Nurses Must Be Experienced, Feel Competent When Providing End-of-Life Care

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Many nurses feel unprepared to provide the spiritual component of end-of-life care.
Many nurses feel unprepared to provide the spiritual component of end-of-life care.

Deciding how terminally ill patients want to live and die can be complicated. Nurses experienced in palliative and end-of-life care can guide patients and their families through this difficult process. However, nurses must feel competent before entering uncomfortable situations with patients/families when providing this care, according to researchers at South Dakota State University. Their study, published in the Journal of Clinical Nursing, suggests changes in nursing curriculum to include purposeful engagement and focused debriefing in spiritual assessment and care may be needed.1,2 

Nurses are called on to provide a holistic approach and help with physical, psychological, and spiritual components. However, the researchers write that spiritual care is largely missing from nursing care, and subsequently many nurses feel unprepared to provide spiritual care.

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The Study

The researchers surveyed nurses working at 6 health facilities in eastern South Dakota. They analyzed the narrative descriptions from 10 experienced palliative/hospice care nurses and also conducted individual, face-to-face interviews (45 to 60 minutes long). For this study, the researchers started with the same lead-in questions. They recorded the audio and had it transcribed verbatim.

The team used an assessment tool they developed called C-COPE (Comfort With Communication in Palliative and End-of-Life Care), which is also now being used by other nurse-researchers. Nurses at 6 facilities in eastern South Dakota (4 rural and 2 urban locations) were invited to complete the online survey. Of the 750 to 1000 registered nurses at these facilities, 277 responded, ranking their comfort level on facets of palliative and end-of-life care communication ranging from physical symptoms to cultural and religious concerns.2

"Further testing of the tool is needed in more diverse settings and with interprofessionals. The tool could feasibly be used with students as well as with practicing clinicians to test pre/post knowledge in conjunction with an educational intervention specific to palliative and end-of-life communication," said study investigator Mary Minton, PhD, CNS, CHPN, associate dean for Graduate Nursing and associate professor in the College of Nursing at South Dakota State University, Brookings.  

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