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American Journal of Critical Care. 2009;18: 263-271 doi:10.4037/ajcc2009727
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Nurses’ 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. Lissi Hansen and Teresa Goodell are assistant professors, Josi DeHaven is a nursing practice and education coordinator, and MaryDenise Smith is a palliative care clinical nurse specialist at Oregon Health and Science University, Portland, Oregon.

Corresponding author: Lissi Hansen, RN, PhD, Assistant Professor, Oregon Health and Science University School of Nursing, SN-6S, 3455 SW US Veterans Hospital Rd, Portland, OR 97239-2941 (e-mail: hansenli{at}ohsu.edu).

Background Nurses working 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 describe 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 specific work situations in the context of end-of-life care before (phase 1) and after (phase 2) implementation of approaches to improve end-of-life care. The approaches were a nurse-developed bereavement program for patients’ families, use of a palliative medicine and comfort care team, preprinted orders for the withdrawal of life-sustaining treatment, hiring of a mental health clinical nurse specialist, and staff education in end-of-life care.

Methods Nurses in 4 intensive care units at a university medical center 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 mean scores on the 5 sub-scales 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 (<2.0, good). Analysis of variance indicated that some improvements occurred over time differently in the units; other improvements occurred uniformly.

Conclusions Continued practice development is needed in end-of-life care issues.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe current trends used in handling end-of-life issues.
  2. Recognize how moral distress is associated with nurses’ inability to influence end-of-life decisions between nurses, physicians, and families.
  3. Identify some key strategies that will help nurses with interventions when dealing with end-of-life decisions.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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