The Effect of Palliative Care Nursing Education to Improve Knowledge in Palliative Care of Hospital-Based Nurses Caring for Patients with Chronic, Serious Illness

Background: Palliative care nursing provides care for the relief of pain and suffering throughout the course of a patient’s chronic, serious illness. Hospital-based nurses need to be equipped with palliative care nursing knowledge to provide optimal care for patients and their families to improve the quality of life. Lack of education in pain and symptom management and communication about goals of care can result in a suboptimal and high cost of care. Objectives: To determine if a brief palliative care nursing education can improve the knowledge of hospital-based nurses about palliative care nursing. Methods: A cross-sectional quantitative pre-posttest design used a convenience sample of 73 nurses from oncology (n=26), geriatric (n= 24), and medical-surgical (n=23) units. A paperpencil survey was used to collect data. A brief palliative nursing education served as an intervention for the study, with a pretest and posttest comparison for improvement. A Palliative Care Quiz for Nursing (PCQN) was used to assess knowledge in palliative care. Data entry and analysis were done using Excel and SPSS 24. Results: Out of 73 nurses selected, 61 (83.5%) were able to participate. Paired t-test was used to compare pretest and posttest scores (t value -12.044, P = <0.001). The analysis revealed a highly significant finding that a brief palliative care nursing education was effective in improving nurses’ knowledge in palliative care. Conclusions: Nurses’ knowledge improved after a brief palliative nursing education. It was recommended that palliative nursing education should be included as part of a continuing education for nurses. BALICASM_PALLIATIVE_NURSING_EDUCATION 3 Background Palliative care (PC) is an approach that improves the quality of life for patients and their families facing problems associated with chronic, serious illness (World Health Organization [WHO], 2015). It is a specialized medical field that involves physical, psychological and spiritual assessment, management of pain and other symptoms with the diagnosis of serious illness, throughout treatment, and at the end-of-life (Kelly & Meier, 2010). Palliative care services integrate the expertise of interdisciplinary team providers and coordinate care to address the complex needs of patients with chronic, serious illness and their families. Palliative care is a specialty that provides care for the relief of suffering throughout the course of a patient’s serious, chronic illness. There is an increased need for palliative care due to the increasing number of people with chronic illness. There are 47.6 million people aged 65 years and older, and this number is predicted to increase to 72.8 million by 2030 (Center for Disease Control and Prevention [CDC], 2013). There is an increased burden of chronic, serious illness due to the increased aging population and advancing technology. The rising burden of chronic, serious illness, such as cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), strokes, Alzheimer's, dementia, human immunodeficiency virus (HIV), end-stage renal disease, depression, and the aging population increase the global need for palliative care services. Chronic, serious illnesses are conditions that have uncontrolled symptoms that tend to worsen over time and eventually cause death despite medical management. Pain, symptom management, goals of care, and caregiver burden are major issues in the management of patients with chronic, serious illness. The Institute of Medicine (IOM) reported that many American adults have not addressed their end-of-life care partly because of lack of awareness and education related to palliative care BALICASM_PALLIATIVE_NURSING_EDUCATION 4 services (IOM, 2014). The Regence Poll (2011) reported that 71% believed that it is important to enhance the quality of life for seriously ill patients even if it means a shorter life, compared to 23% who favored every medical intervention to extend a life. When medicine can no longer change the eventual outcome of illness, patients may want to discuss their poor prognosis and impending death. This conversation may be uncomfortable and daunting to some nurses. The effectiveness of this encounter depends on nurses’ knowledge and level of comfort to discuss EOL issues. The lack of communication skills to discuss end-of-life issues and lack of competency in symptom management are some of the limiting factors to effectively manage pain and suffering of patients with chronic, serious illness and their families. The National Consensus Project [NCP] (2009) defined palliative care as an art and science of care with a philosophy that lies in an organized structure of care delivery that requires competent knowledge of pain and symptom management and interpersonal skills with patients and families receiving palliative care services. The American Society of Clinical Oncology (ASCO) presented an opinion that substantial evidence demonstrated better patient and caregiver outcomes if palliative care is started in concurrence with standard cancer care at initial diagnosis of malignancy (Smith et al, 2012). In addition, the lack of competency to provide optimal palliative care services can lead to inappropriate health care spending and an exorbitant cost of care.