Nurses' Knowledge, Attitude, and Confidence in Delivering Palliative Care for Hospitalized Patients with Heart Failure: An Integrative Review (S707)

Abstract

•Define the current heart failure clinical practice guidelines regarding the nurses’ role in communicating palliative care options to patients.•Identify the nurses’ perceived communication barriers to delivering information to individuals in the palliative phase of heart failure.•Discuss opportunities and strategies to remove palliative care communication barriers in the acute care setting. Heart failure is a nonmalignant, chronic, complex, syndrome that is common and burdensome. International heart failure clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients. The aim was to conduct an integrative review to review how nurses perceived communication barriers to delivering information to individuals in the palliative phase of heart failure. CINAHL, Embase, PubMed, Scopus, and the gray literature were searched from January 1987 to February 2017. Articles were considered if participants involved nurses caring for adult heart failure in the acute care setting and the nurses identified communication barriers that inhibited palliative care discussions. Articles were excluded if the nurse was not in direct care or primarily an outpatient setting. Studies were graded for strength and quality using a reliable critical appraisal tool. Articles were formatted into a summary tool and key themes were extracted and synthesized. Sixteen articles met the full inclusion criteria. Most studies were qualitative or non-experimental studies of good quality. Several studies found that nurses lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of health providers of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach. The results of this review emphasize a lack of knowledge as a barrier to delivering palliative care. Nurses caring for individuals with heart failure need palliative care knowledge, skills and competencies to ensure that this vulnerable population receives patient centered care. To bring about practice change, education will need to be incorporated into all levels of nursing, including students and practicing nurses.