End of Life Care

Nurses’ Perceptions of End-of-Life Care After Multiple Interventions for Improvement Lissi Hansen, Teresa T. Goodell, Josi DeHaven and MaryDenise Smith Am J Crit Care. 2009;18: 263-271 doi: 10. 4037/ajcc2009727  © 2009 American Association of Critical-Care Nurses Published online http://www. ajcconline. org Personal use only. For copyright permission information: http://ajcc. aacnjournals. org/cgi/external_ref? link_type=PERMISSIONDIRECT Subscription information http://ajcc. aacnjournals. org/subscriptions Information for authors http://ajcc. acnjournals. org/misc/ifora. shtml Submit a manuscript http://www. editorialmanager. com/ajcc Email alerts http://ajcc. aacnjournals. org/subscriptions/etoc. shtml AJCC, the American Journal of Critical Care, is the official peer-reviewed research journal of the American Association of Critical-Care Nurses (AACN), published bimonthly by The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Telephone: (800) 899-1712, (949) 362-2050, ext. 532. Fax: (949) 362-2049. Copyright  © 2009 by AACN. All rights reserved. Downloaded from ajcc. aacnjournals. org by on February 11, 2010 Nursing Education in Critical Care PERCEPTIONS OF END-OF-LIFE CARE AFTER MULTIPLE INTERVENTIONS FOR IMPROVEMENT By Lissi Hansen, RN, PhD, Teresa T. Goodell, RN, PhD, CNS, CCRN, ACNS-BC, Josi DeHaven, RN, MPH, CCRN, and MaryDenise Smith, RN, CNS, ACHPN Background Nurses working in intensive care units may lack knowledge and skills in end-of-life care, find caring for dying patients and the patients’ families stressful, and lack support to provide this care. Objectives To describe nurses’ perceptions of (1) knowledge and ability, (2) work environment, (3) support for staff, (4) support for patients and patients’ families, and (5) stress related to specific work situations in the context of end-of-life care before (phase 1) and after (phase 2) implementation of approaches to improve end-of-life care. The approaches were a nurse-developed bereavement program for patients’ families, use of a palliative medicine and comfort care team, preprinted orders for the withdrawal of life-sustaining treatment, hiring of a mental health clinical nurse specialist, and staff education in end-of-life care. Methods Nurses in 4 intensive care units at a university medical center reported their perceptions of end-of-life care by using a 5-subscale tool consisting of 30 items scored on a 4-point Likert scale. The tool was completed by 91 nurses in phase 1 and 127 in phase 2. Results Improvements in overall mean scores on the 5 subscales indicated that the approaches succeeded in improving nurses’ perceptions. In phase 2, most of the subscale overall mean scores were higher than a desired criterion (