Facing the Inevitable

Preparing Nurses to Deliver End-of-Life Care

Shelly Orr, PhD, RN, CNE; Mary Falk, MSN, RN, CCRN; R.K. Elswick, PhD

Disclosures

Journal of Hospice and Palliative Nursing. 2021;23(5):462-468. 

In This Article

Abstract and Introduction

Abstract

Health care providers have an ethical obligation to reduce suffering during a patient's end of life (EOL), but few receive formal education on EOL care principles. The objective of this project was to determine the feasibility and potential benefits of an education initiative in which the principles of EOL care were taught to senior-level nursing students and practicing nurses. To assess feasibility, data regarding recruitment rates, retention rates, and implementation issues were collected. Workshop effectiveness was evaluated through use of the End-of-Life Nursing Education Consortium–Knowledge Assessment Test survey, which evaluates knowledge levels regarding EOL care principles. A mixed-effects linear model was used to test for changes from the preworkshop to postworkshop scores. Demographic information and satisfaction data were also collected. Nineteen students and 24 nurses participated (total N = 43). There was a statistically significant time difference (P = .0001), with the postworkshop scores being higher (43.5 ± 0.93) versus the preworkshop scores (41.2 ± 0.93). However, no statistically significant workshop date difference (P = .3146) emerged. Satisfaction data were positive. Retention for the second workshop was negatively affected by COVID-19. The unique needs of patients nearing their EOL are significant. This project describes the implementation and outcomes of an education initiative, focused on EOL care principles, that was both feasible and beneficial.

Introduction

Health care providers have an ethical obligation to reduce suffering during a patient's end of life (EOL), but few receive formal education on EOL care principles.[1,2] Deficiencies in EOL care communication can compromise the quality of EOL care received by patients[3] and increase resource utilization.[4] When health care providers are well versed in EOL care principles, they are able to provide high-quality EOL care, including enhanced symptom management.[5] Furthermore, a positive EOL experience for patients can limit moral distress experienced by nurses[6] and physicians.[7]

The End-of-Life Nursing Education Consortium (ELNEC) project is an educational initiative that was designed to improve EOL care throughout the world.[8] Developed as a partnership between the American Association of Colleges of Nursing and the City of Hope, ELNEC provides "train-the-trainer" preparation for nursing faculty and other educators. Once trained, these educators can go on to teach essential EOL care principles to others. Principles covered include symptom management, communication, final hours, loss, grief, bereavement, leadership, self-care, cultural considerations, and ethical issues. The ELNEC project was developed for nurses but is encouraged for any health care provider with an interest in EOL care, including physicians. Faculty receiving "train-the-trainer" preparation are given access to educational materials that can be utilized when providing training for others. Studies evaluating the effectiveness of ELNEC training for nursing students, practicing nurses, and advanced practice nurses consistently report significant knowledge improvement in EOL care after training.[9–11] However, little is known regarding the feasibility of such training and outcomes when students and various levels of clinicians are included in the same training.

The long-term goal of this project is to contribute to a health care workforce that is more adept to providing patient-centered, effective EOL care. As an initial step, the objective of this project was to determine the feasibility and potential benefits of an education initiative in which principles of EOL care, utilizing ELNEC resources, were taught to senior-level nursing students and interested practicing nurses.

To achieve the objective of this project, the investigators pursued the following aims:

Aim 1: Evaluate the feasibility of offering a workshop that covers EOL care principles. To achieve this aim, we offered an EOL care workshop for senior-level nursing students and interested practicing nurses and assessed corresponding recruitment and retention rates. In addition, we gathered information on any issues with resources needed to carry out the workshop.
Aim 2: Evaluate the effect of an evidenced-based workshop on the knowledge of EOL care principles. To achieve this aim, we offered an EOL care workshop for senior-level nursing students and interested practicing nurses and compared their knowledge of EOL care principles before and after the workshop.
Aim 3: Evaluate satisfaction with an evidence-based EOL care workshop. To achieve this aim, we offered an EOL care workshop for senior-level nursing students and interested practicing nurses and gathered satisfaction data after its completion.

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