Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards
Objectives Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care.Methods We developed an...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/2/e002219.full |
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| author | Julie C Reid Jill C Rudkowski Deborah J Cook Neala Hoad Anne Boyle Daniel Brandt Vegas Kathleen Willison Rajendar Hanmiah Mino Mitri Amanda Weatherston Susan Lohin Deborah McInnes Michelle Joyner |
| author_facet | Julie C Reid Jill C Rudkowski Deborah J Cook Neala Hoad Anne Boyle Daniel Brandt Vegas Kathleen Willison Rajendar Hanmiah Mino Mitri Amanda Weatherston Susan Lohin Deborah McInnes Michelle Joyner |
| author_sort | Julie C Reid |
| collection | DOAJ |
| description | Objectives Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care.Methods We developed an 85-item survey informed by the Theoretical Domains Framework and Capability–Opportunity–Motivation–Behaviour system. We included demographics and two main domains (knowledge and practice; delivering end-of-life care) with seven subsections. Nurses from four GIM wards and the nursing resource team completed this survey. We analysed and compared results overall, by Capability, Opportunity, and Motivation, and by survey domain. We considered items with median scores <4/7 barriers. We conducted an a priori subgroup analysis based on duration of practice (≤5 and >5 years).Results Our response rate was 60.5% (144/238). 51% had been practising for >5 years; most respondents were female (93.1%). Nurses had similar scores on the knowledge (mean 76.0%; SD 11.6%) and delivering care (mean 74.5% (8.6%)) domains. Scores for items associated with Capability were higher than those associated with Opportunity (median (first, third quartiles) 78.6% (67.9%, 87.5%) vs 73.9% (66.0%, 81.8%); p=0.04). Nurses practising >5 years had significantly higher scores on all analyses. Barriers included engaging with families having strong emotional reactions, managing goals of care conflicts between patients and families, and staffing challenges on the ward. Additional requested resources included formal training, information binders and more staff. Opportunities for consideration include formalised on-the-job training, access to comprehensive information, including symptom management at the end of life, and debriefing sessions.Conclusions Front-line nurses reported an interest in learning more about end-of-life care and identified important barriers that are feasible to address. These results will inform specific knowledge translation strategies to build capacity among bedside nurses to enhance end-of-life care practices for dying patients on GIM wards. |
| format | Article |
| id | doaj-art-4e0019fbdca6450bac6eebeb5e7e95a7 |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-4e0019fbdca6450bac6eebeb5e7e95a72024-12-20T15:20:11ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-06-0112210.1136/bmjoq-2022-002219Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wardsJulie C Reid0Jill C Rudkowski1Deborah J Cook2Neala Hoad3Anne Boyle4Daniel Brandt Vegas5Kathleen Willison6Rajendar Hanmiah7Mino Mitri8Amanda Weatherston9Susan Lohin10Deborah McInnes11Michelle Joyner12Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, Ontario, CanadaDepartment of Critical Care, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, Ontario, CanadaDepartment of Critical Care, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Medicine, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Medicine, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Medicine, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Medicine, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Medicine, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Medicine, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Patient Experience, Quality, and Patient Safety, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Patient Experience, Quality, and Patient Safety, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaDepartment of Patient Experience, Quality, and Patient Safety, St. Joseph`s Healthcare Hamilton, Hamilton, Ontario, CanadaObjectives Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care.Methods We developed an 85-item survey informed by the Theoretical Domains Framework and Capability–Opportunity–Motivation–Behaviour system. We included demographics and two main domains (knowledge and practice; delivering end-of-life care) with seven subsections. Nurses from four GIM wards and the nursing resource team completed this survey. We analysed and compared results overall, by Capability, Opportunity, and Motivation, and by survey domain. We considered items with median scores <4/7 barriers. We conducted an a priori subgroup analysis based on duration of practice (≤5 and >5 years).Results Our response rate was 60.5% (144/238). 51% had been practising for >5 years; most respondents were female (93.1%). Nurses had similar scores on the knowledge (mean 76.0%; SD 11.6%) and delivering care (mean 74.5% (8.6%)) domains. Scores for items associated with Capability were higher than those associated with Opportunity (median (first, third quartiles) 78.6% (67.9%, 87.5%) vs 73.9% (66.0%, 81.8%); p=0.04). Nurses practising >5 years had significantly higher scores on all analyses. Barriers included engaging with families having strong emotional reactions, managing goals of care conflicts between patients and families, and staffing challenges on the ward. Additional requested resources included formal training, information binders and more staff. Opportunities for consideration include formalised on-the-job training, access to comprehensive information, including symptom management at the end of life, and debriefing sessions.Conclusions Front-line nurses reported an interest in learning more about end-of-life care and identified important barriers that are feasible to address. These results will inform specific knowledge translation strategies to build capacity among bedside nurses to enhance end-of-life care practices for dying patients on GIM wards.https://bmjopenquality.bmj.com/content/12/2/e002219.full |
| spellingShingle | Julie C Reid Jill C Rudkowski Deborah J Cook Neala Hoad Anne Boyle Daniel Brandt Vegas Kathleen Willison Rajendar Hanmiah Mino Mitri Amanda Weatherston Susan Lohin Deborah McInnes Michelle Joyner Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards BMJ Open Quality |
| title | Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards |
| title_full | Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards |
| title_fullStr | Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards |
| title_full_unstemmed | Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards |
| title_short | Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards |
| title_sort | learning needs and perceived barriers and facilitators to end of life care a survey of front line nurses on acute medical wards |
| url | https://bmjopenquality.bmj.com/content/12/2/e002219.full |
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