Most nurses comfort the dying by listening to them and by administering pain medication, but more than half of the nurses in the hospital setting never discuss hospice care, a Yale study has found.
The study was a collaborative effort conducted with the John D. Thompson Institute for Education, Training, and Research (The Institute), an organization that has been promoting educational and research efforts to improve care of terminally ill patients and their families for more than 20 years.
More than 80 percent of the nurses surveyed reported using a range of palliative care practices in caring for terminally ill patients in the hospital. However, many reported large gaps in knowledge about hospice and palliative care, and a minority of these nurses feel well-trained to take care of terminally ill patients.
"These results underscore the importance of including curriculum related to the care of the dying in nursing educational programs," said Ruth McCorkle, director of the Center for Chronic Illness Care in the Yale School of Nursing and a co-author of the study published in the current issue of the Journal of Professional Nursing. "The content needs to be integrated across nursing specialties and concentrated as core content that meets the standards of good practice. Hospice care is an important part of health care delivery today and all professionals need to be able to discuss it as an option for patients and their families."
Claire Pace, vice president of advancement at The Institute, added, "Over the last six years, it has been very helpful to the students at schools of nursing, particularly at the Yale School of Nursing, to offer field placement at the Institute for a six-week period, which enables further understanding of palliative and hospice care."
The researchers surveyed 180 nurses at six randomly selected hospitals in Connecticut. To be eligible to participate, the nurses had to be employed full-time in the hospital and be assigned to medical, cardiology, pulmonology, or oncology patient care units.
The study's principal investigator, Elizabeth Bradley, assistant professor in the Department of Epidemiology and Public Health at Yale School of Medicine, said nurses' ease in talking to patients about hospice care is important because most people still die in the hospital setting, despite the growth of hospice services in the United States. Only 14.7 percent of people die receiving hospice services.
Other studies have found that patients with terminal illnesses often do not receive hospice care because of physicians' reluctance to discuss prognostic information with patients; the patients and families desire for aggressive treatment; the suddenness with which death often occurs, and inadequate training in palliative care among health care professionals.
Nearly two-thirds of the nurses surveyed had some hospice training, but less than 30 percent felt they were knowledgeable enough to discuss hospice care with patients. Many did not know when a patient can become eligible for hospice care and other basic information that might be needed by patients and their families considering care alternatives for their terminal illness.
"The implications of the research for nursing education are substantial," the authors said in the study. "The results suggest that, despite strong educational programs such as those offered by the Institute and the Yale School of Nursing, there are large gaps in knowledge about hospice among nurses in the acute care setting, and a minority of nurses in the acute care setting feel knowledgeable enough to discuss hospice with terminally ill patients and their families. Those with clinical expertise and research data, such as the Institute, may be helpful to address the educational needs apparent from this study."
"Further, the results suggest that such knowledge and training deficits have a measurable effect on both the use of specific palliative care skills and more general communication with patients and families in the end of life," she said.
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