The Impact of End-of-Life Care Training on Medical-Surgical Nurses

Monday, 9 November 2015

Suzanne P. Graf, BSN, RN, PHN
School of Nursing; Adult-Gerontology Clinical Nurse Specialist track, Mount Saint Mary's University, Valley Village, CA, USA

According to the Centers for Disease Control (CDC), the number of Americans age 65 years and older will double in the next 25 years. This translates to approximately 20% of the United States population being age 65 years or older by the year 2030. The CDC also reports that the predominant cause of death for older Americans has shifted from infectious disease to chronic disease. Currently, two out of three older Americans have multiple chronic diseases. These patients are often in and out of hospitals for intermittent treatments. However, even if the issues are acute in nature, they are occurring in the presence of multiple advancing diseases that together could result in a fatal event.

The National Center for Health Statistics reported that in 2010 one-third of the 2.5 million recorded deaths occurred in hospitals. Of those deaths, 75% were people age 65 and older. The Bureau of Labor Statistics reported in 2013 that of the 2.6 million registered nurses in the United States, 1.5 million were employed in hospitals. Of these professionals, the majority work in acute care areas often referred to as medical-surgical units. Therefore, it is easy to see that most registered nurses will likely experience the death of a patient while on duty during their career.

When one obtains a license to practice as a registered nurse, it is implied that you are trained to care for ill persons throughout the lifespan, which includes death. Currently, in the State of California, there is no specific requirement for nursing schools to teach end-of-life (EOL).

The aim of this study was to investigate the impact of EOL care training and other environmental variables on the lived experience of medical-surgical nurses caring for dying patients. The majority of research with regard to EOL has concentrated on the areas of intensive care and oncology. This research intended to bring to light the necessity of EOL care training for medical-surgical nurses in order to improve the quality of care for the growing number of older and chronically diseased patients that will die while hospitalized in these types of units.

A qualitative, phenomenological study was conducted utilizing a purposive sampling of registered nurses who have cared for a dying patient while working in a medical-surgical unit of a hospital, excluding oncology, in the United States. A total of 31 nurses completed a one-time survey of up to 20 closed and open-ended questions via an internet-based third party data collection service. The first incident of caring for a dying patient was reported to be between pre-licensure and two years of practice by 87%. The vast majority also reported having experienced losing a patient to death while on duty in a medical-surgical unit. Only 55% stated they had some sort of basic training in EOL in pre-licensure school or from an employer. All participants who had training indicated that it was valued and made some difference in their provision of care. More consistent and required EOL training needs to take place both pre-licensure and in continuing education. A vast majority of all participants (91%) desired future EOL care training primarily in the area of communication with the family. Time management and support, both emotional and institutional, were additional issues of concern for nurses caring for the dying.