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Vol. 33. Issue 2.
Pages 102-114 (March - April 2023)
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Vol. 33. Issue 2.
Pages 102-114 (March - April 2023)
Original Article
Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia
Modelo de aprendizaje de cuidados paliativos basado en la teoría de aprendizaje transformacional de cuidados paliativos de los estudiantes de enfermería en Indonesia
Ni Luh Putu Inca Buntari Agustinia,b, Nursalam Nursalama,
Corresponding author

Corresponding author at: Doctoral Nursing Program, Faculty of Nursing, Universitas Airlangga, Indonesia.
, Tintin Sukartinia, I Dewa Ayu Rismayantia, Ni Wayan Suniadewic
a Faculty of Nursing, Universitas Airlangga, 60286, Indonesia
b Nursing Department, Faculty of Health, Institute of Technology and Health Bali, 80226, Indonesia
c Candidate of Doctor in Nursing, Faculty of Nursing, Universitas Airlangga, 60286, Indonesia
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Figures (2)
Tables (5)
Table 1. Respondents’ characteristics.
Table 2. Descriptions of the students’ characteristics, educators’ characteristics, palliative competencies, learning media, palliative TLT-based learning, and competency achievement.
Table 3. Hypothesis testing of Palliative Learning Model on the competency achievement among nurse students.
Table 4. Model fit.
Table 5. Construct reliability and validity.
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Palliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice.


This study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique.


SEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model.


It can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.

Transformational learning theory
Palliative care
Nursing students
Learning model

La competencia sobre cuidados paliativos es una de las aptitudes que deben poseer los enfermeros generales. Por este motivo, deben llevarse a cabo estrategias para desarrollar modelos de aprendizaje de cuidados paliativos a fin de garantizar que los estudiantes de enfermería posean competencias en dicha materia. Por tanto, este estudio fue estructurado para desarrollar un modelo de aprendizaje de cuidados paliativos basado en la teoría de la transformación, que priorice la participación activa de los estudiantes, de cara a tratar los cuidados paliativos en la práctica futura.


Estudio transversal que incluyó a 189 estudiantes de enfermería como participantes. El modelo propuesto incluye seis variables: características de los estudiantes, características del educador, medios de aprendizaje, competencias sobre cuidados paliativos, formación en paliativos basado en la teoría de aprendizaje transformativo (TLT) y logro de competencias. Los datos fueron recopilados utilizando un cuestionario probado mediante la técnica SEM (Structural Equation Modeling – Modelo de ecuaciones estructurales).


El análisis SEM mostró que el valor R2 del aprendizaje de cuidados paliativos basado en TLT fue de 0,707, o 70,7%. Dichos resultados indican que la diversidad de las variables del aprendizaje de cuidados paliativos basado en TLT pueden explicarse mediante las variables de estudiantes, educadores, competencias sobre paliativos, y medios de aprendizaje en un 70,7%. Cada constructo tuvo un valor de Q2 > 0, lo cual significa que el modelo es satisfactorio. El valor del coeficiente por pasos de 0,627 indica que las características de los educadores tienen la contribución más significativa al modelo de aprendizaje de cuidados paliativos basado en TLT.


Puede concluirse que el proceso de aprendizaje-formación basado en TLT es una estrategia prometedora para respaldar el logro de la competencia de cuidados paliativos por parte de los estudiantes de enfermería.

Palabras clave:
Teoría de aprendizaje transformacional
Cuidados paliativos
Estudiantes de enfermería
Modelo de aprendizaje


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