Research Activities, May 2011: Outcomes/Effectiveness Research: Nurse survey identifies important but underused end-of-life care skills

Outcomes/Effectiveness Research
Nurse survey identifies important but underused end-of-life care skills

Improving end-of-life care has become a major goal of the health care community. Compared with other health care providers, nurses often have the most contact with patients and their families at the end of life. Thus, it is important for nurses to be skilled in end-of-life care. In a survey, nurses identified 19 extremely important end-of-life care skills as being underutilized.

Researchers from the University of Washington and the Medical University of South Carolina questioned 717 nurses in 4 States to determine the specific end-of-life skills that practicing nurses consider important, but that are currently underutilized. Their survey was adapted from the Quality of End-of-life Care Questionnaire, which was designed for patients, families, and nurses to measure physician skill at end-of-life care. The 45-item survey included 5 areas: communications skills, technical skills, affective skills, patient-centered values, and patient-centered care systems. The highest number of skills identified as extremely important and underutilized came from the areas of communications skills and patient-centered care systems. To be extremely important, an item had to be endorsed by 60 percent or more of the respondents; to be considered underutilized, no more than 25 percent of respondents could say that the skill was "already practiced."

Nurses' professional characteristics (such as practice setting, years of professional experience, and amount of continuing education) were significantly associated with importance ratings on eight under-utilized skills, including "being comfortable with people who are dying," "not blaming or being judgmental about lifestyles," and "telling patients how their illness may affect their life." For example, nurses with the most professional experience were significantly more likely to report "being comfortable with dying patients" as an underutilized skill.

The researchers suggest that the skills identified as underutilized could serve as a template to develop targeted curricula. These skills focus on communications, symptom management, and patient-centered care systems. Once the curricula are developed, they could then be taught to practicing nurses within the context of the setting and the patient population they serve. This study was supported in part by the Agency for Healthcare Research and Quality (HS11425).

See "Nurses' identification of important yet under-utilized end-of-life care skills for patients with life-limiting or terminal illnesses," by Lynn F. Reinke, Ph.D., Sarah E. Shannon, Ph.D., R.N., Ruth Engelberg, Ph.D., and others in the Journal of Palliative Medicine 13(6), pp. 753-759, 2010.


Research Activities, May 2011: Outcomes/Effectiveness Research: Nurse survey identifies important but underused end-of-life care skills