Evidence-Based End-of-Life Comfort Care Guidelines

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. 3 EVIDENCE-BASED END-OF-LIFE COMFORT CARE GUIDELINES End-of-Life Comfort Care Guidelines The provision of end-of-life (EOL) care is highly complex; therefore, nurses must receive support and vital resources to render comfort, quality care, and dignified death (Matzo & Sherman, 2015). This project aimed to explore the in-depth creation of an evidence-based (EB) project promoting the use of comfort care guidelines (CCGs). This project's core mission was to ensure that nurses had leadership support and EB resources to improve their confidence in providing holistic and patient-centered care for dying patients requiring EOL care. Topics discussed in this paper covered the significance of the problem, PICOT question, quality improvement framework, change theory, evidence search results, project overview, project plan, evaluation, and practice recommendations. Significance of the Practice Problem There were about 2.7 million deaths in the United States in 2015, which was equivalent to 1% of the population (Aldridge & Bradley, 2017, para. # 1). Globally, the calculated mortality rate in 2018 was 7.7 deaths per 1,000 population (Aldridge & Bradley, 2017, para. # 3). In a similar year, the Centers for Disease Control and Prevention (CDC, 2018) reported that life expectancy was 78.6 years, with a fatality rate of 863.8 deaths per 100,000 population (para. # 1). The above data revealed that many people were dying worldwide annually, and some of them suffered from failing to receive a quality of care during the EOL expedition (Aldridge &