Assessing the Attitudes and Beliefs of Health Care Providers on End-of-Life Care Submitted by: Leslie Hodge RN, MSN

1. Assessing the Attitudes and Beliefs of Health Care Providers on End-of-Life Care Submitted by: Leslie Hodge RN, MSN Faculty: Dr. Kathy Ellison RESULTS Recommendations INTRODUCTION • Background • An alarmingly high number of clinicians, both doctors and nurses, stated they have a high level of discomfort in ordering and implementing the measures necessary to ensure a quality death. Many say lack of education is to blame. Therefore, extensive education on this topic is imperative to ensure patients are receiving the care they deserve. • PICO Question • In actively dying patients, should hospitals implement an end-of-life protocol to ensure proper pain and symptom management? • Search Strategy • A comprehensive literature review was executed using many highly acclaimed nursing databases such as EBSCO host, CINAHL, Academic Search Premier, Alt Healthwatch, Business Source Premier, Health Source: Nursing/Academic Edition, and Health Source: Consumer Edition. Keywords used for searching were pain management, end-of-life care, terminal illness, palliative care, and protocol. • Summary of Evidence • After the literature review, there were two Level I articles and four Level IV articles. Overall, end-of-life protocols proved to be effective when used in a hospital setting. They assisted in prompting doctors on what orders were suggested to provide the most effective care. Nurses also cited more involvement from supportive disciplines such as social workers and chaplains that helped give the family support. Family satisfaction was also higher when these protocols were used as opposed to when not used. After extensive research regarding end-of-life protocols, they were consistently supported and recommended for use. Extensive educational programs are imperative in the development of an end-of-life protocol. An unusually high number of clinicians stated they had a high level of discomfort in ordering and implementing measures necessary to ensure a quality death. Educational programs would be effective since all the clinicians did recognize it was their responsibility to provide this care to their patients, making it obvious they would all be open to this education. METHODS The small test of change project took place at L.V. Stabler Memorial Hospital in Greenville, Alabama. The target population was nurses and physicians. A flyer was given to each Department (medical/surgical and ICU) that described the purpose of the project, the educational program, and the survey. The student developed a short educational program that was presented to staff at shift change of their departments. A pre and post survey was given to assess the attitudes regarding end-of-life care. No staff member was required to participate and there were no rewards or punishments for participating or not participating. The data was collected and analyzed to determine where future education should be focused and what improvements are needed in the hospital setting to ensure effective end-of-life care. CONCLUSIONS This project successfully showed the weaknesses of providers regarding end-of-life care. The patient and family centered statements were the major area providers felt uncomfortable. However, it was also the area that showed the most improvement after education. This area focused on issues such pain management and the ability to recognize signs of pain. Therefore, future education must be focused on patient care such as methods to provide more effective pain management during the end-of-life stage and improved recognition of pain in these patients. It is imperative for future education to focus on the medications necessary to control pain and the dosage and frequency required to maintain proper management. Many providers don’t understand that dying patients need these medications in higher doses and more often than a “normal” patient. Therefore, they fail to adjust the dosage and frequency which can lead to improper pain control. For future implications, the end-of-life protocol will address pain management and have medications listed that have been proven effective in pain management. This will help guide the physicians in what they order and help ensure proper pain management for dying patients. Key References Fineberg, I.C., Wenger, N.S., Brown-Saltzman, K. (2006). Unrestricted opiate administration for pain and suffering at the end of life: knowledge and attitudes as barriers to care. Journal of Palliative Medicine, 9(4), 873-883. Retrieved from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=6&hid=112&sid=3f54b518- 5a21-4022-8e52-6baf735a3ce9%40sessionm Walling, A.M., Brown-Saltzman, K., Barry, T., Quan, R.J., Wenger, N.S. (2008). Assessment of implementation of an order protocol for end-of-life symptom management. Journal of Palliative Medicine, 11(6), 857-865. Doi:10.1089/jpm.2007.0268 Yale University School of Nursing. “End-of-life professional caregiver survey.” Retrieved from http://nursing.yale.edu/node/1681/done?sid=1838