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 was limited by a small convenience sample recruited from a single hospital unit. Given the frequency of EOL care provided by nurses working on this unit, it is possible that the skill level of this sample was more advanced than that of general progressive care nurses. Despite an improvement in all postintervention survey components after use of the CARES tool, only 5 of 9 were statistically significant. This may be explained by the likely above average baseline knowledge of this nursing sample. The self-developed preintervention and postintervention survey was chosen as the method of evaluation versus a validated preexisting tool for the purpose of assessing EOL care components specific to the CARES tool.

Another limitation of this project involved possible bias because the author/principal investigator conducted the interviews. Face-to-face interviews were chosen as the method of evaluation in an effort to obtain more candid and elaborate insight from nurses. Despite detailed responses from nurses during interviews, the information obtained regarding feedback from families about Final Journey was secondary and therefore at an increased risk for bias. Nursing discretion was used when providing Final Journey to emotionally distraught family members. As a result, all 30 families may not have received the booklet.