Improving end-of-life care through quality improvement

Stilos, Kalli; Wynnychuk, Lesia; DasGupta, Tracey; Lilien, Tammy; Daines, Patricia

doi:10.12968/ijpn.2016.22.9.430

Cited by 18 publications

(20 citation statements)

References 23 publications

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“…Today, special interest is growing in experiential learning because constant exposure to the process of dying helps nurses learn about the care of terminal patients (15) . Insufficient nursing knowledge of research (16) was improved by educational projects and evidence-based practice guides for the care of dying patients and their families (17) . Barriers such as gaps in the knowledge of research and the feeling of a lack of support and leadership on the part of nurses make it difficult to implement evidence-based care in practice (18) .…”

Section: Introductionmentioning

confidence: 99%

Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey

Povedano-Jiménez

Gámez

García‐Caro

2020

Rev. Latino-Am. Enfermagem

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Objective: to explore self-perception competence among Spanish nurses dealing with patient death and its relationship with work environment, evidence-based practice, and occupational stress. Method: a cross-sectional web-based survey collected information from a convenience sample of 534 nurses from professional Spanish Colleges who answered four validated questionnaires: Coping with Death Scale, Practice Environment Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP) and Nursing Stress Scale. Results: a total of 79% of the participants were women, the average age was 40 years old, 38% had a postgraduate degree and 77% worked in public health settings. Many nurses evaluated their work environment as unfavorable (66%), reported high occupational stress (83.5±14.9), and had high scores on knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an optimal coping (>157 score). The multivariate logistic model indicated positive associations with work environment and EBP characteristics (OR: 1.30, p=0.054; OR: 1.04, p=0.007; OR: 1.13, p<0.001, respectively) but negative associations with occupational stress and short work experience (OR: 0.98, p=0.0043; OR: 0.74, p<0.002, respectively). These factors explained 23.1% of the coping variance (p<0.001). Conclusion: although most nurses perceived optimal coping, the situation could be enhanced by modifying several contextual factors. The identification of these factors would improve the quality of end-of-life care by facilitating nursing management.

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Section: Introductionmentioning

confidence: 99%

Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey

Povedano-Jiménez

Gámez

García‐Caro

2020

Rev. Latino-Am. Enfermagem

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“…In-services were conducted on the hospital's general internal medicine and oncology units, as a previous study demonstrated that these units generate the highest volume of referrals for end-of-life care. [ 18 ] Nurses were asked to complete a baseline survey and a follow-up survey after the in-service training.…”

Section: Methodsmentioning

confidence: 99%

Improving the Management of Terminal Delirium at the End of Life

Sutherland

Pyakurel

Nolen

et al. 2020

Asia-Pacific Journal of Oncology Nursing

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Objective: Terminal delirium is a distressing process that occurs in the dying phase, often misdiagnosed and undertreated. A hospital developed the “comfort measures order set” for dying patients receiving comfort care in the final 72 h of life. A chart review of patients experiencing terminal delirium revealed that the current medication option initially included in the order set was suboptimally effective and patients with terminal delirium were consistently undertreated. The purpose of this pilot study was to highlight an in-service intervention educating nurses on the management of terminal delirium at the end of life and to assess its effect on their knowledge of the management of patients with terminal delirium. Methods: A before-and-after survey design was used to assess the effect of the in-service training on nurses' knowledge of terminal delirium. Results: We describe the results from a small sample of nurses at a large urban tertiary care center in Canada. Of the twenty nurses who attended the in-services, 60% had cared for a patient with terminal delirium; however, 50% felt that their knowledge of the topic was inadequate. Despite no statistical significance between the pre- and posttest scores for both the oncology and the medicine unit nurses, all participants who completed posttest survey found the in-services useful. Conclusions: The findings from this study provide initial insights into the importance of in-service trainings to improve the end-of-life care and nursing practice. Future research will include expanding this pilot project with sufficient power to assess the significance of these types of interventions.

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“…Our hospital developed and implemented a standardized approach to EOL care, the CMOS, as previously described. 21 The CMOS was created through a rigorous approach, the rationale of which was to facilitate hospital-wide education for identifying, evaluating, and addressing palliative needs of "imminently dying patients" with or without a malignancy. Standardized order sets can be an invaluable tool in establishing best practices for EOL care in acute care settings.…”

Section: Comfort Measures Order Set With Cied Deactivation Embeddedmentioning

confidence: 99%

“…22,23 The CMOS contains elements of symptom assessment and management, patient/family education, and guidance on offering spiritual and emotional support. 21 The deactivation of ICDs is embedded in the CMOS order set. Order sets decrease variability of orders among prescribing clinicians who are less familiar with managing EOL care symptoms while encouraging all clinicians to address important facets of patients' needs in the final hours to days of life.…”

Section: Comfort Measures Order Set With Cied Deactivation Embeddedmentioning

confidence: 99%

Quality dying: An approach to ICD deactivation in the hospital setting

Turner

Torabi

Stilos

2020

Am J Hosp Palliat Care

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Background: In Canada, cardiovascular disease is the second most common cause of death. A subset of these patients will require a cardiovascular implantable electronic device (CIED). An estimated 200 000 Canadians are living with a CIED. CIEDs can improve life and prevent premature death. However, when patients reach the end of their lives, they can pose a challenge. An example of which is a painful shock delivered from an implantable cardioverter defibrillator (ICD) for an arrhythmia in a dying patient. Receiving a shock at the end of life (EOL) is unacceptable in an age when we aim to ease the suffering of the dying and allow for a comfortable death. Methods: As a quality standard of practice, all clinicians are expected to engage in EOL conversations in patients requiring CIED deactivation. Due to the potential discomfort of an ICD shock, specific conversations about deactivation of an ICD are encouraged. A process improvement approach was developed by our hospital that included an advance care planning simulation lab, electronic documentation and a standardized comfort measures order set that includes addressing the need for ICD deactivation at EOL. Results: EOL conversations are complex. Health care providers have been equally challenged to have conversations about ICD deactivation. Standardization of the process of ICD deactivation ensures an approach to EOL which respects the individuality of patients and promotes quality dying. Conclusion: Our hospital is committed to assisting clinicians to provide quality care by improving conversations about EOL care. On the basis of a synthesis of existing literature, we describe the importance of and the ideal process for having EOL conversations in patients about ICD deactivation at the EOL.

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Improving end-of-life care through quality improvement

Cited by 18 publications

References 23 publications

Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey

Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey

Improving the Management of Terminal Delirium at the End of Life

Quality dying: An approach to ICD deactivation in the hospital setting

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