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.

Development of a multichannel dispersion interferometer at TEXTOR

The design and main characteristics of 14-channel dispersion interferometer for plasma profile measurement and control in TEXTOR tokamak are presented. The diagnostic is engineered on the basis of modular concept, the 10.6 microm CO(2) laser source and all optical and mechanical elements of each module are arranged in a compact housing. A set of mirrors and retroreflectors inside the TEXTOR vacuum vessel provides full coverage of the torus cross section with 12 vertical and two diagonal lines of sight, no rigid frame for vibration isolation is required. Results of testing of the single-channel prototype diagnostic and the pilot module of the multichannel dispersion interferometer are presented.

Influence of the static Dynamic Ergodic Divertor on edge turbulence properties in TEXTOR

Systematic measurements on the edge turbulence and turbulent transport have been made by Langmuir probe arrays on TEXTOR under various static Dynamic Ergodic Divertor (DED) configurations. Common features are observed. With the DED, in the ergodic zone the local turbulent flux reverses sign from radially outwards to inwards. The turbulence properties are profoundly modified by energy redistribution in frequency spectra and suppression of large scale eddies. The fluctuation poloidal phase velocity changes direction from electron to ion diamagnetic drift, consistent with the observed reversal of the Er x B flow. In the laminar region, the turbulence is found to react to an observed reduced flow shear.