a3f3c6","order_by":3,"name":"Yuezhong Tang","email":"","orcid":"","institution":"KangJian Community Health Service Center","correspondingAuthor":false,"prefix":"","firstName":"Yuezhong","middleName":"","lastName":"Tang","suffix":""},{"id":380862286,"identity":"6022ffab-a83b-4d2f-bd43-b2f44f28c232","order_by":4,"name":"Zhijie Yu","email":"","orcid":"","institution":"KangJian Community Health Service Center","correspondingAuthor":false,"prefix":"","firstName":"Zhijie","middleName":"","lastName":"Yu","suffix":""},{"id":380862287,"identity":"17077d51-b6eb-466b-8ca7-05ab4a83d3e0","order_by":5,"name":"Wen Chen","email":"","orcid":"","institution":"KangJian Community Health Service Center","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-11-18 11:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5475575/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5475575/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12904-026-02151-8","type":"published","date":"2026-05-20T17:09:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71882414,"identity":"5ccf2dbf-678a-4325-b7f3-54cc6af54285","added_by":"auto","created_at":"2024-12-19 11:44:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":255326,"visible":true,"origin":"","legend":"\u003cp\u003eEvaluation of Community Health Service Center Training Base and Content by Shanghai Palliative Care Nurse Training Participants\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5475575/v1/56065b55211c4c9671406c28.png"},{"id":110497336,"identity":"d5ac58c7-73bc-4da5-ada3-7dc97d5f484c","added_by":"auto","created_at":"2026-06-01 17:27:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":459572,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5475575/v1/0a6b3262-0f6d-47ce-b76c-65fd02cf5cb6.pdf"},{"id":71882415,"identity":"f05af51d-5591-4569-a2d5-15063f79ea50","added_by":"auto","created_at":"2024-12-19 11:44:36","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17355,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1TrainingProgramforQualifiedNursesinPalliativeCareattheKangjianCommunityHealthServiceCenterShanghai2024.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5475575/v1/84458068b94e073301634256.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Community Health Service Center Training Base by Shanghai Hospice Care Competent Nurse Trainees: A Qualitative Study","fulltext":[{"header":"Background","content":"\u003cp\u003eHospice care is specialized, compassionate care, what addresses the needs of the patients and their families in the final stages of a terminal illness\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The founder of modern hospice care is Dame Cicely Saunders, a British nurse, social worker, and physician. She is credited with establishing the first modern hospice, St. Christopher's Hospice, in London in 1967. Saunders' work focused on providing compassionate care for terminally ill patients, addressing not only their physical symptoms but also their emotional, social, and spiritual needs\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.As an emerging clinical discipline, over the past half-century, hospice care has seen significant development alongside hospice care in many countries. However, especially in comparison to developed countries, hospice care in China, starting relatively late, is still lags far behind\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. To promote the development of hospice care, several documents related to hospice care were issued in mainland China in 2015, and the guidelines for hospice care and regulations for the management of hospice care centers were released by the government in 2017, However, hospice care in mainland China still lacks practical experience and systematic training programs. Previous literature has reported several factors contributing to the slow progress of hospice care in mainland China, including public misconceptions about end-of-life care based on traditional perceptions, a lack of systematic training, fear of medical disputes and legal actions, insufficient financial support and etc\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe rapid growth of the aging population and rising prevalence of chronic diseases in China are driving an accelerated demand for hospice care, posing substantial challenges to China's healthcare system. According to the data from the seventh national census of China, as of November 2020, the total population of mainland China was 141178\u0026nbsp;million people, with 19064\u0026nbsp;million people aged 65 and above, accounting for 13.5% of the total population\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Population aging leads to a rapid rise in demand for medical services, particularly for hospice care in terminal stages. Elderly people often face various symptoms such as pain, difficulty breathing, nausea, etc. in the final stages of their life, requiring specialized pain management and symptom control. Hospice care addresses these needs by prioritizing comprehensive pain and symptom control. Moreover, it gives emotional and psychological support, allowing patients to experience less distress in their final days and assists families in better planning for the future\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.China now remains more than 200 hospitals and institutions providing hospice care services\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The growing aging population has further driven the demand for hospice care among geriatric patients\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The demand for hospice care in China is