Nursing Protocol Enhances Care of the Family at End of Life in the Hospital Setting

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Despite the fact that most patients die in a hospital settings, most current research focuses on end-of-life care in hospice or at home.
Despite the fact that most patients die in a hospital settings, most current research focuses on end-of-life care in hospice or at home.
The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.            

Denver, CO — Nursing interventions at the end of life often extend beyond the clinical care of the patient to support for the grieving families. A pilot project of a protocol for optimizing care of the family at end of life was presented at the 2017 Oncology Nursing Society Annual Congress.

Historically, nurse quality metrics are identified for infection, errors, falls, and responses to codes; however, such measures are rarely applied to quality of care at the end of life. Deborah Boyle, MSN, RN, AOCNS, FAAN, of University of California Irvine Health in Huntington Beach, California, and colleagues sought to create an evidence-based acute family bereavement support protocol modeled on the perinatal and NICU family interventions when an infant dies.

Neonatal death programs allow for physical bonding and provide an opportunity for families to let go of the deceased and collect items for a memory keepsake.

Existing research on determinants of quality end-of-life care is limited in that nursing actions are not distinguished from care team actions. Furthermore, despite the fact that most patients die in a hospital settings, most research focuses on end-of-life care in hospice or home settings.

In this study, the researchers used a 13-item survey procured from a literature critique of hospice nurse practices to survey families on their preferences for specific nursing interventions during end-of-life care of a loved one in the hospital. They also sought to delineate nurse and family perceptions of quality care at the end of life in the acute care setting. Nurses having contact with family at the end of life were invited to explore and compare impressions that could ultimately influence their practice.

A planning group from the facility's unit-based practice council, unit nurse managers, nurse educator, and clinical nurse specialist reviewed the findings and devised a protocol template for the pilot intervention. The protocol included interventions for the period before death and after death.

Predeath interventions included placing a dove sign on the door, ensuring that there were enough chairs in the room for visitors, determining the need to call “No One Dies Alone,” and asking the family about religious or cultural needs.

At death and immediately following death, interventions included asking the family if they wanted to assist in the final bathing, preparation of a memory keepsake, or performing an honoring ceremony. In addition, nurse managers would plan coverage for the primary nurse to allow the nurse to help the family gather the loved one's belongings and walk the family to main hospital entrance, and give the family a dove card to show the parking attendant.

The protocol also established a process for hospital staff to sign a sympathy card to send to the family 1 month after their loved one's death.

Preliminary responses to the protocol, which is still in the pilot phase, are overwhelmingly positive. Follow-up plans are to call the first 20 family members for their evaluation of the protocol.

Institutional data revealed that dying in the hospital occurs more frequently in the intensive care unit (ICU)setting than the oncology setting, and medical ICU/ICU nurses at the facility expressed an interest in the project. The pilot protocol will also include those units.

Read more of Oncology Nurse Advisor's coverage of the 2017 Oncology Nursing Society's Annual Conference by visiting the conference page.

Reference

1. Boyle D, Oliver J, Reyes C. Optimizing care of the family at the end-of-life in the hospital setting: putting research findings into clinical practice. Oral presentation at: Oncology Nursing Society 42nd Annual Congress; May 4-7, 2017; Denver, CO.

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