Development of End-of-Life Peer Nurse Coaches

Abstract

New nurse hires lacked end-of-life nursing experience in the hospital, and mechanisms were unavailable to guide them. A quality improvement project was developed to address this. Seventy-three registered nurses representing 39 nursing units received training as end-of-life peer nurse coaches. This training included 2 hours of end-of-life education and 2 hours of communication/simulation training. Coaches were provided with communication prompt cards, a Nurse to Nurse: Palliative Care book, and additional resources. The outcome of the project on peer nurse coach self-perceived competency was measured using an abridged version the Scale of End of Life Care in the ICU tool before and after training, at 6 months, and at 1 year. A report card was used to record coaching activities at 6 months, and a survey was conducted to evaluate these activities at 1 year. Peer nurse coach self-perceived competencies in end-of-life care delivery improved after training, at 6 months (P < .01), and at 1 year (P < .05). Qualitative findings highlighted various ways peer nurse coaches manifest these new roles. The plan-do-study-act method, the peer nurse coach approach, availability of unit-based end-of-life resources, and peer nurse coach mentoring had positive effects on peer nurse coach self-perceived end-of-life competence and their abilities to coach new nurse hires. KEY WORDSacute care, end-of-life care, peer nurse coach, quality/ improvement/review/assurance, staff education E nd-of-life (EOL) care in acute care hospitals is said to often be inadequate, of poor quality, and deficient in both the amelioration of physical symptoms and the ability to address the emotional and psychosocial needs of dying patients. 1 In the past, families of dying patients reported severe pain, dyspnea, agitation, and other symptoms in their loved ones, 2 and although some of these patients desired comfort care, many received unwanted aggressive life-sustaining treatments until death. 2 More recent studies indicate that seriously ill, aged, and dying hospitalized patients continue to experience symptom distress. Many die after ICU stays within the last month of life. 3-5 These patients frequently require ventilator withdrawal and experience less than ideal attention to quality of care in the aftermath. 4 A focus on prolongation of life, the propensity toward inadequate symptom control, and insufficient communication are associated with lack of awareness of approaching death and shortcomings regarding health care professional knowledge and skills in the delivery of EOL care. This is particularly true in hospital health care settings where death is viewed as failure. 1 Hospital care of the dying is of concern in the United States because a majority of EOL patients die in hospital settings despite the growth of hospice 3,4 and because hospitals continue to be places where day-to-day EOL care is delivered by nurses with insufficient EOL support and training. 6,7 Studies indicate variability in palliative and EOL nursing education in undergraduate, 7,8 gr...

Health Professionals Perceived Concerns and Challenges in Providing Palliative and End-of-Life Care: A Qualitative Analysis

“…In summary, timely code status discussions are imperative to honor patients' wishes, decrease suffering and delivery of escalating care, and promote peaceful EOL situations. 19 These results highlight common challenges revolving around the delivery of quality palliative/EOL care to hospitalized patients and their families. This study found that communication issues occurred on many levels, not only between the patient/provider, but between provider services and interprofessional team members.…”

“…Health-care professionals inherently may not have expertise in communicating with patients and families at end of life and can be effectively coached and educated in order to best facilitate and meet patient/family needs. 7,8,[16][17][18][19] The facilitation of seamless transitions of care when goals changed from curative to comfort was often identified, recognizing the importance of implementing supportive interventions that convey empathy and compassion. One respondent described the situation of a patient who transitioned to comfort care and discussed how staff provided an additional patient room to allow more space for an abundant number of family members to grieve and have private time.…”

“…(We) need more honest discussions with some patients about their poor prognosis.” Health-care professionals inherently may not have expertise in communicating with patients and families at end of life and can be effectively coached and educated in order to best facilitate and meet patient/family needs. 7,8,16 -19…”

“…The amazing nursing staff and NICU faculty were able to guide the family through the steps of withdrawing care to create a good pediatric end-of-life situation.In summary, timely code status discussions are imperative to honor patients’ wishes, decrease suffering and delivery of escalating care, and promote peaceful EOL situations. 19…”

Concept Analysis of End-of-Life Care

“…This person needs family support and care, as their human needs may gradually increase and be severely affected. 19 Consequences: EOLC leads to an increase in QOL and a reduction in moral distress, emotional exhaustion, a decrease in psychological and social stress, imposing lower costs on the family and the health system.…”