END-OF-LIFE CARE: -Part 6
ARE NURSES EDUCATIONALLY PREPARED?
III. RECOMMENDATIONS
A major deficiency in current nursing texts in the area of EOL
care and consequently, deficiencies in nursing care of the
dying exists. Although many examples of inaccurate information
were found, the most significant deficiency was the absence of
essential content on EOL care in curricula and texts (Ferrell,
1999). Nursing care should enable the terminally ill to
continue as vital, functioning participants in life, and to
maintain their identity and capacity to contribute as full
human beings, with family support, until the end of their
lives. Nurses rated the lack of nursing education in EOL care
as an obstacle, but many may not realize the full benefits of
an in-depth course in EOL care. A current study identified 87%
of nurses stated that they care for dying patients in their
current role; 28% said they never cared for a dying patient
during nursing school. Most respondents (89.5%) believe that
end-of-life content is important for basic nursing education.
When asked how well their basic nursing education prepared them
for providing EOL care, however, 71 % rated pain management
education as inadequate, 62% rated overall content of EOL care
as inadequate, and 59% rated management of other symptoms as
inadequate. One-third of the nurses stated they received less
than two hours of continuing education at their job site in EOL
care (Ferrell, 2000). Nursing staff identified two major areas
in which additional knowledge would be welcomed. These areas
include: spiritual-psychosocial health areas and physical
health areas. Education should focus on these areas. Although
educators have begun to recognize the importance of EOL care
education in nursing schools, few programs have specialties
related to EOL care and continuing education is minimal and
inconsistent. Because of this, EOL dilemmas are common in
nursing practice and barriers exist in providing high quality
EOL care.
Despite progress, practicing nurses face many dilemmas and
barriers to providing high quality EOL care. Changing
educational curricula and continuing professional education is
the first step toward changing practice. Although efforts are
being made to improve curricular content regarding EOL care,
practicing nurses have varying exposure to basic education and
continuing education for effective EOL care outcomes.
To achieve consistent high quality EOL care practices, I
believe that the following core competencies should be
incorporated into course curricula and continuing education
classes as recommended by the American Association of Colleges
of Nursing. These competencies address the major deficiencies
cited as focus areas for improvement that encompass
spiritual-psychosocial health and physical health.
Competencies Necessary for Nurses to Provide High-Quality Care
to Patients and Families during the Transition at the End of
Life
1. Recognize dynamic changes in population demographics, health
care economics, and service delivery that necessitate improved
professional preparation for end-of-life care.
2. Promote the provision of comfort care to the dying as an
active, desirable, and important skill, and an integral
component of nursing care.
3. Communicate effectively and compassionately with the
patient, family, and health care team members about end-of-life
issues.
4. Recognize one's own attitudes, feelings, values, and
expectations about death, and the individual, cultural, and
spiritual diversity existing in these beliefs and customs.
5. Demonstrate respect for the patient's views and wishes
during end-of- life care.
6. Collaborate with interdisciplinary team members while
implementing the nursing role in end-of-life care.
7. Use scientifically based standardized tools to assess
symptoms (e.g., pain, dyspnea, gastrointestinal symptoms,
anorexia/cachexia, asthenia, anxiety, delirium, depression, and
communication barriers) experienced by patients at the end of
life.
8. Use data from symptom assessment to plan and intervene in
symptom management using state-of-the-art traditional and
complementary approaches.
9. Evaluate the impact of traditional, complementary, and
technological therapies on patient-centered outcomes.
10. Assess and treat multiple dimensions, including
spiritual-psychosocial and physical needs to improve quality at
the end of life.
11. Assist the patient, family, colleagues, and one's self to
cope with suffering, grief, loss, and bereavement in
end-of-life care.
12. Apply legal and ethical principles in the analysis of
complex issues in end-of-life care, recognizing the influence
of personal values, professional codes, and patient
preferences.
13. Identify barriers and facilitators to patients' and
caregivers' effective use of resources.
14. Demonstrate skill at implementing a plan for improved
end-of-life care within a dynamic and complex health care
delivery system.
15. Apply knowledge gained from palliative care research to
end-of-life education and care.
The purpose of these competency statements is to assist nurse
educators in incorporating EOL content into nursing curricula
(AACN, 2001). The competencies were developed with the
understanding that few schools of nursing offered a discrete
course in EOL care. Thus, the competencies offer an approach to
incorporating EOL content throughout the currently existing
curriculum.
A deficiency in current nursing texts in the area of EOL care
also exists. Quantitative results show only 2% of content
related to EOL care (Ferrell, 1999). To strengthen nursing
education in EOL care, I believe that revision of texts based
on this analysis will help accomplish this goal. Texts devoted
to overall EOL care including current research and clinical
practice advances must be incorporated by publishers in future
editions. Revision of texts is a major endeavor requiring
considerable time until new editions are published with
improved EOL content. Using supplemental materials for EOL care
until adequate content is available in texts will be important
for educators.
Cont'd
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