growing, yet the current development in this field remains insufficient and outdated. Therefore, first and foremost, it is crucial to cultivate professional and competent nurses in hospice care. To address the training demand, Shanghai Nursing Association launched the \"Hospice Care Competent Nurse Practical Training Base Project\" in 2023. On the one hand, it aims to identify professionals who can teach knowledge and skills in hospice care. On the other hand, through the construction of practical training bases, it aims to standardize teaching management and provide a comprehensive learning and development environment for competent nurses in hospice care, ensuring that they can acquire the necessary knowledge, skills, and experience to provide high-quality services. The Community Practical Training Base for Competent Nurses in Hospice Care based in Shanghai, where this research is located, was approved by the Shanghai Nursing Association in 2024 and has successfully completed two batches of four training sessions for competent nurses in hospice care. To improve the curriculum and enhance the quality of teaching at the training base, the research team conducted semi-structured interviews with 15 nurses who participated in the hospice care training at the base. The purpose of these interviews was to assess the quality of teaching at the community-based terminal care competent nurse practice training base, ensuring that the educational content and methods meet the specific needs of the trainees, thereby enhancing the effectiveness and quality of the training.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSettings and participants\u003c/h2\u003e \u003cp\u003eWe conducted semi-structured interviews with 15 eligible nurses specializing in hospice care from seven administrative districts in Shanghai between September and November 2024. The criteria for being eligible for participation included: 1. had to be aged 18 years older; 2. undergraduate or master's degree students in nursing studies; 3. had at least 5 years clinical experience.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews were used for data collection. Based on a review of the literature and the research objectives, the research team developed an interview outline. Interviews were conducted in a conference room on the last day of the training. Before the interviews, participants were informed of the research purpose and discussion topics, adhering to confidentiality principles. Each interview was limited to 45 minutes. The interviews were recorded using a recording device, and two researchers took notes on the key points and non-verbal information (such as expressions, tone, and gestures).\u003c/p\u003e\n\u003ch3\u003eInterview Data Analysis and Quality Control\u003c/h3\u003e\n\u003cp\u003e Within 24 hours after the interviews, the recordings were transcribed into written data, and the interview records were coded. The Colaizzi 7 analysis method was used to analyze the interview data: carefully read all the materials; extract significant statements; code recurring viewpoints; aggregate the coded viewpoints; write a detailed, complete description; identify similar viewpoints; and return to participants for verification. To ensure the authenticity and reliability of the interview data, leading questions were avoided, interviewers refrained from expressing personal opinions, and participants were encouraged to provide details, with timely clarifications and confirmations of their viewpoints.\u003c/p\u003e\n\u003ch3\u003eTraining Base and Project Introduction\u003c/h3\u003e\n\u003cp\u003e The Community Health Service Center of Xuhui District, Fudan University Shanghai Medical College (referred to as \"the Center\"), registered its hospice care department in March 2012 and began providing services.The Center adheres to a service philosophy that combines medical care with humanistic care, collaborating with multiple educational institutions and academic organizations. It has established several teaching and practice bases, including the Demonstration Base for hospice Care of the China Life Care Association, the National Caring Nursing Project Construction Base, the Medical Social Work Practice Base of the School of Social Development at Shanghai University, the Practice Base of the Shanghai Medical Ethics Association, and the Professional Nursing Master's Practice Base at Soochow University, among others. In 2023, the Center's Hospice Care Department became one of the first training bases for competent hospice nurses recognized by the Shanghai Nursing Association.\u003c/p\u003e \u003cp\u003eThe hospice care team at the center applied the multi-professional team service model to teaching. Courses were carefully designed based on the training outline from the Shanghai Nursing Society. The nursing department had established a specialized nurse training committee to formulate relevant management regulations and standards, teaching plans, and to review the qualifications of teaching staff. The training involved two full-time doctors, six full-time nurses, and one medical social worker from the hospice care team, along with instructors from the Wanqing Foundation and the Hand-in-Hand Life Care Development Center.\u003c/p\u003e \u003cp\u003eIn the practical training process, the base adopted various training methods such as core courses, special lectures, case analysis, group discussions, workshops, and hands-on practice. For example, simulated family meetings were conducted using a multi-team collaboration model involving family members, healthcare professionals, social workers, and ethicists to collectively discuss the patient's treatment and care plan. By simulating real scenarios, this approach helped trainees better prepare for and respond to actual family meetings, ensuring that patients and their families received appropriate support and decision-making guidance at critical moments.