Effect of a Palliative Care Nurse Champion Program on Nursing Care of Dying Patients in the Hospital: A Controlled before and after Study

Abstract

Objective: Hospitals increasingly appoint nurse champions to improve quality of care. This study investigated the effect of palliative care nurse champions on nursing end-of-life care. Methods: Imbedded in a controlled before-after study (June 2009-July 2012) on care for the dying patient in the hospital, nurses completed questionnaires on end-of-life care within two weeks after the patient’s death. Halfway the study, seven out of 18 participating wards appointed two palliative care nurse champions. Characteristics of end-of-life care were compared for patients who died before and after the introduction of the nurse champion program and with outcomes in 11 control wards. Results: In the intervention wards, data were collected on 81 patients in the pre-intervention period and on 93 patients in the post-intervention period; in control wards these numbers were 114 and 121, respectively (response 54%). After the introduction of the nurse champion program, nurses in the intervention wards more frequently discussed imminent death with patients (35% pre-intervention vs 50% post-intervention, p=0.05), were more frequently aware of psychological symptoms (57% vs 71%, p=0.04), and performed less futile interventions during the final hours (on average 0.8 vs 0.4 out of 4 interventions, p<0.01). These differences were not found in the control wards. No effect was found on nurses’ awareness of patients’ imminent death. Nurses’ median score for quality of dying was lower in the postintervention period (7.5 vs 7.0 on a 0-10 scale; p=0.02). Conclusion: It had a beneficial effect on end-of-life nursing care in hospital. We found increased communication and more awareness of patients’ palliative care needs. Increased awareness seems to have made nurses more critical about the quality of dying.