Eliminating Apprehension Amoung Nurses Towards End-of-Life Care. Jennifer Dees

Improvement in palliative care can happen with more interest from nurses towards this area of practice. Nurses are the health care providers that spend the most time with the patient and their families, making them advocates for patients who need end-of-life care. Nurses can also change the quality of care that is given. There are many ways to change the concepts of palliative care through both schools, hospitals, and nurses themselves. Since there is apprehension among nurses to provide end-of-life care, nursing schools should promote further education in this area, and allow students more clinical time to build the necessary skills and therapeutic technique to care for patients as well as specific training for caring for the family members, as well as teaching nurses how to deal with their own fears and emotions related to working with patients during their final days.
There are several factors that keep nurses as well as newly graduated nursing students from choosing palliative end-of-life care as their focus in their nursing career. Having little or no exposure to end-of-life care in school is a contributing factor, as well as the increased needs of the patient’s family during this time. Another obstacle is the nurse’s own fears about death and the potential feelings of loss for each patient. When a patient is referred to palliative care, the focus is no longer on curing. Palliative nursing is focused on caring for the patient and making them a comfortable as possible. Caring for a patient during this time involves several emotions and nurses should have training on how to deal with these feelings.
Encouraging nurses to explore this area of nursing is critical. More clinical experience in palliative care is needed. Training for nurses dealing with dying patients is needed as well, in order to recruit new nurses choosing this area of focus. Being exposed to end-of-life care will help nurses deal with apprehension issues, and allow the student to work through their own fears with the dying process. It may also be an enlightening experience as it may be an area some students would never chose until they are exposed to it, and realize it is something they are comfortable with. Exposure in nursing school can be beneficial even if the student does not intend to focus on end-of-life care. Integrating palliative end-of-life care into the daily practice of every nurse, regardless of specialty, can improve healthcare overall (Rushton, 2004). Patients can pass away on any floor of a hospital or nursing home, before they are referred to palliative care. The nurse working with this dying can implement some of the same strategies without specializing in end-of-life care. These strategies can also be implemented if a patient is not dying, such as assisting a family of a patient with an acute or chronic illness. The dying process includes psychological, social, spiritual, physical, and existential aspects. Facing a terminal illness is a stressful experience that affects many aspects of life (Smith, 2005). If nurses could specialize in this area, their focus would be on all of these aspects instead of just one or two (Smith, 2005). Further training in these areas, as well as exposure to dying patients will help the nurse to cope with his/her own apprehension about providing end-of-life care. Including palliative care in nursing schools would enable perspective palliative nurses to adjust to working with a dying client base. Since an important component of palliative nursing is to achieve the trust of the patient, the nurse-patient relationship can be further explored in schools, as well as in hospitals (Chiu, 2003). End-of-life care patient training should also be implemented early in nursing school and continued throughout one’s nursing career. With baby boomers aging, it is evident that end-of-life care will become an important part of nursing (Weigel, 2007).
Because end-of-life care involves caring for the patient’s family as well as the patient themselves, a nurse should keep the family informed and allow them to participate in the care of their loved one. Nurses have the most contact with the patients families, so they play a critical role in assessing the needs of the family during this sensitive time (Brajtman, 2005). Although, the death of the patient is unavoidable, providing sensitive, caring nursing will comfort the loved ones. A nurse should communicate with the family and provide information about the patient’s condition including things a family can do to provide care. Including the family members in the implementation and planning of care of their loved one with alleviate questions and concerns as well as giving them the sense of involvement. Informing the family of what is being done as the nurse performs tasks, i.e. pain meds, and their expected effects will help calm their fears and allow them to know what signs to look for, as well as giving family members the peace of mind that their loved one is comfortable. Nursing schools should implement caring for more than just the patient as curriculum. It is an emotional experience for the patient as well as for the family they are leaving behind. One of the most important things a nurse can do for the family is to listen to their concerns.
Caring for patients who are entering their final days of life is an emotional experience (Weigal, 2007). Nurses are hesitant to care for patients in this state because of the fear of their own emotional experience during the process. The fear of death itself is a factor that makes some nurses concerned about choosing this specialty to apply their skills. The fear of working with the family at such an emotional and life altering time is also an obstacle. As a nurse providing end-of-life care, there is an intense amount of time spent with the patient as well as the family members involved. Some healthcare professionals may find themselves with feelings of hurt and loss with each patient that passes away, because of the bond that was built during the patient’s final days. This is something a nurse working in this area would have to overcome. Hospitals could implement a counseling service as well as support groups for nurses to talk about their experiences and to deal with their emotions throughout these critical times.
There is apprehension among nurses to provide palliative care. Some ways to alleviate their hesitation are having curriculum in nursing schools as well as more clinical time with end-of-life patients. Schools, as well as hospitals should provide additional training for nurses on how to address and care for patients families during end-of-life care, and counseling for nurses individually to assist them in dealing with their own fears and emotions both before they work in palliative and continuing on during their career. One way for schools to consider these suggestions is for current palliative nurses to voice their concerns and advocate for student nurses to be exposed during their education. This is an important area of nursing. Patients deserve the best care possible regardless of the prognosis. Having more, quality trained nurses chose this area of nursing will ensure that.


Intervention 1: Nursing schools should have curriculum and clinical time devoted to end-of-life care.
I: Disadvantage 1 Time constaints
There is a nursing shortage in all areas, and having nursing schools devote more time to certain areas will only prolong the amount of time it takes to produce new nurses. If nursing schools were to implement curriculum with a special emphasis on end-of-life care, the curriculum would need to be updated continually (Dickinson, 2007), further taking up both time and money which are both scarce at this time in nursing education. The entire course may not fit into curriculum causing an extension of time nurses spend in training (Dickinson, 2007).
II: Disadvantage 2 Lack of Teachers
Many faculty feel under prepared to teach, and fail to provide adequate feedback about communication in end-of-life care (Sullivan, 2003). It is also a view that patient’s in end-of-life care offer too few learning opportunities and are not assigned as often (Sullivan, 2003). It is difficult for some medical professionals to teach about something that contradicts what they have been taught, which is to save lives (Sullivan, 2003).
Intervention 2: Hospitals could implement a counseling service for nurses to talk about their experiences and emotions felt about the dying process.
Disadvantage 1: Comforts levels about dying are different with each individual.
Everybody has different views and beliefs about death. Counseling and support groups may not curb reservations about dealing with this issue. Some people can’t be trained to be comfortable with the topic (Dickinson, 2007). Personal attitudes may also hinder ones ability to deal with this type of client.
Disadvantage 2: Funding and staffing for this unit
If hospitals implement counseling services specific for end-of-life care nurses, there would have to be funding and staffing for the unit. Anxiety levels may increase from increased exposure to death (Dickinson, 2007) causing an increased number of counseling sessions. Anxiety in the workplace can also show through in home life.

Reference Page

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