Dedicated End-of-Life Education Program Improves Nurses' Care, Patient and Family Satisfaction

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Despite exposure to many dying patients, many oncology nurses lack sufficient end-of-life training.
Despite exposure to many dying patients, many oncology nurses lack sufficient end-of-life training.
The following article features coverage from the 2018 Oncology Nursing Society's Annual Conference in Washington, DC. Click here to read more of Oncology Nurse Advisor's conference coverage. 

WASHINGTON, DC — A dedicated nurse education program to enhance care of patients with cancer and their families at the end of life can improve nurse confidence in their management of end-of-life care, a presentation at the 2018 Oncology Nursing Society (ONS) Annual Congress has shown.

Although oncology nurses have a high likelihood of caring for dying patients, end-of-life training tends to be inadequate and inconsistent, explained Frances Johnson, BSN, RN, an oncology nurse at Huntington Hospital in Pasadena, California. “Oncology nurses at our facility often expressed frustration and uncertainty about how to care for dying patients, how to answer difficult questions, manage end-of-life symptoms, and express empathy.” 

Using funding provided by an endowment from a family who received end-of-life care, a team of 5 nurses developed an education program with 2 goals: enrich the dying experience for both patients and families and reduce compassion fatigue and burnout among nurses.

To create the program, the team, led by Johnson, conducted a literature search, collated clinical experiences, reviewed evidence-based research, attended End-of-Life Nursing Education Consortium (ELNEC) training, and collaborated with symptom management nurses and a palliative care physician. The resulting 3.5-hour interactional class used PowerPoint presentation, videos, and role play to encourage new caring behaviors such as treating the patient with care and respect, allowing nurses to express emotions, and caring for physical needs of the patient and their family, and to introduce nurses to their innovative CARE cabinet.

The CARE cabinet is equipped with essentials for providing compassionate care. It contains educational pamphlets on symptom management, blankets, remembrance and spiritual items (eg, tokens, religious items, journals), and a voice recorder to encourage legacy therapy.

In addition, the team developed a translational research project to evaluate the effectiveness of the program and the CARES tool. The results of which showed statistically significant improvement in 3 categories: ability to communicate with the patient and family regarding dying (30.7% before the intervention to 36.2% after the intervention), ability to enhance cultural and ethical values (19% to 22.9%, respectively), and ability to deliver effective care (18.3% to 21.6%, respectively). 

“The purpose of our CARE program was to promote practice change, and enhance our nurses' ability to provide compassionate, individualized, and dignified care during the end of life,” explained Johnson. Follow-up to the program includes restocking the CARE cabinet, development of a class for all new employees and new graduate nurses, and, due to the success of the pilot program, hospital-wide expansion of the program.

Reference

Johnson F, Stadeli A. My patient is dying; how do I CARE for them? Compassion and respect at the end-of-life (C.A.R.E.). Oral presentation at: ONS 43rd Annual Congress; June 17-20, 2018; Washington DC.


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