\u003c/p\u003e \u003cp\u003eBuilding on the training provided by the Shanghai Nursing Association and integrating the base's unique characteristics, the curriculum included topics such as life education, parallel medical record writing, the information technology development of hospice care centers, and aromatic care. At the end of the training, an assessment was conducted for the trainees, focusing on estimating survival time and relevant theoretical knowledge of hospice care. This assessment not only reinforced the trainees' professional skills but also deepened their understanding of the importance of dignity and the weight of life. The training was divided into four phases: 1. Core courses in hospice care; 2. Practical experience in hospice care wards; 3. Tours of the center's facilities; 4. Home-based hospice care practice (Supplementary material 1).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of participants\u003c/h2\u003e \u003cp\u003eThe 15 selected participants are from various districts of Shanghai, and they participated in community hospice care base training. The selection criteria include: 1. Being at least 18 years old; 2. Holding a bachelor's degree or above in nursing; 3. Having at least 5 years of clinical experience; 4. Currently working in hospice care-related fields. Participants are aged 26\u0026ndash;49, primarily 30\u0026ndash;45, with work experience ranging from 5 to 30 years, mostly over 10 years, distributed across multiple districts in Shanghai, covering departments such as outpatient, geriatrics, and oncology, mostly as general nurses, with a few holding positions such as head nurse or higher, all with bachelor's degrees or above (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of the interviewee\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYears of Experience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWork District\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDepartment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHuangpu District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eXuhui District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eXuhui District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eXuhui District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYangpu District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWard Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYangpu District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh Cadre Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWard Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYangpu District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePutuo District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePudong New District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWard Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGraduate Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePudong New District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePudong New District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePudong New District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePudong New District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBaoshan District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChongming District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDepartment of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDeputy Director of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants' evaluation of hospice care training\u003c/h3\u003e\n\u003cp\u003eThe structure of the interview mainly revolves 4 topics, which are: Operational and Personalized Deficiencies in Course Content, Hospice Care Concept, Training Environment and Facilities, and Difficulties in Training Transfer for Hospice Care (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eTopic 1: Operational and Personalized Deficiencies in Course Content\u003c/h3\u003e\n\u003cp\u003eThe curriculum demonstrates shortcomings in practicality and personalization. Content should be updated to reflect the latest developments in end-of-life care, integrating theory with practice to facilitate a more intuitive understanding and mastery among trainees.\u003c/p\u003e \u003cp\u003eN2: \u0026ldquo;\u003cem\u003eSome participants found the full-day presence at the training site inconvenient. It is suggested that lectures and ward visits be scheduled separately\u0026mdash;theoretical learning in the morning and practical sessions in the afternoon. Additionally, courses should be tailored to meet individual learner needs.\u0026rdquo;\u003c/em\u003e N8: \u0026ldquo;\u003cem\u003eThe family meeting and nursing document writing sections were overly theoretical. It is recommended to incorporate practical exercises or educational videos, using real-life cases to make the content more visually and easily comprehensible.\u0026rdquo;\u003c/em\u003e N9: \u0026ldquo;\u003cem\u003eTo better evaluate learning outcomes, it is suggested that each participant submit a written report summarizing their learning insights and takeaways at the end of the course.\u0026rdquo;\u003c/em\u003e N10: \u0026ldquo;\u003cem\u003eSome course content overlapped with previous theoretical sessions. It is recommended that family meeting and parallel case record courses be integrated to enhance continuity and practicality.