Nursing Comfort with End-of-Life Care of Patients and Families
Analytics
318 views ◎263 downloads ⇓
Abstract
Background: Majority of Americans are faced with mortality in the acute care setting and require excellent care in order to maintain comfort, quality, and dignity at the end-of-life (EOL). Nurses play a large role in palliative and EOL care. Current nursing programs lack palliative education and clinical opportunities. Also, the Cone Health Palliative Medicine Team has recently expanded to Alamance Regional Medical Center. Along with the excitement of this expansion, come the challenges of educating staff on palliative medicine and EOL care. Cone Health nurses do not have yearly continuing education requirements that relate to palliative or EOL care. Purpose: The purpose of this scholarly project was to evaluate comfort level and gaps in knowledge of bedside nurses caring for EOL patients and families. There are many skills nurses need to feel comfortable with when caring for a dying patient and family including communication and patient care delivery. Methodology: This descriptive pilot study was implemented in a 218 bed hospital located in Burlington, North Carolina. The target population included voluntary nurses working on a medical/surgical unit or an intensive care unit. There were no exclusions regarding age, gender, ethnicity, education, length of nursing career, or length of employment at ARMC. The End-of-Life Professional Caregiver Survey (EPCS) was the measurement tool to identify a baseline nursing comfort level with aspects of EOL care. Nurses were provided a detailed palliative PowerPoint and multiple unit in-services throughout implementation. After the educational intervention, it was requested that nurses complete the post EPCS to evaluate if there was increased comfort with EOL care. The EPCS also identified gaps in knowledge with certain EOL topics. Data was collected in Survey Monkey and analyzed in Excel and SPSS. Quantitative and qualitative methods were used to draw conclusions from the data. Results: Recruitment emails were sent to 75 nurses. A total of 37 nurses completed the pre-survey and a total of 25 nurses completed the post survey after educational intervention. There were 7 participants that completed the post survey that did not complete the pre-survey. Eighteen (n=18) participants completed the pre and post survey for comparison. Pre comfort score was compared to post comfort score by paired t-tests that revealed statistical significance (p=0.00021). Three question domains also proved to be statistically significant by paired t-tests. Linear regression evaluated comfort level with demographics which did not reveal statistical significance with gender, age, ethnicity, education, length of nursing career, and length of employment at ARMC. Qualitative themes were identified from reflection questions in the post survey. Implications: Despite many limitations identified, there are implications appropriate for further implementation of this project. Although sample size was small, data from 18 surveys was statistically significant. EOL knowledge gaps were also identified and serve as a foundation for future education on this topic. Post survey reflection questions provided valuable information too. The goal is for change to be sustained as best practice with EOL communication and patient care delivery. With future incentive for nurses on other units in the health system, increased motivation for participation may be possible. In general, there remains a knowledge gap with some EOL concepts and role of palliative medicine in healthcare. Continuous education is essential throughout the entire healthcare team. Conclusion: Bedside nurses are at the forefront of patient care delivery when death is imminent. It is necessary for nurses to have a good understanding of primary palliative nursing and feel comfortable with the many skills involved with EOL care. In the last days and hours of a patient’s life, it is essential to provide comfort, quality, and a dignified death. Nurses are given these opportunities to connect with patients and families in ways that will never be forgotten.