Evidence-Based End-of-Life Comfort Care Guidelines

Abstract

Practice Problem: In the absence of end-of-life (EOL) comfort care guidelines, the nurses in a medical-surgical unit are apprehensive about caring for patients in their active stage of dying, which leads to abandoning the values of holistic and patient-centered care. PICOT: The PICOT question that guided this project was: "How do acute care bedside nurses (P) who utilize the evidence-based comfort care guidelines (I) compare to not using the evidence-based guidelines (C) perceive their confidence in their capability to provide holistic and patient-centered care (O) during the active onset of the patient's end-of-life stage (T)?" Evidence: The literature indicated that accessible, evidence-based EOL comfort care guidelines could help nurses to enhance their confidence and skills to deliver holistic and patient-centered care at the bedside for actively dying patients. Intervention: The nurses identified primary stressors for a dying patient within 24 hours of the patient deemed on EOL stage using a Patient Dignity Inventory Tool as an embedded part of EOL comfort care guidelines. The nurses initiated individualized plans of care based on the stressors identified, which upheld holistic and patient-centered EOL care concepts. Outcome: Pre-and post-EOL intervention survey data attested that having accessible EOL comfort care guidelines was valuable for nurses in attaining more confidence in providing patient-centered and holistic care at the bedside for the actively dying patient. Conclusion: Accessible, standardized, evidence-based EOL comfort care guidelines fostered the nurses' ability to provide care to patients who were actively dying, embracing the core concepts of holistic and patient-centered care.