Provision of palliative care in acute care settings is significantly lacking despite evidence that early integration leads to better patient/family-related outcomes and improved healthcare cost and efficiency.
Objective:
This study investigated influencing factors that affect the nature and frequency of palliative care practices of acute care nurses.
Methods:
A descriptive, cross-sectional design was used to examine the effects of personal and environmental factors on nurses’ palliative care practices in the acute care setting. Registered nurses (N = 325) completed an electronic survey including a demographic questionnaire and 6 other measures to measure the study variables (palliative care practices, palliative care knowledge, self-efficacy, perceived competency, attitudes toward care of the dying, and perceived barriers). Hierarchical multiple linear regression evaluated the degree to which each set of variables explained the variance in self-reported frequency of palliative care practices while controlling for the others.
Results:
The final regression model with demographics, personal factors, and environmental factors accounted for 32.1% of the variance in the frequency of nurses’ self-reported palliative care practices and was significant (F[14, 238] = 8.050, P < .001). Step one (demographics) explained 12.3% of the variance (F[7, 245] = 4.916, P < .001). Step two (personal factors) explained 19.4% (F[5, 240] = 13.678, P < .001). Step three (environmental factors) explained 0.4% (F[2, 238] = 9.053, P = .519).
Conclusions:
Personal factors, especially self-efficacy and attitudes toward care of the dying, are the most significant influencing factors to the frequency of acute care nurses’ palliative care practices.
Center to Advance Palliative Care. America’s care of serious illness: a state-by-state report card on access to palliative care in our nation’s hospitals:2019. Published 2019. Accessed July 22, 2020. https://www.capc.org/documents/download/2/
3.
AndersonWGPuntilloKBoyleD, et alICU bedside nurses’ involvement in palliative care communication: a multicenter survey. J Pain Symp Manage. 2016;51(3):589-596. doi:10.1016/j.jpainsymman.2015.11.003
4.
AslaksonRAWyskielRThorntonI, et alNurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: a qualitative exploration. J Palliat Med. 2012;15(8):910-915. doi:10.1089/jpm.2011.0481
5.
AttiaAKAbd-ElazizWWKandeelNA.Critical care nurses’ perception of barriers and supportive behaviors in end-of-life care. Am J Hospice Palliat Med. 2013;30(3):297-304. doi:10.1177/1049909112450067
6.
FriedenbergASLevyMMRossSEvansLE.Barriers to end-of-life care in the intensive care unit: perceptions vary by level of training, discipline, and institution. J Palliat Med. 2012;15(4):404-411. doi:10.1089/jpm.2011.0261
7.
GanzFDSapirB.Nurses’ perceptions of intensive care unit palliative care at end of life. Nurs Crit Care. 2018;24(3):1-8. doi:10.1111/nicc.12395
8.
RanseKYatesPCoyerF.Modelling end-of-life care practices: factors associated with critical care nurse engagement in care provision. Intensive Crit Care Nurs. 2016;33:48-55. doi:10.1016/j.iccn.2015.11.003
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 4th ed.National Coalition for Hospice and Palliative Care; 2018.
11.
RogersJGPatelCBMentzRJ, et alPalliative care in heart failure: the PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol. 2017;70(3):332-341. doi:10.1016/j.jacc.2017.05.030
MayPNormandCCasselJB, et alEconomics of palliative care for hospitalized adults with serious illness. JAMA Intern Med. 2018;178(6):820-829. doi:10.1001/jamainternmed.2018.0750
15.
TemelJSGreerJAMuzikanskyA, et alEarly palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. doi:10.1056/NEJMoa1000678
16.
SullivanDRChanBLapidusJA, et alAssociation of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the veterans health administration. JAMA Oncol. 2019;5(12):1702-1709. doi:10.1001/jamaoncol.2019.3105
17.
BarkleyJEMcCallAMaslowALSkudlarskaBAChenX.Timing of palliative care consultation and the impact on thirty-day readmissions and inpatient mortality. J Palliat Med. 2019;22(4):393-399. doi:10.1089/jpm.2018.0399
18.
BanduraA.Self-Efficacy: The Exercise of Control. W.H. Freeman and Company; 1997.
19.
DesbiensJFGagnonJFillionL.Development of a shared theory in palliative care to enhance nursing competence. J Adv Nurs. 2012;68(9):2113-2124. doi:10.1111/j.1365-2648.2011.05917.x
20.
EvenblijKTen KoppelMSmetsTWiddershovenGOnwuteaka-PhilipsenBPasmanH.Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy. BMC Palliat Care. 2019;18(1):1-11. doi:10.1186/s12904-018-0388-z
21.
SchlairetM.End-of-life nursing care: statewide survey of nurses’ education needs and effects of education. J Prof Nurs. 2009;25(3):170-177.
22.
GranekLKrzyzanowskaMKTozerRMazzottaP.Oncologists’ strategies and barriers to effective communication about the end of life. J Oncol Pract. 2013;9(4):e129-e135. doi:10.1200/JOP.2012.000800
23.
DakkaFJ.Nurses barriers to evidence-based practice in palliative care: a systematic review. SAGE Open Nurs. 2022;8:23779608221142957. doi:10.1177/23779608221142957
24.
BeckstrandRLLamoreauxNLuthyKEMacintoshJLB. Critical care nurses’ perceptions of end-of-life care obstacles: comparative 17-year data. Dimens Crit Care Nurs. 2017;36(2):94-105. doi:10.1097/DCC.0000000000000234
25.
NelsonJEAngusDCWeissfeldLA, et alEnd-of-life care for the critically ill: a national intensive care unit survey. Crit Care Med. 2006;34(10):2547-2553. doi:10.1097/01.CCM.0000239233.63425.1D
26.
LippeMDavisAThreadgillHRicamatoA.Development of a new measure to assess primary palliative care perceived competence. Nurse Educ. 2019;45(2):106-110. doi:10.1097/NNE.0000000000000682
27.
WhileAE.Competence versus performance: which is more important?J Adv Nurs. 1994;20(3):525-531. doi:10.1111/j.1365-2648.1994.tb02391.x
28.
BanduraA.Social cognitive theory of moral thought and action. In: KurtinesWMGewirtzJL eds. Handbook of Moral Behavior and Development. Vol 1. Erlbaum; 1991:45-103.
29.
NakazawaYMiyashitaMMoritaTUmedaMOyagiYOgasawaraT.The palliative care self-reported practices scale and the palliative care difficulties scale: reliability and validity of two scales evaluating self-reported practices and difficulties experienced in palliative care by health professionals. J Palliat Med. 2010;13(4):427-437. doi:10.1089/jpm.2009.0289
30.
DavisALippeMBurduliEBarbosa-LeikerC.Development of a new undergraduate palliative care knowledge measure. J Prof Nurs. 2019;36(1):47-52. doi:10.1016/j.profnurs.2019.06.007
31.
FrommeltKHM. The effects of death education on nurses’ attitudes toward caring for terminally ill persons and their families. Am J Hosp Palliat Med. 1991;8(5):37-43. doi:10.1177/104990919100800509
32.
McDarbyMCarpenterBD.Barriers and facilitators to effective inpatient palliative care consultations: a qualitative analysis of interviews with palliative care and nonpalliative care providers. Am J Hosp Palliat Med. 2019;36(3):191-199. doi:10.1177/1049909118793635
33.
BradleyECherlinEMcCorkleR, et alNurses’ use of palliative care practices in the acute care setting. J Prof Nurs. 2001;17(1):14-22. doi:10.1053/JPNU.2001.20255
34.
American Association of Colleges of Nursing. Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care. American Association of Colleges of Nursing; 1998.