\u0026rdquo;\u003c/em\u003e N15: \u0026ldquo;\u003cem\u003eWhen launching hospice care in non-central urban areas such as Chongming, the course content may need to be adjusted and improved based on regional characteristics to better adapt to the local actual conditions and cultural background.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThere is room for improvement in hospice care practice training in areas such as grief counseling, pain assessment procedures, the value manifestation of multidisciplinary teams, and the promotion of practical care tools.\u003c/p\u003e \u003cp\u003eN1: \u0026ldquo;\u003cem\u003eGrief counseling courses are very helpful, especially in providing valuable guidance and methods on how to help patients and their families navigate difficult times.\u0026rdquo;\u003c/em\u003e N2: \u0026ldquo;\u003cem\u003eIt is recommended to integrate continuous pain assessment into pain management, eliminating the need for a separate form, thus saving time on assessment and documentation.\u0026rdquo;\u003c/em\u003e N7: \u0026ldquo;\u003cem\u003eMultidisciplinary team members often take on multiple roles in their daily work but may struggle to demonstrate their value. By learning, we can document the details of our daily work in parallel medical records, thereby better showcasing our professional value.\u0026rdquo;\u003c/em\u003e N10: \u0026ldquo;\u003cem\u003eThe oral brush mentioned in the comfort care course is very practical. I just tried it and felt great, and I recorded a video of its use, which I believe can serve as a teaching resource.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe training schedule is reasonable, but some participants feel that the course content was not fully explored due to time constraints and hope for more opportunities to learn more knowledge and skills.\u003c/p\u003e \u003cp\u003eN2: \u0026ldquo;\u003cem\u003eThe training schedule is reasonable and relaxed, meeting the requirements of this training. There is good interaction between the teaching staff and participants, and an opportunity to reacquaint with each other, which helps to enhance the learning effect.\u0026rdquo;\u003c/em\u003e N7: \u0026ldquo;\u003cem\u003eAlthough the community has fewer medical resources compared to second and tertiary hospitals, we can focus more on humanistic care. The course content is good, but due to limited time, if it could be slightly expanded, we would have the opportunity to learn more knowledge and skills.\u0026rdquo;\u003c/em\u003e N8: \u003cem\u003e\u0026ldquo;The course arrangement was very thoughtful, with a grand opening ceremony and everyone's name tags designed to add a formal touch to the learning. This format made the entire learning process feel ceremonial.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTopic 2: Hospice Care Concept\u003c/h2\u003e \u003cp\u003eThe training deepened participants' understanding and perception of hospice care. However, some tertiary hospitals need to enhance their service content, particularly in terms of humanistic care and psychological support, and improve awareness of multi-professional team collaboration.\u003c/p\u003e \u003cp\u003eN8: \u0026ldquo;\u003cem\u003eDue to personal experiences, I initially had a resistant attitude towards hospice care. Through the course, I gained a deeper understanding of life and death, no longer fearing to discuss the topic, and this transformation has had a profound impact on me.\u0026rdquo;\u003c/em\u003e N13: \u0026ldquo;\u003cem\u003eIn tertiary hospitals, we focus more on symptom control, such as comfort care, with less emphasis on humanistic care and psychological support. Initially, I mistakenly thought that hospice care was just the job of nurses. Through learning, I realized that the team includes doctors, nurses, social workers, psychologists, volunteers, and other multi-professional personnel, which has changed my understanding.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTopic 3: Training Environment and Facilities\u003c/h2\u003e \u003cp\u003eThe overall training environment is comfortable, but there are suggestions for improvements in small conference rooms and seating arrangements. Also, the convenience and functionality fineness of the nursing information system need to be enhanced, and can be learned from the higher-level training hospital's PAD login operation method.\u003c/p\u003e \u003cp\u003eN5: \u0026ldquo;\u003cem\u003eThe comfort of the environment is crucial, and I did not feel confined. Instead, the open and artistic space was refreshing and relaxing. Artworks combined with the theme of life showcased the sublimation of life. The humanistic atmosphere here makes one feel the dignity, peace, and serenity of life, perfectly aligned with respect for life. This experience made me reevaluate community hospitals.\u0026rdquo;\u003c/em\u003e N9: \u0026ldquo;\u003cem\u003eI think the training venue needs further improvement. If everyone sits closer in a smaller conference room, it will facilitate discussions and interactions, enhancing the learning effect. The convenience and functionality fineness of the nursing information system need to be improved: On one hand, the nursing information system can reduce the workload of nurses, and on the other hand, it can better meet the needs of patients. The information equipment in this base has room for improvement.\u0026rdquo;\u003c/em\u003e N10: \u0026ldquo;\u003cem\u003eIn the higher-level training hospital, they use PAD login operations for all forms, with most of the programs on nurses' computers accessible via PAD. You can consider adopting this approach.