Nursing homes care for people at the end of life (EOL). There is evidence to suggest, however, that nursing staff in these settings is often unprepared to provide a high level of EOL care. This article reports the findings from three preliminary studies that investigated the needs of licensed staff and certified nursing assistants in nursing homes regarding EOL care. The studies involved needs assessment surveys, focus group interviews with staff members, and telephone interviews with nursing home administrators. Data show that the major needs included a lack of knowledge and skills in symptom management; communication difficulties; conflicts with families and physicians; and emotional distress in dealing with time constraints and attachment to residents. Implications for nursing home staff education are described.
Get full access to this article
View all access options for this article.
References
1.
Callahan D: Frustrated mastery: The cultural context of death in America. West J Med. 1995; 163: 226-230.
2.
Coolican M, Stark J, Doka KJ, Corr CA: Education about death, dying, and bereavement in nursing programs. Nurs Educat. 1994; 19(6): 35-40.
3.
Copp G: Palliative care nursing education: A review of research findings. J Adv Nurs. 1994; 19: 552-557.
4.
Durlak JA, Reisenberg LA: The impact of death education. Death studies. 1991; 15: 39-58.
5.
Institute of Medicine. Approaching death: Improving care at the end of life. Washington, DC: National Academy Press, 1997, pp. 268-269.
6.
Jodrell N: Nurse education. In Doyle D, Hanks GWC, MacDonald N (eds): Oxford textbook of palliative medicine (2nd ed). Oxford: Oxford University Press, 1998: 1201-1208.
7.
Klingma R: Spotlight on: Revising death education. Nurse Educator. 1994; 19(5): 15-16.
8.
Scott JF, MacDonald N, Mount BM: Palliative medical education. In Doyle D, Hanks GWC, MacDonald N (eds.): Oxford textbook of palliative medicine (2nd ed). Oxford: Oxford University Press, 1998: 1169-1199.
9.
Gibbs G: Nurses in private nursing homes: A study of their knowledge and attitudes to pain management in palliative care. Palliat Med. 1995; 9: 245-253.
10.
Ferrell BR, McCaffery M, Rhiner M: Pain and addiction: An urgent need for changing nursing education. J Pain Symp Manage. 1992; 7: 117-124.
11.
McCaffery M, Ferrell BR: How would you respond to these patients in pain?Nursing. 1991; 21(6): 34-37.
12.
Agency for Health Care Policy and Research. Nursing home update—1996: MEPS highlights No. 2. Rockville, MD: ACHPR Publication No. 97-0036, 1996.
13.
Bernabei R, Gambassi G, Lapane K, et al.: Management of pain in elderly patients with cancer. JAMA. 1998; 279: 1877-1882.
14.
Cleary JP, Carbone PP: Palliative medicine in the elderly. Cancer. 1997; 80: 1335-1347.
15.
Shapiro RS: Liability issues in the management of pain. J Pain Symp Manage. 1994; 9: 1-7.
16.
Maccabee J: The effect of transfer from a palliative care unit to nursing homes—are patients’ and relatives’ needs met?Palliat Med. 1994; 8: 211-214.
17.
Hanson LG, Danis M, Garrett J: What is wrong with end-of-life care? Opinions of bereaved family members. J Am Geriatr Soc. 1997; 45: 1339-1344.
18.
Cutchins CH: Making room for hospice. Geriatr Nurs. 1991; 12: 144-146.
Novak M, Chappell NL: The impact of cognitively impaired patients and shift on nursing assistant stress. Intl J Aging Human Develop. 1996; 43: 235-248.
31.
Phillips RM, Baldwin BA: Teaching psychosocial care to long-term care nursing assistants. J Contin Educ Nurs. 1997; 28: 130-134.
Ferrell BR, Grant M, Ritchey KJ, Ropchan R, Rivera LM: The Pain Resource Nurse training program: A unique approach to pain management. J Pain Symp Manage. 1993; 8: 549-556.
34.
Grant M, Ferrell BR, Rivera LM, Lee J: Unscheduled readmissions for uncontrolled symptoms: A health care challenge for nurses. Nurs Clinics North Amer. 1995; 30: 673-682.
35.
Kovach CR, Wilson SA, Noonan PE: The effects of hospice interventions on behaviors, discomfort, and physical complications of end stage dementia nursing home residents. Am J Alzheimer’s Dis. 1996; 11(4): 7-15.
36.
Wlodkowski RJ: Strategies to enhance adult motivation to learn. In Galbraith MW (ed): Adult learning methods. Malabar, FL: Krieger Publishing, 1990: 97-118.
37.
European Oncology Nursing Society. Report and recommendations of a workshop to study the feasibility of educational programmes in palliative care for nurses in Europe. London: Good News Press, 1994.
38.
National Council of Hospice Professionals. Guidelines for curriculum development on end-of-life and palliative care in nursing education. Arlington, VA: National Hospice Organization, 1998.
39.
McCormick TR, Conley BJ: Patients’ perspectives on dying and on the care of dying patients. West J Med. 1995; 163: 236-243.
40.
Ptacek JT, Eberhardt TL: Breaking bad news: A review of the literature. JAMA. 1996; 276: 496-502.
41.
Swadi H, Grantham P: An introduction to communication skills: Six hours or one week—A pilot study. Education for Health. 1998; 11(1): 89-92.
42.
Fagin C: Collaboration between nurses and physicians: No longer a choice. Acad Med. 1992; 67: 295-303.
43.
Blickensderfer L: Nurses and physicians: Creating a collaborative environment. J Intravenous Nurs. 1996; 19(3): 127-131.
Green D: Reduce the stress of calling the physician. Am J Nurs. 1997; 97(9): 49-51.
46.
Surdacki JV, Hoffpauir DC: Understanding physician perspectives on hospice: A framework for effective communication and patient advocacy. Home Health Care Manage Prac. 1997; 9(5): 16-20.
47.
Buchan ML, Tolle SW: Pain relief for dying persons: Dealing with physicians’ fears and concerns. J Clinical Ethics. 1995; 6: 53-61.
48.
American Nurses Association. Code for nurses. Washington, DC: ANA, 1985.
49.
Agency for Health Care Policy and Research. Management of cancer pain: Clinical practice guideline. Rockville, MD: AHCPR Pub. No. 94-0592, 1994.
50.
Ferrell BA: Pain management in elderly people. J Am Geriatr Soc. 1991; 39: 64-73.
51.
Ferrell BR, Rhiner M, Ferrell BA: Development and implementation of a pain education program. Cancer. 1993; 72 (11 Suppl): 3426-3432.
