Abstract:
A decade after release of the landmark Study to Understand Prognoses and Preferences
for Outcomes and Risks of Treatment, improvements in end of life (EOL) care are
apparent. Notwithstanding an improved dialogue focused on EOL care, evidence suggests
persistent shortcomings in our ability to meet the needs of the dying. Registered Nurses
must possess the knowledge/skill to assist patients/families in managing health across all
stages of life, including the EOL phase. A significant proportion of practicing nurses
have not received formal EOL care education. Of further concern, deficiencies in existing
formal EOL care education have been well described. Insufficient information exists on
specific EOL care educational needs of practicing RNs. Few surveys exploring
educational needs of nurse generalists have been available and no large scale utilization
of any one instrument has been identified. To aid in development of EOL continuing
education (CE) for RNs, a survey was designed to explore nurses EOL care
attitude/belief, knowledge/skill, education, and learner characteristics. The survey was
published in a state nurse association newspaper and mailed to all RNs in one
southeastern state. A Web based version of the survey was also available. The accessible
population consisted of 51,000 licensed RNs. Return of 567 surveys, primarily via the
Web, resulted in a response rate of 1.1%. Reliability was assessed with calculation of
coefficient alpha of 0.96 across survey sections. The majority of respondents had neither
formal EOL education nor prior EOL CE. Yet, nurses held positive attitude/belief toward
EOL care and the majority desired EOL CE. T tests revealed nurses with prior EOL CE
scored significantly better than nurses without CE across all survey subsection nurses
who received formal EOL instruction during initial nursing education failed to score
better on objective EOL knowledge/skill questions than nurses without formal EOL
education. MANOVAs identified a similar counterintuitive pattern. Bimodal distributions
were observed in analyses of workplace appropriateness and desire for education
scores across 23 EOL care topics. Chi square analyses revealed significant contributions
of EOL attitude/belief, prior EOL CE, and objective EOL knowledge/skill toward
positive views on EOL workplace appropriateness and desire for EOL education.