Heart Failure Nurses Learn How to Have Palliative Care Conversations

Saturday, March 28, 2020: 10:55 AM

Caroline Jenkins, BSN1
Stephanie L. Turrise, PhD, RN, BC, APRN, CNE, CHFN-K1
Tamatha Arms, DNP, PMHNP-BC, NP-C, RN1
Andrea Jones, PhD, MSW, LSW2
(1)School of Nursing, University of North Carolina Wilmington, Wilmington, NC, USA
(2)School of Social Work, University of North Carolina Wilmington, Wilmington, NC, USA

Purpose: Heart failure (HF) is a progressive condition affecting 6.2 million Americans (Benjamin et al., 2019). The use of palliative and supportive care for symptom management and improved quality of life (QOL) is recommended for those with HF (Yancy et al., 2013). However, 91% of nurses felt they needed further training to have palliative care conversations due to the unpredictable disease trajectory of HF (Hjelmfors et al., 2014). It is essential for nurses to have these conversations in a sensitive and meaningful way (Achora & Labrague, 2019). The purpose of this pre-test, post-test pilot intervention study was to determine feasibility and effectiveness of an e-learning module providing nurses with education on the timing and content of palliative care conversations to increase their perceived skill and knowledge in having these conversations.

Methods: After receiving IRB approval, nurses caring for HF patients in southeastern North Carolina were recruited via an email listserv through the Southeast Area Health Education Center (SEAHEC). Participants were directed via a link to a learning module that contained a screening question verifying that the individual was a nurse who worked with HF patients, pre-test demographic survey and the End of Life Professional Caregiver Survey (EPCS) (Lazenby, Ercolano, Schulman-Green, & Mccorkle, 2012) in Qualtrics. Nurses then viewed a short testimonial from a caregiver on palliative care, and then an hour long webinar titled: What do Your Patients Need to Hear From You and When do They Need to Hear It?: Appropriate Communication Across the Trajectory of Heart Failure. The EPCS was completed again post-webinar completion. Nurses’ perceived knowledge and skill was assessed using the EPCS total score and three subscales, patient and family centered communication, cultural and ethical values, and effective care delivery. As an incentive to participate, nurses could earn one hour of free continuing education credit. Descriptive statistics and independent t-test were used to analyze de-identified data.

Results: Twenty-one nurses completed the pre-test; twenty started the post-test but only thirteen of these were complete. Majority of participants were female (n=21, 100%), Caucasian (n=18, 85.7%), age 60-69 (n=6, 28.6%), married (n=14, 66.7%), ADN prepared (n=8, 38.1%). employed full time (n=16, 76.2%), had worked with heart failure patients for 0-9 years (n=11, 52.4%) and reported “other” as the type of facility they worked in which included the health department, physician’s office, home health, home palliative care, and hospice. Scores increased on all dimensions from pre-test to post-test. There were statistically significant differences in effective care delivery and total EPCS scores from pre-test to post-test indicating that the webinar was effective in improving nurses perceived skills in effective care delivery and overall skills in palliative and end of life care conversations.

Conclusion: Providing asynchronous education on the timing and content of palliative care conversations with HF patients is a feasible and effective way to improve nurses’ perceived skill and knowledge in having these discussions. Nurses who are better equipped to have these conversations may result in more referrals for palliative care services earlier in the illness trajectory, resulting in improved symptom management and QOL.

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