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTopic 4: Difficulties in Training Transfer for hospice Care\u003c/h2\u003e \u003cp\u003eLack of specific promotion opportunities and incentive mechanisms, making it difficult for tertiary hospitals to fully implement humanistic care in practice. While the nursing department has the willingness to learn and implement hospice care, it lacks comprehensive support, and the salary for hospice care nurses need to be adjusted to prevent staff turnover.\u003c/p\u003e \u003cp\u003eN2: \u0026ldquo;\u003cem\u003ePromotion opportunities are crucial. If a job requires long-term commitment without discussing advancement, it will be difficult to sustain. Specific incentive mechanisms are needed. N6: \u0026ldquo;The practice of our tertiary hospital has both similarities and differences with other places. Here, we focus on patient comfort, while our unit emphasizes efficiency. Under the current workload, it is difficult for us to fully implement \u0026ldquo;humanistic\u0026rdquo; care.\u0026rdquo;\u003c/em\u003e N13: \u0026ldquo;\u003cem\u003eCurrently, only the nursing department in our hospital has the willingness to learn and implement hospice care, but I know this is far from enough. Hospital leadership and department heads also need to pay high attention. Training nurses alone is not enough; comprehensive support is needed.\u0026rdquo;\u003c/em\u003e N14: \u0026ldquo;\u003cem\u003eThe salary for hospice care nurses should be adjusted, or there may be low wages and staff turnover. Our hospital's training requires at least a college degree and stable emotions and compassion.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003ePublic awareness and acceptance of hospice care still need gradual improvement. It is recommended to first popularize knowledge among general nurses and learn from the model of reproductive education by introducing basic education courses on life and death from elementary school, to facilitate the smoother implementation of hospice care work in the future.\u003c/p\u003e \u003cp\u003eN9: \u0026ldquo;\u003cem\u003eIt may still take a gradual process to popularize hospice care among the public. First, relevant knowledge should be popularized among general nurses, then gradually expanded to community residents. In the education system, we can follow the model of reproductive education and introduce education courses on life and death from elementary school. Such basic education will help in the smoother implementation of hospice care work in the future.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHome-based hospice care relies on a scoring system, and those meeting the criteria can be included in the plan. Outpatient hospice care provides counseling services but has limited resources. In emergency situations, hospitals will also include them under hospice care, but this admission pathway needs further standardization and assessment of patient needs.\u003c/p\u003e \u003cp\u003eN1: \u0026ldquo;\u003cem\u003eOur home-based hospice care is mainly based on a scoring system. As long as patients meet the intervention criteria of hospice care, they can be included in the home-based hospice care plan. Outpatient hospice care leans more towards providing counseling services, including physical care and life education, but due to resource limitations, the intervention scope is relatively limited.\u0026rdquo;\u003c/em\u003e N4: \u0026ldquo;\u003cem\u003eIn cases where elderly patients with multiple chronic diseases face a sudden situation, such as being estimated to have two to three months of survival, we will also include them under hospice care. This is a pathway of admission for hospice care patients in our hospital.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFrom the results of the qualitative study on the 15 interviewees, this training program demonstrates several advantages: the content is practical, benefiting both the professional and personal lives of the participants. The training format and atmosphere are conducive to learning, broadening the participants' knowledge and perspectives, helping them face death with a deeper understanding of the value of life, and encouraging them to plan for the future while maximizing attention to the present. It also enhances understanding of community health service centers, and the humanistic care environment at the training base offers valuable reference for the development of humanistic care in other institutions. The program raises awareness about the low level of hospice care health literacy among the public and society, contributing to future efforts in promoting public education. The research findings provoke the following reflections and discussions.