End-of-Life Care Competencies Among Critical Care Nurses

Introduction: End of life care is integral to critical care nurses’s competencies. The need for ongoing education in this area of practice is widespread and the consensus and standardization is somewhat lacking. It is important to understand that with the diversities in the educational, socio-cultural and ethnic backgrounds among these nurses, it is a often a challenge to determine the continuing educational needs. The purpose of this study was to understand the critical care nurses’ attitudes, perceptions, proficiency as well as the coping mechanisms in providing the end of life care to the patients and their families. Data collected from the study is aimed at designing the educational modules for ongoing training and support of critical care nurses.

Methods: An anonymous web-based needs assessment survey was utilized to study the attitudes, perceptions, proficiency of critical care nurses working at a community teaching hospital. Four-point Likert scale was utilized to collect data regarding several areas of end of life care, including self-reported competencies in performing essential end of life care functions, as well as the attitudes towards various practices with respect to legal and/or ethical concerns. Further, common coping mechanisms were also identified.

Results: Critical care nurses (n-123) practicing in the Intensive Care Unit (ICU) and Emergency Department (ED) participated in the study. Critical care nurses with >10 years of experience reported having a higher levels of competence in delivering bad news (p=0.00046) and referring patients to hospice (p=000001). Differences in self-perceived proficiency in various patient/family interactions and pain management areas were not statistically significant. Further, participants were also asked about their practices in coping mechanisms to handle the emotional burden of providing care at the end of life of patients. The most common coping mechanisms were; talking to coworkers, self-reflection and participation in individual hobbies. The nurses’ levels of concerns while providing maximal pain relief to non-terminal cancer patients were also studied. Nurses with >10 years of experience had greater (statistically significant) ethical, legal and religious concerns about providing maximum pain relief and withdrawing life support in non-terminally ill patients compared to those nurses with >10 years of experience.

Conclusion: Critical care nurses with >10 years of nursing experience perceived themselves as more proficient in delivering bad news and hospice referrals. Also, these nurses with >10 years of nursing experience were also more aware of ethical, legal and religious sensitivities compared to those with <10 years of experience. This study reaffirms the need for ongoing and periodic education in end of life care for all critical care nurses. This study also reiterates that the support system to speak to other coworkers as well as the opportunities for self-reflection remain common coping mechanisms for nurses providing end of life care.