| Abstract: |
Nearly one-third of patients with cancer in the United States die in a hospital. Nurses who care for the dying are obliged to provide quality end-of-life (EOL) care that addresses relief of pain and other symptoms. Many nurses express a lack of comfort and capability caring for patients who are dying. Having little EOL education, experience, and support can contribute to these sentiments. Nurses less experienced can be guided by the structure inherent within an order set designed to promote patient comfort. This project aimed to evaluate an electronic order set, including evidence-based medications and structured symptom assessments, on nurses' self-perceived capability and comfort with EOL care. An education module accompanied the intervention. A new EOL order set was built by a multidisciplinary group from the supportive care service and information systems department to support a newly developed EOL nursing standard of care. It was designed for patients who have chosen comfort as their primary goal of care and are remaining in the hospital to die. Prior to implementation an electronic module was developed to educate nurses about EOL care and the order set. Prompts within the order set guide the nurse to perform regular assessments for common symptoms at EOL and outline interventions to address them. A descriptive design was used to evaluate nurse demographic information and perceptions about EOL care capability and comfort. Data was captured with an anonymous survey. A published survey, used with permission, was sent to nurses two months after order set implementation. An independent two group t-test was used to compare aggregate survey results of those who and did not interface with the order set. There was a statistically significant difference in the comfort and capability scores of those nurses who interfaced with the EOL order set verses those that did not. The educational module alone was not independently associated with greater survey scores. The use of a structured order set providing appropriate medications and focused nursing assessments provided guidance to the nurse in addressing symptoms at EOL. This in turn enhanced their comfort and capability with EOL care. The use of technology, interfaced with the best evidence and education, guided nursing practice resulting in an innovation that impacts quality care. |
