Promoting neonatal staff nurses comfort and involvement in end of life and bereavement care

Transcription

1 Promoting neonatal staff nurses comfort and involvement in end of life and bereavement care Weihua Zhang, RN, MS, PhD Clinical Assistant Professor 1520 Clifton Road, Atlanta, GA Nell Hodgson Woodruff School of Nursing Emory University

2 Background Nurses who provide end of life (EOL) and bereavement care to infants and their families are potentially at great risk for developing stress related health problems. The stress experienced by a nurse can even impact the quality of care provided to patients and parents.

3 Background There has been an increase in the proportion of deaths associated with decisions to forgo intensive care treatment from 23% in 1987 to 1988 to 64% in 1998 to 1999 (Hagen & Hansen, 2004). Three quarters of neonatal deaths are associated with withdrawal of treatment (Wilkinson et al., 2006).

4 Background Studies have indicated neonatal nurses often are not comfortable with providing end of life or palliative care to infants. Some of the reasons associated with this discomfort are inadequate nursing education related to bereavement care in nursing school or in their environment of employment (Chan, Wu, Day, & Chan, 2005; Ferrell, Grant, & Virani, 2001).

5 Purpose Nurses has some knowledge about end-of-life issues and bereavement, and are at the front line provide quality end of life care and bereavement. How comfortably they are doing it is a question we need to ask. A seminar was designed to provide information on end of life care/bereavement to nurture a community of caring in end of life care. This study was to evaluate the effect of a end of life seminar on the attitudes of nurses regarding end of life (EOL) and palliative care of neonates.

6 Research Questions 1) What are the characteristics and attitudes of nurses who provide end of life/bereavement care to infants? 2) Is there a difference on nursing role, comfort, and involvement in providing end of life care between pre and post test scores of nurses who attended a bereavement seminar? 3) Will nurses who attend the educational seminar have higher scores on the domains of comfort, role, and involvement than the control group?

7 Design A pre and post test design with an intervention (n=14) and control group (n =44) was used to assess changes in nurse bereavement attitudes in relationship to the domains of Comfort, Role, and Involvement. The setting for the study was a community hospital in the Southeast of the United States. A convenience sample of nurses who provide care to neonates completed a Bereavement/End of Life Attitudes about Care of Neonatal Nurses Scale (BEACONNS).

8 Instrument There are three domains in the BEACONNS scale, these consist of: 1) The comfort level of handling end of life and bereavement care. 2) Role propensity for providing end of life and bereavement care. 3) Tendency of allowing family involvement in providing end of life care.

9 Intervention or seminar The seminar entitled How do I make IT feel better. IT refers to the physiological and psychological impact of loss on both family and staff. In order to alleviate this impact and reduce staff s moral stress. The strategies on how to support the caregiver and family dealing with grief; how to utilize support services in the community and hospital; how to deal with ethics issues, and improving communication skills are also the focus of this seminar.

10 Who came to the seminar The majority was married (83%), Protestant (34.4%), and Caucasian (82.3%), and had children (84%). Most held a BSN (46.8%) or an ADN (41.9%) degree and worked in the NICU (38.7%). The average nurse was (SD 10.5) years of age and had worked in nursing 5.29 (SD=8.2) years. Nineteen percent had experienced a significant personal loss in the past year. Seventy-one percent had end of life/bereavement care in their basic nursing education. Less than half were (43.5%) were satisfied or very satisfied with their prior end of life nursing education. Slightly more than a fourth (28.6%) had attended continuing education courses on EOL/bereavement care. Over three-fourths had cared for dying infants.

11 Findings Nurses comfort level with end of life /bereavement care was significantly increased (t = -3.37, p =.01). Post-Role scores were not significantly different than the Pre-Role scores (t = 1.09, p =.30). Likewise, Post-Involvement scores were not significantly different than that the Pre-Involvement scores (t = -.19, p =.84).

12 Discussion Those who came to the work shop were less satisfied with their previous end of life nursing education training, which may have been a motivator for their attendance at the Bereavement workshop.

13 Discussion The results of this study support the use of a Bereavement seminar to increase nurse comfort levels in the provision of EOL/bereavement care to infants and families. The comfort level increments could be the result of the seminar content as well as the interactions among nurses during the day-long seminar. This suggested that nurses' comfort level can be improved by attending continuing education on end of life care and having their thoughts on ethical issues in end of life care acknowledged by their peers.

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