End-of-life care education for nurses : is it effective?

Abstract

Purpose of the study: Caring for dying patients has always been part of nursing, as highlighted by Florence Nightingale herself during the Crimean war. However, the international and local literature shows constant limitations in nurses' skills and knowledge to meet the needs and best assist dying patients and their families. Research illustrates that preparation to care for dying patients can be an excellent resource to influence and improve the end-of-life care for dying patients and their families. Research Question: Among nurses working in hospitals does education about the end-of- life care improve their delivery of care to dying patients? Search Strategy: A systematic search using a variety of eleven databases accessible at the University of Malta and Middlesex University was conducted for original articles that accessed the effectiveness of nursing education towards the end of life care as from 2000 to 2011. The search was extended by searching-the reference list of retrieved articles for pertinent articles and by hand searches in the library for any relevant nursing and palliative journals. Selection criteria: The inclusion criteria were English language articles related to end of life care education intervention for graduated nurses, which addressed communication training, empathy, skills or attitudes towards death or a combination of these. Appraisal of the Literature: A total of seven out of eighteen studies were identified when they were critically appraised using a specifically tailored tool the Critical Appraisal Skills Programme (CASP tool). Findings: Several studies pointed out that nurses, are inadequately prepared to meet the need of the dying patient and their families, which they claim to be due to lack of training. Various studies demonstrated that educational courses could improve nurses' attitudes, and increase power over their emotions, whereas anxiety caused by caring for dying patients, was reduced. Moreover, they felt less stressed in general and could offer emotional support to patients and their families. Others, reported a significant improvement of communication skills and confidence scores when dealing with patients and their families.

Recommendations: Additional research in terms of communication skills programs, the use of utilizing reflective diaries, and about end-of-life care content in the curriculum are recommended. There is also space for further educational programs for all nurses regarding culturally competent care. Furthermore, educational programs at ward levels can easily be implemented while they can also be delivered electronically. Mentors can also be trained to help students in delivering quality end-of- life care; whereas articles related to end-of life care can be published in the Malta Nursing and Midwifery Journal "Il- Musbieh." In addition, emotional help and support should be offered to all staff caring for dying patients. Moreover, regular sessions can be organised to discuss encountering difficulties when caring for dying patients. Keywords: end of life care, nurse education, death and dying, communication skills, anxiety, knowledge.