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


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

In This Article


Participant Demographics

A total of 19 nursing students, 23 registered nurses, and 1 nurse practitioner participated in the study (Table 1). The mean age of participants was 36.5 years, with most being female (86%) and White (72%). The distribution of years in profession was skewed positive so that the median of 2.25 years with a minimum of 0 and maximum of 42 is a more appropriate summary measure. Most participants had some previous experience with EOL, either personally (67%) and/or professionally (60%).


Recruitment occurred without any issues. Within 3 weeks of flyer distribution, both workshop dates had 30 participants registered. The retention rate for the first workshop was 80%; 1 participant fell ill the morning of the workshop, 1 participant never completed their postworkshop surveys, and 4 others failed to show up for the workshop. Because of social distancing mandates, the second workshop was changed to virtual 1 week before the scheduled date. Because participants initially agreed to participate in a face-to-face workshop, they were contacted regarding their desire to remain in the study. Eight participants elected to not continue with workshop participation. In addition, 1 participant was unable to attend because of an emergency the morning of the workshop and 2 others failed to attend the workshop. The retention rate for the second workshop was 63.3%, bringing the overall retention rate to 71.65%.

The first workshop was implemented without any issues. The second workshop, offered virtually via Zoom, required additional preparation by the facilitators but occurred without any major issues. Two participants had Internet connection issues; 1 was able to call in via phone when their connection was lost periodically but the other continued to experience connection issues throughout the workshop.


As planned, a mixed-effects linear model was used to test for changes from the preworkshop to postworkshop ELNEC-KAT scores (Table 2). The model had 2 error terms, including the usual residual error term and an error due to subject. The subject error term modeled the correlated data (preworkshop vs postworkshop scores) within a participant. The model had 2 "fixed effects" terms: one for time (preworkshop vs postworkshop scores) and a second for the workshop date (February vs April). There was a statistically significant time difference (P = .0001), with the postworkshop scores being higher (43.5 ± 0.93) versus the preworkshop score (41.2 ± 0.93). There was, however, no statistically significant workshop date difference (P = .3146).

Important to note, the difference between the preworkshop and postworkshop scores was about 2.5 points on a 50-point scale, which equates to about a 5% improvement (Figure). In addition, 33 of the 43 participants (77%) had a pretest score at 80% or higher. Five participants' pretest and posttest scores were the same and 6 participants' posttest scores were lower than their pretest scores.

Figure 1.

Postworkshop score by preworkshop score: points above the red line show improvement.


Overall, participants were satisfied with the workshop (Table 3). High satisfaction (either "strongly agree" or "agree") was noted for items related to the implementation of the workshop, knowledge gained from the workshop, and the instructors who taught the workshop. For the few participants who indicated "disagree" or "strongly disagree" on select survey items, comments included were helpful in determining potential points of dissatisfaction.

When participants were asked how they would improve the workshop, comments received included the following:

Include more discussion questions to break up the PowerPoint lecture.
I think the only way that I would improve this workshop would be to add more interactive activities to make the information a little less heavy and, in an effort, to include everyone in the group in the discussion.
I felt like the content was more on the fundamental level. I would have liked more advanced topics.
It was impromptu meeting this way [virtual] however it was great, I would further recommend that some other workshops be presented this way.
It was a lot of information for one day. Maybe two days would be better.

When participants were asked about what they found most valuable about the workshop, comments received included the following:

Being able to reflect on your own experiences and see how things could have been better. There's always an opportunity for improvement!
Dying is a process every individual goes through at some point but is not always talked about at great length. As a student, I feel I never had many opportunities in class or clinical to understand the scope of end-of-life care. This workshop is not only valuable because it helps to educate on end-of-life practices, but it makes discussing and practicing them more comfortable for a less experienced health care provider.
The opportunity to have access to resources for sharing this information with colleagues.
The videos and the interaction with current healthcare providers who offered amazing examples!
Symptom management and discussions with families at end of life.
How to improve communication and collaboration between different team members, the family, and the patient.