A QI initiative to enhance nurses comfort level in providing EOL care on a general internal medicine ward

Abstract

Background and objective: Ideally, nurses should have acquired the knowledge and skills to provide not only pain and symptom management, but emotional support to dying patients and their families. In actual fact, nurses often feel under-educated, under-skilled, inexperienced and uncomfortable in providing comprehensive end of life care. A standardized protocol for assessing imminently dying patients’ symptoms and psychosocial needs was implemented at a tertiary academic hospital. The aim of this quality improvement initiative was to enhance the education and training of nurses on one acute care ward, around the implementation of the Comfort Measures Order Set for end of life care, specifically focusing on the provision of emotional support for dying patients and their families.Methods: Education sessions were offered to the nurses on one acute care ward as the study intervention, and the initial phase of one PDSA cycle. Descriptive statistics were used to analyze questionnaire responses; content analysis was used in reviewing the qualitative data.Results: Pre-intervention, over 70% of nurses did not feel comfortable providing emotional support to dying patients for whom the Comfort Mesaures Order Set was initiated. Post-intervention, nurses reported being more comfortable and knowledgeble.Conclusions: The goal of comfort care at end of life requires the skilled use of the Comfort Measures Order Set. The Advance Practice Nurse role, as part of the Palliative Care Consult Team, is specialized in providing emotional support to patients on comfort measures through research, theory development, education, practice, collaboration, and leadership across the institution.