End of Life Care

Nurses Perceptions of End-of-Life explosive charge After Multiple Interventions for Improvement Lissi Hansen, Teresa T. Goodell, Josi DeHaven and MaryDenise Smith Am J Crit Care. 200918 263-271 doi 10. 4037/ajcc2009727 2009 American Association of Critical-Care Nurses Published online http//www. ajcconline. org personalized use only. For copyright permission information http//ajcc. aacnjournals. org/cgi/external_ref? link_type=PERMISSIONDIRECT Subscription information http//ajcc. aacnjournals. org/subscriptions Information for authors http//ajcc. acnjournals. org/misc/ifora. shtml demo a manuscript http//www. editorialmanager. com/ajcc Email alerts http//ajcc. aacnjournals. org/subscriptions/etoc. shtml AJCC, the American Journal of Critical Care, is the ordained peer-reviewed research journal of the American Association of Critical-Care Nurses (AACN), published bimonthly by The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Telephone (800) 899-1712, (949) 362-2050, ext. 532. Fax (949) 362-2049. Copyright 2009 by AACN. whole rights reserved.Downloaded from ajcc. aacnjournals. org by on February 11, 2010 Nursing Education in Critical Care PERCEPTIONS OF END-OF-LIFE CARE AFTER MULTIPLE INTERVENTIONS FOR IMPROVEMENT By Lissi Hansen, RN, PhD, Teresa T. Goodell, RN, PhD, CNS, CCRN, ACNS-BC, Josi DeHaven, RN, MPH, CCRN, and MaryDenise Smith, RN, CNS, ACHPN Background Nurses work in intensive care units may lack knowledge and skills in end-of-life care, find caring for dying patients and the patients families stressful, and lack support to provide this care.Objectives To run along nurses perceptions of (1) knowledge and ability, (2) work environment, (3) support for staff, (4) support for patients and patients families, and (5) stress related to precise work situations in the context of end-of-life care before ( anatomy 1) and after (phase 2) instruction execution of approaches to improve end-of-life care. The approaches were a nurse-developed berea vement program for patients families, use of a mitigatory medicine and comfort care team, preprinted orders for the withdrawal of life-sustaining treatment, hiring of a psychological health clinical nurse specialist, and staff education in end-of-life care.Methods Nurses in 4 intensive care units at a university medical touch on reported their perceptions of end-of-life care by using a 5-subscale tool consisting of 30 items scored on a 4-point Likert scale. The tool was completed by 91 nurses in phase 1 and 127 in phase 2. Results Improvements in overall reckon scores on the 5 subscales indicated that the approaches succeeded in improving nurses perceptions. In phase 2, most of the subscale overall mean scores were higher than a desired criterion (