\u003c/p\u003e \u003cp\u003eThe integration of practice and theory is essential in hospice care training. The training curriculum could include more practical exercises, such as ward visits, conducting family meetings, drafting nursing documentation, applying nursing interventions tailored to patients' specific conditions, accompanying patients\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Equally critical are strategies for alleviating patients' negative emotions and managing pain. As well as the nursing staff, proper training is also crucial for volunteers, especially those providing direct patient support. Since most volunteers participate in multiple service areas, their training must be thorough and well-rounded\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to physical, psychological, and social suffering, the World Health Organization (WHO) defines psychological suffering as one of the four specific areas of health concerns in its definition of total suffering\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, it is widely reported that the nursing of patients' psychological suffering and needs is the least developed and most neglected aspect\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The 28-day mortality rate for critically ill patients in the intensive care unit was reported as 61.5%\u003csup\u003e16\u003c/sup\u003e. The severity of the illness causes immense suffering for patients, and the high mortality rate also places significant mental and psychological strain on healthcare staff. Both patients and healthcare workers may experience anxiety, depression, and grief\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Prolonged negative emotions can lead to burnout among frontline nurses, reducing their empathy and sense of self-efficacy, and causing resistance to hospice care work\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Effective pre-service training, shift rotations during the process, and ongoing support for frontline nurses in their daily work can help alleviate negative emotions\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Therefore, the training should not only strengthen the skills for emotional support of patients but also emphasize teaching nurses how to manage their own emotions, alleviate negative feelings, and maintain sustained empathy and a positive sense of self-efficacy.\u003c/p\u003e \u003cp\u003eNon-pharmacological interventions, as a form of alternative therapy and an expression of humanistic care, have garnered widespread attention for their potential to enhance patient comfort. An increasing number of healthcare professionals recognize the significant benefits of complementary and alternative therapies, particularly for terminally ill or critically ill patients. These approaches can reduce the dosage of certain analgesics required by terminal patients, promote physical and emotional well-being, and improve overall quality of life\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The findings of several studies provided evidence that indoor therapeutical horticulture has a positive effect on mental health\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Interacting with nature or stay with elements of nature has been shown to enhance positive emotions, alleviate anxiety, and promote calmness\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Plants, as a key component of natural therapies, offer psychological comfort through touch, sight, and scent. Aromatic plants, in particular, have been demonstrated to play a role in the treatment of various mental health disorders\u003csup\u003e\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Hospice care institutions are recommended to implement indoor therapeutic horticulture programs. For instance, the \"Life Space\" at this training base serves as a public indoor garden created by multidisciplinary artists for hospice care patients, which initiative significantly enhances the comfort of the living environment for patients at their terminal stage.\u003c/p\u003e \u003cp\u003eTrainees commonly report that hospice care nurses face unsatisfactory salary and promotion opportunities. Research shows a clear correlation between overall job satisfaction and turnover intention, with significant positive correlations between salary and overall job satisfaction, relationships with the organization, professional pride, autonomy, and control\u003csup\u003e\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. To strengthen the professional hospice care workforce in response to the growing demand, it is essential for employers to enhance recognition and salaries, create a more positive work environment, reduce workload, and focus on patient needs rather than profit.\u003c/p\u003e \u003cp\u003eMoreover, modern facilities, such as the use of smart healthcare technologies, including electronic medical records, remote visits, automated alarms, and smart prescriptions, play a crucial role in improving the efficiency of healthcare services, reducing the workload of healthcare professionals, allowing to focus more on patient care, and enhancing the overall patient sense\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research has been conducted for better understanding of the perceptions and feedback of nursing trainees regarding the current training program. By analyzing the strengths and areas for improvement in the teaching content, arrangement, and philosophy, the study was sought to provide insights for enhancing and refining hospice care training programs. Future improvements include continuous curriculum optimization, skill enhancement in end-of-life care, expanded training reach, and continued public education efforts. These findings support advancing hospice care initiatives.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our gratitude to all the nurses who participated in the interviews, as well as the instructors at the hospice care training base, and we also thank the organization's management for their support in terms of personnel, materials, and venues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData available on request from the authors. The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor's Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYJH: Participated in data collection and manuscript drafting. GW: Participated in study concept and design, data collection, data analysis and interpretation, and manuscript drafting and revision. XYL: Participated in manuscript drafting and revision. YZT, ZJY, and WC: Participated in data collection, data proofreading, and manuscript revision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Medical Research Ethics Committee of the School of Public Health at Fudan University approved Professor Luo Li's ethics application for the study titled \"Investigation on the Development of Nursing Talent in Xuhui District\" on September 19, 2024. The approval number is IRB#2024-09-1161.