Paper
Sunday, November 4, 2007
171
Exploration and Assessment of Interventions for Symptom Mangement for Older End of Life Patients
Sheila Grossman, PhD, APRN-BC, FNP, School of Nursing, Fairfield University, Fairfield, CT, USA
Background: There are multiple gaps in end-of-life care for older adults with advanced chronic illness. Palliative care programs are either nonexistent or underutilized in long term care facilities. Studies indicate that nurses do not feel competent or confident in implementing symptom management at end-of-life.
Purpose: The purpose was to identify the frequency of documented symptoms [fatigue/weakness, anorexia/cachexia, sadness/depression, dyspnea, nausea & vomiting, anxiety/fear, confusion/delirium, diarrhea, pain, and constipation], the pharmacological and non-pharmacological interventions conducted for the symptom(s), and patient response in older end-of-life patients prior and post an educational intervention on symptom management for nurses.
Study Design: A retrospective 3 month chart review was conducted on 64 patients at two long term care agencies pre and post an educational intervention to assess frequency of identified symptoms, interventions, and responses. The educational program was based on the End of Life Nursing Education Curriculum (ELNEC). A pre and post test was given to the nurses (KR 20= .59 - .61) to measure knowledge base.
Findings: Aggregate frequency data revealed a statistically significant increase in number of interventions and improved patient response for seven out of nine symptoms. Comprehensive descriptions of interventions and patient outcomes were documented more frequently for pain, dyspnea, and nausea & vomiting post education for nurses. There were no significant correlations between symptom management and demographic data or medical diagnosis. There was a statistically significant difference in pre and post test scores for nurses.
Conclusions: Nurses improved their knowledge base on end-of-life care as evidenced by increased post test scores and improved practice as measured by increased documented interventions and patient response to symptom management. Findings indicate that more education should further improve patient outcomes regarding end-of-life symptom management.