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


Based on knowledge gained through the aims of this project, the investigators were able to implement an education initiative focused on EOL care principles that was both feasible and beneficial. However, to fully understand the knowledge gained and lessons learned, further discussion is warranted.

The project described in this article was supported by grant funding. This allowed for the investigators to provide the workshops without costs to the participants. Although this allowed for potential benefits to participants (ie, learning, ELNEC resources, CE credits, meals), it may have negatively impacted the retention rate by decreasing the investment that participants experienced because they had no financial obligation tied to the experience.

The retention rate for the second workshop was negatively affected by COVID-19. However, this provided an opportunity for the investigators to learn more about the potential impact of offering the education initiative virtually. Data analysis revealed no differences in the learning experienced by those attending the workshop virtually versus face-to-face. In addition, the costs associated with the virtual offering were less because physical space and food were no longer needed. However, the satisfaction survey revealed the desire for most of the virtual participants to have attended the workshop in person, the reliable Internet connection that is needed to maintain engagement throughout the workshop, and the need to ensure that the virtual environment allows for participants to engage with each other. Based on the knowledge gained, virtual offerings are a viable option for future workshops but will need to be thoughtfully designed in a manner that precludes "zoom fatigue" and keeps learners engaged and enthused,[15] especially given the continued volume of screen time being expected of learners during the current pandemic.

Based on the expertise of the investigators and comments received on the satisfaction survey, the principles covered within ELNEC Core are likely too simple for experienced practicing nurses, especially those with EOL experience. Future offerings could be targeted to practicing nurses who are early in their careers, in addition to continuing to target nursing students who are near graduation. However, even for the experienced nurses, the resources obtained through the initiative proved to be valuable. The resources received during training are allowed by ELNEC to be used to educate others. Imagine the effect that this initiative can have if those who obtained the resources go on to use them to educate others.

The ELNEC project was developed for nurses but is also encouraged for any health care provider with an interest in EOL care. Although the School of Medicine and Health System received information on the project via distribution of the recruitment flyer via email, no medical students or physicians participated in the project. As the importance of interprofessional education has been highlighted as potentially improving the quality of care delivered to patients,[16] a more purposeful recruitment of other clinicians outside of nurses is warranted for future workshops. This would allow for more interprofessional discussion of EOL principles and education of additional professions involved in providing the unique care that is often needed for patients during their EOL. To help facilitate this, it would be beneficial to consider the addition of other interprofessional providers to help facilitate the course.

The difference between the mean pretest and posttest scores was only about 2.5 points on a 50-point scale (or about 5% improvement), yet it was statistically significant. One might claim that, although statistically significant, the difference in the mean scores are not clinically relevant. One reason that the differences between the means was small may be explained by a ceiling effect. Because 33 of 43 (or 77%) of the participants had pretest scores at 80% or above, there may have not been much room for improvement. Again, this may support the need to target the training for students and those early in their career who likely know less about EOL care.

The unique needs of patients nearing their EOL is significant. As such, there is a need to adequately prepare clinicians to respond to these unique needs. Based on knowledge gained through this project, the investigators were able to implement an EOL care education initiative that was both feasible and beneficial. With this knowledge, and our goal of contributing to a health care workforce that is more adept to providing effective EOL care, next steps include partnering with local American Association of Critical-Care Nurses and American Hospice and Palliative Nurses Association chapters to offer the education initiative on a larger scale.