Hospital care for COPD exacerbations DQ

Hospital care for COPD exacerbations DQ

Hospital care for COPD exacerbations DQ

Our review of the literature and our own experiences led us to postulate that inpatient staff

nurses may not be prepared to provide optimal care to end of life (EOL) and palliative care

patients and their families (Chan and Webster, 2011; Patel, Gorawara-Bhat, Levine, and

Shega, 2012; Prem, Karvannan, Kumar et al., 2012; Agustinus, Wai Chi Chan, 2013).

Palliative care patients can continue to seek curative treatments while evaluating their goals

and care needs. End-of-life (EOL) care patients usually are no longer receiving aggressive

curative treatment; instead they are receiving comfort care only. In the US, the word

“hospice” is interchangeable or synonymous with EOL care. These patients usually die at

home or in the intensive care unit limiting the contact a regular staff nurse may have in

providing care to them. Nurses skilled and comfortable in communicating with patients and

families about EOL (hospice) and palliative care may improve the quality of life and patient

satisfaction in the hospital setting.

Some patients transition during a hospital stay from curative-based care to hospice care.

Whether the transition is made smoothly and gradually, depends on the kind of

communication and education patients receive from doctors, nurses, and other caregivers

while in the hospital (Adams, 2005;

Beck, Tornquist, Brostrom and Edberg, 2012; Brummen

and Griffiths, 2013). Palliative care options should be provided in a way that helps patients

understand its goals and how it differs from end of life care. However, many people opt for

palliative care only when they are very close to the end of their lives (Raljmakers et al.,

2011; Wilson, Gott and Ingleton, 2011).

It seems reasonable to think that a lack of education and accompanying uneasiness among

clinical nurses in discussing palliative care with patients and their families may negatively

impact the transition from curative-based care to hospice care. The current research focused

on the role of the nurse during the transition in patients’ lives from curative to palliative

care. The study aim was to determine the perceived educational needs of inpatient staff

nurses in our facility when communicating with patients and families about palliative and

EOL care.Hospital care for COPD exacerbations DQ

Study Design / Methodology

A non-experimental survey design was utilized to examine differences by the age of the

nurse, years of nursing experience, and the unit on which he/she worked.

To measure palliative and EOL educational needs among nurses (i.e., their current degree of

comfort in caring for this population) the End-of-Life Professional Caregiver Survey was

distributed to a convenience sample of clinical nurses working exclusively in telemetry,

oncology and critical care units (EPCS; Lazenby, Ercolano, Schulman-Green and McCorkle,

2012). Permission to use the EPCS was granted by the authors. The EPCS is a 28-item,

psychometrically valid scale developed to assess the palliative and EOL educational needs

of professionals and was validated in a large study encompassing doctors, nurses and social

workers (Lazenby et al., 2012). For each item, a Likert-style scale is presented where 1=Not

at All, and 5=Very Much. Items represent care-provider comfort with a variety of situations

related to palliative and EOL care (e.g., “I am comfortable helping families to accept a poor

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prognosis”). Higher scores indicate greater skill or comfort. Three distinct factors were

identified by Lazenby et al. (2012): 1) Patient and Family-Centered Communication

(PFCC), 2) Cultural and Ethical Values (CEV), and 3) Effective Care Delivery (ECD). See

Lazenby et al (2012) for factor loading (p.429). Hospital care for COPD exacerbations DQ

Data collection began following approval from the hospital Institutional Review Board

(IRB). Permission to distribute the survey was also acquired from individual unit managers

prior to distribution. Data was collected over a one month period. We had sixty participants

respond.

The survey was conducted at a 378 bed hospital in the intermountain region. Telemetry,

oncology, and critical care units were chosen for their patient populations; that is, patients

on these units were most often among those transitioning from curative based care to end of

life care. The three units employed a combined clinical nursing staff of approximately 215

(telemetry unit 90, oncology 35, and critical care 90). Recruitment emails were sent to 175

clinical nurses (identified from the 215 as having active email addresses) employed on the

designated units, requesting participation in the research project. In addition, recruitment

flyers were also posted on the selected units to inform nurses of the project and request

participation. Online and paper-and-pencil survey options were available. Both options were

anonymous. Paper and pencil surveys were made available on each unit. An investigator-

addressed envelope was attached to each paper survey for nurses to return the completed

instrument through interoffice mail to retain anonymity. The paper and pencil surveys was

kept in a locked office and shredded after data collection was complete. The online survey

was hosted by REDCap at the University of Washington, Institute of Translational Health

Sciences (https://www.iths.org/).

Data Analysis and Results

Sixty nurses participated. Based on the number of active email addresses within the three

units, this reflects a 34% participation rate. Data were analyzed using SAS 10.0. Descriptive

statistics and Chi-Square were used to analyze demographic information. PFCC, DEV and

ECD domain scores were calculated as described by Lazenby et al (2012). Mulitvariate

analysis of variance (MANOVA) was used to determine overall effects of age, unit, and

years of nursing experience across domain scores. Duncan’s Multiple Range Test was used

to conduct post-hoc domain comparisons as appropriate.

Sample distribution by unit was similar, with about 37% of respondents were from Critical

Care, about 26% from Oncology, and about 37% from Telemetry. The majority of

respondents were under 50 years of age: 41% were younger than 30, 43% were between 30

and 49, and only 16% were 50 or above. Participant age did not differ by work unit

[Likelihood Ratio Χ2 (6, N = 58) = 5.68, p = .46]. The majority of respondents had two to 10

years of nursing experience: 12% had less than two years, 33% had two to five year, 29%

had five to ten years of experience, and 27% had more than 10 years. Years of experience

did not differ by work unit [Likelihood Ratio Χ2 (6, N = 60) = 9.98, p = .13].

MANOVA revealed that there was an overall effect of experience and unit, but no effect of

age [Experience: F(9,131.57)=2.22, p=0.0246; Wilk’s Λ=0.709; Unit: F(6,110)=2.49,

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http://https://www.iths.org/
p=0.0269; Wilk’s Λ=0.775; Age: F(9,126.7)=1.19, p=0.3083; Wilk’s Λ=0.821]. Duncan’s

Multiple Range test revealed that for all three domains, years of nursing experience was

positively associated with comfort levels; nurses with less than two years of experience had

significantly lower comfort scores than those with five or more years (see Table 1). In

contrast, only the PFCC domain revealed differences by unit; not surprisingly, oncology

nurses reported significantly higher comfort levels than critical care or telemetry nurses with

regard to patient and family-centered communication (see Table 2).

Discussion

Overall, the data suggest that the nurses in our study are relatively comfortable with their

skill in the areas assessed by the EPCS. The scores were moderately high; averaging

between 3 and 4 (‘Somewhat’ and ‘Quite A Bit’) for most domains with more experienced

nurses scoring higher than those with less nursing experience. Not surprisingly, oncology

nurses scored highest and significantly higher than their telemetry counterparts, on the

PFCC domain. This likely reflects their greater degree of experience communicating with

patients and their families about palliative and end of life care options; validating of both the

instrument and the nurse populations in our study.

Scores were lowest within the ECD domain suggesting that all nurses, across patient

population areas, may benefit from end of life education in order to increase their own skill

and comfort in caring for these patients. ECD items focus on familiarity with palliative and

EOL care, effectiveness at helping in end of life patient situations, and resource availability

(Lazenby et al., 2012). Anecdotally, several nurses reported to the study team members that

they thought EOL education would benefit them in communicating with patients and their

families