Quality of End‐of‐Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals

Abstract

Objectives The purpose of this study is twofold: (1) to describe the quality of end‐of‐life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end‐of‐life care quality. Design Cross‐sectional analysis of multiple linked secondary data sources. PARTICIPANTS and SETTING A total of 12,870 direct care registered nurses in 491 acute‐care hospitals. Measurements Measures of end‐of‐life care quality and nurse practice environment were derived from the 2016 RN4CAST‐US survey of nurses. Nurses reported on end‐of‐life care quality for patients for whom death within a year would not be surprising. Nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index, a National Quality Forum validated scale. Results Most nurses gave their hospitals an unfavorable evaluation of end‐of‐life care overall (58%) and said patients often experience painful procedures that were unlikely to change their outcome (53%). The best predictor of poor quality was the nurse practice environment. Nurses in the best environments were 55% less likely than nurses in poor environments to rate their hospital's overall end‐of‐life care quality unfavorably (odds ratio = 0.45; 95% confidence interval = 0.39–0.52; P < .001). Conclusion Quality of end‐of‐life care in US hospitals is imperfect and is significantly worse in hospitals with poor nurse practice environments than in hospitals with the best environments. This study reinforces the importance of nurses in providing high‐quality end‐of‐life care. J Am Geriatr Soc 67:302–308, 2019.

Improving End-of-Life Care for Hospitalized Older Adults: What Can Nurses and Health Care Systems Do?

“…Many nurses rate the quality of end-of-life care provided by their hospital as poor, with a high number of invasive procedures and poor communication at the end of life as significant factors contributing to this poor rating (Lasater, Sloane, McHugh, & Aiken, 2019). A high level of moral distress among nurses surrounding end-of-life issues can exist.…”

“…Increased moral distress has also been correlated with a poorly rated ethical climate (Altaker, Howie-Esquivel, & Cataldo, 2018). Increased nurse involvement in communication and development of the plan of care with the patient, family, and health care team can improve the ethical climate and overall quality of care provided, as well as decrease moral distress (Altaker et al, 2018;Lasater et al, 2019). Higher quality end-of-life care is also linked to better nurse practice environments, including factors such as nurse involvement in hospital aff airs, manager support, adequate staffi ng, and nurse-physician relationships (Lasater et al, 2019).…”

“…Increased nurse involvement in communication and development of the plan of care with the patient, family, and health care team can improve the ethical climate and overall quality of care provided, as well as decrease moral distress (Altaker et al, 2018;Lasater et al, 2019). Higher quality end-of-life care is also linked to better nurse practice environments, including factors such as nurse involvement in hospital aff airs, manager support, adequate staffi ng, and nurse-physician relationships (Lasater et al, 2019). Because of the importance of healthy work environments, the American Association of Critical Care Nurses (AACN; 2016) and the American Nurses Association (ANA; n.d.) have focused eff orts on providing specifi c recommendations for ways to improve the work climate.…”

Nurses' moral distress in end-of-life care: A qualitative study

“…12 Several studies have focused on moral distress among nursing staff, [13][14][15][16] and the triggers and consequences of moral distress associated with end-of-life care have been widely studied. [17][18][19][20][21] However, moral distress is an often neglected issue by palliative education programmes, and research has largely focused on the phenomenon as an occupational problem for nursing staff. 1 To our knowledge, no qualitative study has been conducted in Italy exploring the morally distressing events that occur among nursing hospital staff in onco-haematological settings.…”

Optimising compassionate nursing care at the end of life in hospital settings

“…Furthermore, the hospital is where disease‐modifying treatment is provided and where people will often present when needs are unable to be managed at home. Therefore, providing high‐quality culturally appropriate compassionate palliative care in hospital represents a key priority for nurses (Lasater, Sloane, McHugh, & Aiken, ). However, studies have shown that patient and family experiences of palliative care in hospital settings are often sub‐optimum (Merryn Gott, Ingleton, Bennett, & Gardiner, ; Robinson, Gott, & Ingleton, ).…”