Improving Knowledge, Comfort, and Confidence of Nurses Providing End-of-Life Care in the Hospital Setting Through Use of the CARES Tools

Alison Stacy, DNP, RN, AGACNP-BC; Kathy Magdic, DNP, ACNP-BC, FAANP; Margaret Rosenzweig, PhD, FNP-C, AOCNP, FAAN; Bonnie Freeman, DNP, RN, ANP-BC, ACHPN; Denise Verosky, MSN, RN, CNS


Journal of Hospice and Palliative Nursing. 2019;21(3):200-206. 

In This Article


This project took place over a 5-month period from September 2017 through January 2018. Of 11 nurses employed on this unit, a total of 9 participated (82%). For unknown reasons, 2 nurses did not participate. A total of 30 CMO patients were admitted to this unit during data collection.

Descriptive Statistics

Descriptive statistics of the nurses are displayed in Table 2. All 9 nurses were full-time employees of the progressive care unit. Most nurses were in the age range of 30 to 39 years, had greater than 6 years of nursing experience, and held bachelor degrees in nursing. Years of palliative care experience varied according to years working in that specific unit; however, most (n = 3) nurses had either less than 1 year or more than 6 years (n = 3) of palliative care experience.

Preintervention and Postintervention Survey

Preintervention and postintervention survey results were evaluated for self-reported changes in knowledge and comfort related to EOL care at baseline and after use of the CARES tool (Figure). A paired-sample t test was conducted using SPSS for comparison of survey results with a predetermined significance level of less than 0.05 (Table 3). All postintervention survey scores improved after use of the CARES tool. Of these components, 5 of 9 postintervention survey changes were statistically significant. These 5 components included (1) knowledge regarding EOL care, knowledge, and comfort in addressing symptoms including (2) comfort/pain management, (3) airway, (4) emotional support of the patient and his/her family, and (5) confidence in communicating about the dying process with families of the dying patient.


Results: staff pre- and post-intervention survey.

Nurse Interviews

All 9 nurses participated in a semistructured interview to obtain qualitative information regarding the feedback that nurses received from families about Final Journey. Responses were recorded by the interviewer and reviewed by 2 additional authors for identification of main themes (Table 4). The 3 main themes identified in regard to Final Journey include (1) "reinforces EOL care information for loved ones," (2) "helps nurses answer difficult questions," and (3) promotes and encourages communication between staff and loved ones."