Improving Knowledge, Comfort, and Confidence of Nurses Providing End-of-Life Care in the Hospital Setting Through Use of the CARES Tools

Abstract

Although most individuals prefer to die at home, approximately 60% of Americans die in the hospital setting. Nurses are inadequately prepared to provide end-of-life (EOL) care because of cure-focused education. Friends and family of dying patients report poor quality of death largely as a result of inadequate communication from health care professionals about the dying process. The purpose of this project was to improve nursing knowledge and comfort related to EOL care through use of the CARES tool and to improve the EOL experience of families of dying patients in the hospital setting through use of Final Journey. These acronym organized tools were developed based upon the common symptom management needs of the dying including Comfort, Airway, Restlessness and delirium, Emotional and spiritual support, and Self-care. The CARES tool for nurses improved nursing knowledge and comfort related to EOL care and common symptom management needs of the dying and also enhanced nurses' confidence in communicating about the dying process with friends and family. Final Journey, the friends and family version of the CARES tool, reinforced EOL information for friends and family, helped nurses answer difficult questions, and promoted and enhanced communication between health care professionals and friends and family of the dying.

“Online Training Is Great but Human Interaction Is Better”: Training Preferences of VA Interdisciplinary Palliative Care Consult Teams

“…6 This is attributed, in part, to a growing demand for services as well as shortages in the palliative care workforce and the need to train additional providers to support the care of people living with serious and life-limiting illness and imminently dying inpatients. 7,8 Palliative care educational and training initiatives can be instrumental in expanding the palliative care workforce, 9 enhancing the skills of current providers, 10 increasing the frequency of use and scope of palliative care consult teams, 11 and facilitating the integration of palliative care modalities into the acute care setting. 12 There is growing interest in how palliative care education and training is delivered, with an emerging body of research examining education and training preferences for computerbased versus in-person approaches.…”

Effectiveness of Comfort Nursing Combined with Continuous Nursing on Patients with Colorectal Cancer Chemotherapy

“…At present, most of the nursing work for these patients is conducted in hospitals, with the main purpose to relieve the patient's physical and mental burden, improve treatment compliance, and prevent adverse reactions that may occur during treatment. However, out-of-hospital care services are unavailable, leading to somber compliance and impeding the prognosis [ 19 , 20 ].…”

Nurses’ Communication With the Families of Patients at the End-of-Life

“…As results highlight, inadequate communication literacy restricts the nursing communication skills in the care of families at the end-oflife situations. In this regard, a study by Stacy et al (2019) indicates that nurses are inadequately prepared to communicate with the families of end-of-life patients because of their cure focused education and families often report the poor quality of communication about the dying process. In this study, the nurses were not interested in discussing with the family about the patient's prognosis because of the fear of legal consequences.…”

“…Effective communication strategies include information sharing (Liaschenko et al., 2009), compassion (Doane & Varcoe, 2006), attentive listening, and being honest (Isaacson & Minton, 2018). Effective communication with the family about the treatment plan and the condition of the dying patient improve family’s satisfaction with the care and prepare them to make appropriate end-of-life decisions (Kirchhoff & Faas, 2007; Thompson et al., 2012). By adopting effective communication, nurses will be able to reduce the psychological burden on the family (Schmidt & Azoulay, 2012).…”