End-of-life (EOL) care training in acute medical setting among nurses in Hong Kong

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Authors (including presenting author) :
Leung WH(1), Chong YY(1), Wong MK(1), Lai CT(2)
Affiliation :
(1)Medical & Geriatric, United Christian Hospital, (2)Medical & Geriatric, Ruttonjee Hospital
Introduction :
Palliative care is defined as an approach to improve quality of life of patients and their carers who are facing advanced progressive life-limiting disease by means of prevention and relief of physical, psychosocial and spiritual symptoms (WHO, 2018). End-of-life (EOL) care is defined as any palliative care provided to eligible patients within the last 12 months of life (NICE, 2011). Despite the benefits of EOL care in palliative care unit , majority of deaths occur in acute general medical settings due to limited resources, rapid and unexpected deterioration (Willard & Luker, 2006). Providing EOL care to patients is regarded as an integral part for health care professionals (NICE, 2011). However, evidences showed that lack of knowledge and confidence, misconceptions towards palliative and EOL care among frontline nurses could be a big challenge in acute hospital setting.
Objectives :
(1) To enhance EOL care knowledge among nurses; (2) To clarify nurses' misconception in EOL care.
Methodology :
A single-arm pretest-posttest design was adopted. A total of 25 nurses from general medical ward in the United Christian Hospital were recruited. Identical 1-hour training sessions were provided by two trained interveners in May 2018. A small group training (8 - 9 participants per session) design was adopted to ensure intervention fidelity. Multi-method training approach including presentation, case study and practical tips sharing was carried out in this interactive reinforcement training. Training included general principal of symptomatic control, pain and dyspnea management, clarification of misconception of EOL care and some practical tips to handle personal feeling and emotional detachment. Study outcomes were EOL knowledge, clarification of EOL care and nurses’ satisfaction and competency. Self-administered questionnaire was used.
Result & Outcome :
At baseline, nurses reported lack of competency in providing EOL care. After the intervention, all participants showed improvement in EOL knowledge and symptoms management. The overall correction rate of EOL knowledge increased from 56.8% to 81.5% and the overall correction rate of symptoms management increased from 65% to 76.9%. Nurses reported higher competency and were clearer of EOL concept. They reported the training was helpful in clinical practice. Conclusions: This study showed that a nurse-led structured training was effective to consolidate EOL knowledge and improve nurses’ satisfaction. Nursing staff showed positive learning attitude and great interest in EOL care. They agreed that training helped them to be more competent to help EOL patients in their final life journey. A group-based, multi-method approach demonstrated effectiveness and received positive feedbacks. Further training to nurses and other healthcare professionals in other settings was indicated. Regular reinforcement training is paramount to update and consolidate the knowledge in EOL care.

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