Abstract and Introduction
Abstract
Death is a common occurrence in the hospital setting. Research findings indicate that nurses lack knowledge and are uncomfortable with the care of seriously ill or dying patients. Most nurses report learning about end-of-life care through professional and personal experiences rather than their undergraduate programs. Education may improve nursing knowledge and ultimately behavior, but there are many competing mandatory education requirements. Any widespread education program must be brief, easy to administer, and available to nursing staff working different shifts. A 30-minute online introduction to palliative care (narrated PowerPoint presentation) was created and delivered to registered nurses (n = 23) working on a general medical unit. The Palliative Care Quiz for Nursing was administered prior to viewing the educational presentation, immediately after, and 3 weeks later. Average scores of 57.6% before education increased to 72.2% after the online session and were sustained at 70% 3 weeks later. Nurses believed the education was informative, and most indicated they would change their practice. Although many nurses would prefer a live presentation, there was acceptance of the online format. The results highlight deficiencies in palliative care nursing knowledge and provide direction for future nursing palliative care educational endeavors.
Introduction
In the United States in 2010, 25% of Medicare beneficiaries died in the acute care setting, and 16.7% of these deaths were associated with an intensive care unit admission. Results from the SUPPORT study highlighted deficiencies in care at the end of life in the hospital setting. Palliative care evolved to improve care of people with life-limiting diseases and end-of-life care. More than 1600 hospitals, which accounts for 87.9% of hospitals with more than 300 beds, have palliative care teams today. Clinical guidelines formalize and optimize the delivery of patient- and family-centered palliative care. The Joint Commission (TJC) Advanced Certification for Palliative Care Programs recognizes quality interdisciplinary hospital inpatient palliative care programs that provide optimal care to individuals with advanced disease and their families. To date, 56 US hospitals have earned this certification. Hospitals that have received TJC Advanced Certification for Palliative Care must have structures in place according to palliative care standards, clinical care based on guidelines, and palliative care performance improvement initiatives. Staff competence is essential to meet these standards to provide quality care to individuals with advanced disease and at the end of life.
Nurses can make a difference for those individuals with advanced disease by communicating with health care providers, advocating for patients, providing support to families, facilitating decision making, and ensuring optimum pain and symptom management. Results from several surveys of generalist-level staff nurses have indicated a lack of preparation and comfort with the care of people with advanced disease and the need for continued education in palliative care. Despite having more years of experience and specialist-level critical care backgrounds, nurses still expressed their challenges with communication related to cultural, spiritual, end-of-life, and bereavement issues and how these discussions can impact them emotionally. Lack of palliative care knowledge and skills in nursing extends beyond the United States, according to results from surveys in Australia, Canada, Iran, Korea, and the United Kingdom. Thus, palliative care education is an international imperative to ensure nursing professionals' comfort and competence in caring for those with advanced disease.
Nurses report the lack of adequate palliative care preparation in their undergraduate curricula and a need for education in end-of-life care. In 2000, the End-of-Life Nursing Education Consortium (ELNEC) was developed to address the educational needs of nurses in the care of the seriously ill and those at the end of life and has been adapted in the last decade for specific populations (pediatrics, critical care, veterans, geriatrics) and settings (advanced practice nursing, public hospitals, and international populations). The ELNEC curriculum is consistent with the National Consensus Project for Palliative Care Clinical Practice Guidelines and is divided into the 8 domains of palliative care: Nursing Care at the End of Life; Pain Management; Symptom Management; Ethical/Legal Issues; Cultural Considerations in End-of-Life Care; Communication; Loss, Grief, Bereavement; and Preparation for and Care at the Time of Death. An estimated 390 000 nurses have participated in ELNEC education. In addition, about 11 891 registered nurses (RNs), 161 pediatric RNs, and 1022 licensed practical/vocational nurses nurses have received specialty certification through the National Board for the Certification of Hospice and Palliative Nursing. The ELNEC training and hospice and palliative care nursing certification are available, and nurses can develop specialty-level skills. Lack of finances and lack of time to attend remain primary barriers to this end.
In hospital settings, there are competing interests for mandatory training and education. Online education (Internet [Web] based, computer software programs, or e-mail) is utilized in many areas of nursing education. Results from a systematic review/meta-analysis of 11 studies from 2004 to 2010 to evaluate the impact of e-learning on nursing knowledge, skills, and satisfaction and a similar integrative review of 12 studies from 1997 to 2006 to evaluate the impact computer-assisted clinical nursing skills instruction revealed no significant differences between e-learning/computer-assisted training versus traditional learning.
Palliative care online education has been utilized to teach general palliative care information, palliative care in oncology, communication skills, and cultural and spiritual aspects of care. In 3 online learning implementation studies, there were statistically significant improvements in the posttest scores in medical residents, nursing assistants, and nurse practitioners. Most of the nurse practitioners indicated a change of practice as a result of the program. The programs were rated highly by both nurse practitioners and nursing assistants. Online education has the advantage of being able to reach large populations and may be the best venue to provide nursing with an introduction to palliative care.
The purpose of this study was to design and pilot a brief online introduction to palliative care for hospital nurses. The primary goal was to test an improvement in knowledge immediately after the education and the sustainability 3 weeks later. The secondary outcome was to evaluate the feasibility and likeability of the education and nursing intention to change practice