Paper
Wednesday, 19 July 2006
This presentation is part of : Palliative Care Issues and Studies
Nurses' Perceptions of End-of-Life Care Before and After “Interventions” in Intensive Care Units
Lissi Hansen, RN, PhD1, Teresa Tarnowski Goodell, PhD, RN, CNS, CCRN1, Leslie N. Ray, PhD, RN1, MaryDenise Smith, RN, CNS, ACHPN, MS2, and Josi DeHaven, RN, BSN3. (1) School of Nursing, Oregon Health & Science University, Portland, OR, USA, (2) Palliative Medicine and Comfort Care, Oregon Health & Science University, Portland, OR, USA, (3) Cardiac-Medical Intensive Care Unit, Oregon Health & Science University, Portland, OR, USA
Learning Objective #1: Describe the use of a survey of staff nurses' perceptions in evaluating improvements in end-of-life care in ICUs.
Learning Objective #2: Evaluate the aspects of our end-of-life program that can be applied in their own institutions.
Background: In 2003, based on research literature and clinical practice, we identified a need for improved end-of-life care in medical, surgical, coronary and trauma-neurosurgical intensive care units (ICUs) at an urban teaching hospital. Later that year, a palliative care team and a family bereavement program were implemented. Purpose: The study described nurses’ perceptions of 5 aspects of end-of-life care: (1) their knowledge and ability, (2) work situation, (3) sources of work stress, (4) support for staff, and (5) support for patients and families before (Phase I –2003) and after (Phase II – 2005) the implementation of the palliative care team/family bereavement program. Methods: The study used a repeated measures design. A 30-item survey measuring the 5 aspects was scored on a 4-point scale, ranging from very good (1) to poor (4). Internal consistency reliability for the 5 subscales was acceptable (.78-.92). We surveyed 270 nurses; 91 in Phase I and 127 in Phase II returned completed surveys. Results: Means and standard deviations on the 5 subscales in Phase I and II were respectively: knowledge and ability 2.1 (0.7) and 1.9 (0.6), work situation 2.5 (0.5) and 2.2 (0.6), work stress 3.2 (0.5) and 2.2 (0.6), support for staff 3.1 (0.7) and 2.7 (0.6), and support for patients and families, 2.6 (0.6) and 2.2 (0.6). All 5 subscale scores were significantly improved after implementation of the palliative care team and the family bereavement program. Implications: Despite improvements in nurses’ perceptions, 4 of 5 means remained above the criterion of 2 or less, indicating a need for continuing development in end-of-life care in the ICUs. Current efforts are directed at improving staff and patient/family support, including education and debriefings. The study provided a basis for improvements in end-of-life care in the ICUs that are now being expanded and extended to other departments.

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