Improving Rural Emergency Nurses Comfort during Palliative and End-of-Life Communication


Background: Emergency nurses (ENs) often care for patients nearing the end of their lives or with life-limiting illnesses. However, ENs are hesitant to initiate palliative or end-of-life (PEOL) discussions because of a lack of comfort with these topics. Many ENs have no formal PEOL communication training which contributes to the lack of comfort with PEOL discussions in the emergency department (ED). Thus, the purpose of this quality improvement project was to determine how PEOL communication training affected rural ENs perceived comfort level during PEOL conversations.

Sample/Setting: A convenience sample of 14 registered nurses working in a rural Northern Plains ED.

Methods: A quality improvement project was implemented where nurses received online education using the End-of-Life Nursing Education Consortium Critical Care Communication module. This was followed by communication scenario review and group discussion. Changes in nurse comfort with PEOL communication were evaluated using a pre and post survey and reflective practice in the group discussion.

Findings: This quality improvement project demonstrated a statistically significant increased level of comfort (N = 14, p = 0.006) when communicating with PEOL patients and their families in the ED. Qualitatively, the ED nurses expressed fears and challenges specific to PEOL communication while also identifying new evidence-based strategies they can use during PEOL conversations.

Conclusion: Communication is vital when caring for PEOL patients in the ED. Formal PEOL communication training is effective for improving PEOL communication skills among ENs. Increasing nurse comfort when communicating with PEOL patients has the potential to improve quality of care at end-of-life.

Keywords: emergency nurses, communication, palliative, end-of-life


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