Clinical staff perceptions on the quality of end-of-life care in an Australian acute private hospital: a cross-sectional survey

Perceived Difficulties and Learning Needs Among Acute Care Ward Nurses Providing End-of-Life Care During the COVID-19 Pandemic: Comparison by Years of Clinical Experience

Background

In the daily routine of acute care wards, where priority is given to patients with severe illnesses and those who require urgent care, working with and supporting the decision making of terminally ill patients can be challenging.

Methods

This study aimed to clarify the perceived difficulties of and learning needs among acute care ward nurses providing end-of-life care during the COVID-19 pandemic. In order to perform analyses by years of clinical experience, we conducted semi-structured interviews with both novice and experienced nurses. Participants were nurses working in the acute care ward of hospitals in the Kansai area.

Results

We interviewed 31 nurses who agreed to cooperate, including 18 novice/advanced beginner nurses and 13 proficient/expert nurses. Perceived difficulties were categorized into four main groups for novice/advanced beginner nurses: , , , and . Perceived difficulties were categorized into four main groups for proficient/expert nurses: , , , and . Perceived learning needs were categorized into three main groups for novice/advanced beginner nurses: , , and . Perceived learning needs were categorized into three main groups for proficient/expert nurses: , , and .

Conclusion

Novice/advanced beginner nurses felt anxiety and confusion, and were overwhelmed with how to care for terminal patients. Proficient/expert nurses were able to think about how to make patients and their families feel better, and were able to think specifically about post-mortem care. Many proficient/expert nurses were thinking not only about patient care but also about patients' room environment and how to spend time with their families. They sought learning opportunities regarding angel care, including methods of teaching it and basic techniques for performing it, and realized that information sharing within wards, chain of command within the hospital, information exchange with other hospitals, and inter-hospital collaboration were all important during COVID-19 pandemic.

Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards

OBJECTIVES

Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care.

METHODS

We developed an 85-item survey informed by the Theoretical Domains Framework and Capability-Opportunity-Motivation-Behaviour system. We included demographics and two main domains (knowledge and practice; delivering end-of-life care) with seven subsections. Nurses from four GIM wards and the nursing resource team completed this survey. We analysed and compared results overall, by Capability, Opportunity, and Motivation, and by survey domain. We considered items with median scores <4/7 barriers. We conducted an a priori subgroup analysis based on duration of practice (≤5 and >5 years).

RESULTS

Our response rate was 60.5% (144/238). 51% had been practising for >5 years; most respondents were female (93.1%). Nurses had similar scores on the knowledge (mean 76.0%; SD 11.6%) and delivering care (mean 74.5% (8.6%)) domains. Scores for items associated with Capability were higher than those associated with Opportunity (median (first, third quartiles) 78.6% (67.9%, 87.5%) vs 73.9% (66.0%, 81.8%); p=0.04). Nurses practising >5 years had significantly higher scores on all analyses. Barriers included engaging with families having strong emotional reactions, managing goals of care conflicts between patients and families, and staffing challenges on the ward. Additional requested resources included formal training, information binders and more staff. Opportunities for consideration include formalised on-the-job training, access to comprehensive information, including symptom management at the end of life, and debriefing sessions.

CONCLUSIONS

Front-line nurses reported an interest in learning more about end-of-life care and identified important barriers that are feasible to address. These results will inform specific knowledge translation strategies to build capacity among bedside nurses to enhance end-of-life care practices for dying patients on GIM wards.

End-of-Life Essentials education modules: a quality and safety initiative to improve health professionals end-of-life care knowledge, skills, attitude and confidence

Background

There is a need for expanded end-of-life (EOL) care education and resources for health professionals in acute hospitals to help them increase EOL care skills and knowledge, and build capacity and confidence to provide high-quality EOL care. End-of-Life Essentials (EOLE) is an Australian government-funded project, which offers free peer-reviewed online education modules and implementation resources on EOL care to health professionals in acute hospitals, aiming to help support the provision of high-quality EOL care.

Methods

The development of EOLE education modules included seven major steps and two peer-review processes. In total, ten EOLE education modules and associated toolkits had been developed by the end of 2018. To evaluate the effectiveness of EOLE education modules, premodule and postmodule survey data from all ten modules and registration data were extracted from the EOLE learning management system for a 4-month period. The significance of difference in learners’ self-perceived EOL care knowledge, skills, attitude and confidence before and after module learning were tested by Wilcoxon Signed Ranks Tests.

Results

Results from Wilcoxon Signed Ranks Tests revealed statistically significant improvement in learners’ self-perceived EOL care knowledge, skill, attitude and confidence after completion of EOLE modules regardless of their discipline (p<0.001). The learners from different disciplines also reported a high level of intention (median=4, IQR=1) to change their practice after completion of EOLE module learning.

Conclusion

The evaluation results show a positive impact of EOLE module learning on allied health professionals, doctors and nurses, suggesting that EOLE could be a reliable and accessible online EOL care education resources for health professionals of all disciplines to improve their EOL care knowledge, skills and confidence, build up their capacities in providing quality EOL care to patients and their families, in turn, improve the quality and safety of EOL care in health settings.