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4 actions to help nurses feel more confident in providing end-of-life care

By Donna M. Wilson & Samantha L. Chan
June 27, 2022

Nurses have always cared for dying people. Some would even argue that nurses provide more end-of-life care than any other group, apart from family members. Yet, most nurses today have had little actual end-of-life care experience.

The COVID-19 pandemic has changed that (Northcott & Wilson, 2021). People of all ages have been dying of COVID-19, and these deaths are occurring in all of the many places where nurses work.

Nurses are being confronted, often for the first time, with practical and ethical dilemmas over death, dying, and end-of-life care. This paper explores why nurses often feel unprepared to care for dying people, and what we can do so that all nurses are more confident and supported in their efforts to ensure people get the end-of-life care that they need.

Background

Before COVID-19 began to affect Canada in early 2020, a decades-old shift of death and dying out of hospital was occurring. The last major study, using national inpatient hospital data, found that only 3.5 per cent of all hospital admissions in the 2014–15 year ended in death (Wilson, Shen, & Birch, 2017). That study also showed 43.7 per cent of all deaths in Canada that year occurred in a hospital bed.

With more deaths taking place outside of hospitals, this means that home care and continuing care nurses are more likely to provide end-of-life care, either directly or as care planners and supervisors of bedside care providers.

It is crucial that fellow nurses provide emotional support, encouragement, and assistance.

The 1970s initiation and then welcome growth of hospice and palliative care across Canada also had an impact on nurses. Terminally ill people increasingly became the responsibility of specialist care teams, with general duty nurses no longer routinely involved in planning and providing end-of-life care. Yet, most people have relatively basic end-of-life care needs, such as mouth care, incontinence care, turning and positioning, and quiet reassurance, as well as compassionate support for their grieving families.

Although all undergraduate nursing education programs in Canada have end-of-life content (Wilson, Goodwin, & Hewitt, 2011), nurses more typically gain knowledge, skills, and confidence through planning and providing end-of-life care.

How can more nurses feel confident and supported in providing end-of-life care?

Even in this pandemic, end-of-life care is not a workplace reality for most nurses, but four actions can help nurses feel more prepared and able now or in the future to help dying people and their families.

1. Access to necessary information

Nurses need ready access to practical online and print information on end-of-life care. From 2010 onward, 17 articles on palliative or end-of-life care were published in Canadian Nurse, a journal that all nurses in Canada can access.

Many more topics could be covered in journals to build end-of-life care knowledge among nurses. Articles are especially needed to normalize dying and death, a reality for everyone. A good illustration of this is Morris’s (2021) informative article on the importance of non-verbal communication with dying people and the need for nurse self-care.

2. Emotional support

Looking after dying people can be difficult, as nurses experience care dilemmas when it is not clear what should be done to help someone who may die or will die at some unknown point in the future. Moreover, sad feelings over remembered deaths can also be triggered. It is crucial that fellow nurses provide emotional support, encouragement, and assistance.

3. Practical experience for student nurses

Undergraduate nursing programs also need to ensure that every student has practical end-of-life care experience before they graduate and become responsible for patient care. This experience can be gained through clinical and simulation practicums. Directed learning could ensure that every graduating nurse has been involved in end-of-life care and has therefore gained basic skills and knowledge.

4. Need for specialist teams and care guidelines

Another needed development is for specialist hospice-palliative care teams to ensure end-of-life care guidelines exist in every care setting to help make it clear when people should be referred to them for specialist care. These teams are also called upon to develop basic end-of-life care protocols and then help to ensure that these protocols are widely known and used.

Conclusion

Few nurses have had much experience in providing end-of-life care. The COVID-19 pandemic is reminding us that death and dying are realities that all nurses need to be prepared for. It has been more than two years since the World Health Organization declared a worldwide pandemic. The passing of this anniversary should prompt us to take a renewed interest in the importance of nurses for planning and providing compassionate and effective end-of-life care.

References

Morris, B. (2021, February 22). I’ve been with many patients as they die; here’s why non-verbal communication is so important. Canadian Nurse. https://www.cna-aiic.ca/dev-cn-en/blogs/cn-content/2021/02/22/ive-been-with-many-patients-as-they-die-heres-why

Northcott, H.C., & Wilson, D.M. (2021). Dying and Death in Canada (4th ed.). University of Toronto Press.

Wilson, D.M., Goodwin, B.L., & Hewitt, J.A. (2011). An examination of death education in introductory nursing programs across Canada. Nursing Research and Practice, Article ID 907172. http://dx.doi.10.1155/2011/907172

Wilson, D.M., Shen, Y., & Birch, S. (2017). New evidence on end-of-life hospital utilization for enhanced health policy and services planning. Journal of Palliative Medicine, 20(7), 752–758. http://dx.doi.org/10.1089/jpm.2016.0490

Donna M. Wilson, RN, PhD, is a professor in the Faculty of Nursing at the University of Alberta.
Samantha L. Chan, RN, is a master of nursing (nurse practitioner) student in the Faculty of Nursing at the University of Alberta.