Caring With Confidence: A Guided Approach to End-of-Life Care

Key Message: A brief end-of-life education using the CARES toolset improved nurses' attitudes, confidence, and engagement in caring for dying patients, demonstrating the value of structured tools and training in promoting individualized, compassionate, and sustainable end-of-life care practices.

Abstract:

Background: Nurses may face uncertainty when caring for dying patients due to inadequate education and experience. This uncertainty coupled with varying practices for end-of-life care may affect both care quality and nurses’ attitudes. In nurses caring for hospitalized End-of-Life patients, does having a guided End-of-Life template and care resources, compared to current practices, improve registered nurse attitudes in providing individualized end-of-life care?

Approach: Two inpatient nursing units received a 30-minute End-of-Life educational intervention utilizing the City of Hope’s Comfort, Airway, Restlessness and Delirium, Emotional and Spiritual Support (CARES) toolset as a standard resource to assess and prioritize end-of-life symptom management and family communication. The Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B) measured changes in nursing attitudes pre-intervention and at set intervals post education. A baseline assessment and two follow-up evaluations have been conducted. These have shown some sustained positive changes in attitude. Several key findings emerged after intervention introduction. Initially, 86% of participants agreed with the notion that "death is not the worst thing that can happen" with this sentiment increasing to 91.7% in the first survey and further to 94.4% in the second. Regarding the role of non-family caregivers in discussing death, there was a notable shift from a baseline of 46.7% strongly agreeing to 75% in the first survey. The belief that families should maintain as normal an environment as possible for the dying rose from 68.9% to 77.8%.

Implications/significance: This project suggests improved comfort and confidence among RNs in providing end-of-life care with the use of the CARES toolset. Nurses also demonstrated increased interest in seeking additional education. Given the positive impact of a brief 30-minutes session, we recommend expanding to a full 2-hour class focused on end-of-life care to further improve RN attitudes and confidence in supporting dying patients and their families.

References: Freeman, B.J. (2013). The CARES Tool: Development and Application. DNP Translational Project, Azusa :CA, Azusa Pacific University.

Alison, et al. (2019) Improving Knowledge, Comfort, and Confidence of Nurses Providing End-of-Life Care in the Hospital Setting Through Use of the CARES Tools. doi: 10.1097/NJH.0000000000000510

Rees JN, Shields E, Altounji D, Murray P. An End-of-Life Care Educational Series to Improve Staff Knowledge and Comfort Levels. J Hosp Palliative Nurse. 2020 Dec;22(6):523-531. doi: 10.1097/NJH.0000000000000704. PMID: 33065572.