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is funded by a commissioned contract from the Xuhui District Health Commission in Shanghai for the “Investigation and Research on the Construction of Nursing Talent Team in Xuhui District.” (grant number: waf201649).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eA qualitative study exploring nursing students\u0026apos; perspectives on and attitudes towards hospice care in China. \u003cem\u003eNurse Education Today\u003c/em\u003e. 2022;119:105384. doi:10.1016/j.nedt.2022.105384\u003c/li\u003e\n\u003cli\u003eBogusz H, Pekacka-Falkowska K, Magowska A. 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Relationships between social work involvement and hospice outcomes: results of the national hospice social work survey. \u003cem\u003eSoc Work\u003c/em\u003e. 2004;49(3):415-422. doi:10.1093/sw/49.3.415\u003c/li\u003e\n\u003cli\u003eWojciechowska W, Malecka B, Suchorska L. The level of occupational burnout among nurses working in hospice home care. \u003cem\u003eMed Paliatywna\u003c/em\u003e. 2022;14(1):41-47. doi:10.5114/pm.2022.118723\u003c/li\u003e\n\u003cli\u003eCai X. Development and optimization of platforms of wise information technology of med based on medical internet of things and blockchain technology. \u003cem\u003eInternet Technol Lett\u003c/em\u003e. Published online December 12, 2023. doi:10.1002/itl2.482\u003c/li\u003e\n\u003cli\u003eZanotto BS, Beck da Silva Etges AP, dal Bosco A, et al. Stroke Outcome Measurements From Electronic Medical Records: Cross-sectional Study on the Effectiveness of Neural and Nonneural Classifiers. \u003cem\u003eJMIR Med Inf\u003c/em\u003e. 2021;9(11):e29120. doi:10.2196/29120\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hospice Care, Nurse, Training, Evaluation, Qualitative Study","lastPublishedDoi":"10.21203/rs.3.rs-5475575/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5475575/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEnhancing the training of competent nurses in hospice care helps improve the quality of life for end-of-life care patients. This study aims to improve the effectiveness and quality of the training by exploring the attitudes of trained nurses in community health service centers towards the content and methods of the program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted semi-structured interviews with 15 eligible nurses specializing in hospice care from seven administrative districts in Shanghai between September and November 2024, using Colaizzi 7 method for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe structure of the interview mainly revolves 4 topics, which are: Operational and Personalized Deficiencies in Course Content, Hospice Care Concept, Training Environment and Facilities, and Difficulties in Training Transfer for Hospice Care. The interviewee highlighted that while the project is practical and enhances professional competence and life values, it faces challenges in areas such as promotion opportunities, motivation mechanisms, implementation of humanistic care, nurses' willingness to learn about hospice care, salary adjustments, public awareness of hospice care, outpatient resource constraints, and the inclusion of emergency end-of-life care. These issues need to be addressed for improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study delves into the perspectives and feedback of hospice care nursing trainees on the current training programs, offering insights into enhancing and optimizing end-of-life care training projects by analyzing the strengths and areas for improvement in teaching content, scheduling, and philosophies. The findings support driving improvements in end-of-life care-related programs, including curriculum optimization, skill enhancement, expanded training scope, and ongoing public education.\u003c/p\u003e","manuscriptTitle":"Evaluation of Community Health Service Center Training Base by Shanghai Hospice Care Competent Nurse Trainees: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 11:44:31","doi":"10.21203/rs.3.rs-5475575/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-21T09:55:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-19T13:36:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-19T13:35:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2024-11-18T11:22:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"618a8b49-6619-4fec-8a50-13ca361059fe","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-06-01T17:18:31+00:00","versionOfRecord":{"articleIdentity":"rs-5475575","link":"https://doi.org/10.1186/s12904-026-02151-8","journal":{"identity":"bmc-palliative-care","isVorOnly":false,"title":"BMC Palliative Care"},"publishedOn":"2026-05-20 17:09:43","publishedOnDateReadable":"May 20th, 2026"},"versionCreatedAt":"2024-12-19 11:44:31","video":"","vorDoi":"10.1186/s12904-026-02151-8","vorDoiUrl":"https://doi.org/10.1186/s12904-026-02151-8","workflowStages":[]},"version":"v1","identity":"rs-5475575","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5475575","identity":"rs-5475575","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}