They're Dying. Now What? The Impact of a 2-Hour End-of-Life Educational Intervention on Bedside Nurse Self-efficacy, Knowledge, and Clinical Practice

Abstract

The palliative care team identified a lack of knowledge and confidence for nurses providing end-of-life care in a hospital. The team completed a quality improvement project establishing significant improvement in knowledge and self-efficacy after a 2-hour educational intervention. The next step was to study the impact on practice. Clinical management of pain, dyspnea, secretions, and agitation was compared for a 3-month period before and after intervention. Thirty-six patients were identified in the preintervention group, and 46 patients were in the postintervention group. A 2-sample proportion Z test (α = .05, 2-tailed) showed no statistical significance in the number of doses of opioids administered between preintervention and postintervention groups; however, the number of patients in the postintervention group that received an opioid orally was significantly greater (z = −2.098, P = .0357). A significantly lower proportion of the postintervention group received benzodiazepines (z = −4.334, P < .00001). The postintervention group had a statistically significant lower proportion of anticholinergics administered (z = −4.189, P < .00001). Significantly more patients in the postintervention group had oxygen titrated (z = −3.196, P = .0014) and were on room air at the time of death (z = −3.891, P = .0001). A 2-hour training led to statistically significant changes in the use of evidence-based interventions.