Gaps in Adult End of Life Education: a Multimodal Approach

Topic: Education


Nursing plays a crucial role in the improvement of end-of-life care. In an academic medical center effort must be made to prepare nursing staff to care for a diverse patient population, high acuity, psychosocial factors, intense family dynamics and the emotional response to death. It is an important part of nursing wellness and resilience to anticipate personal reactions and develop appropriate coping mechanisms when providing end-of-life care (Hamilton, 2010). This dynamic requires an innovative educational plan which addresses the intensity of the patient population as well as the organizational and nursing culture. Many challenges exist to ensure that dying individuals receive competent and compassionate care as they face the end-of-life (Ladd, et al 2013). To meet these challenges, we have developed a teaching program to support the nursing staff in obtaining these skills.

The initial group consisted of fifty registered nurses from one medical surgical unit. This nursing unit cares for the general inpatient hospice patients and has the highest number of end-of-life “comfort care” patients in the organization. The instructional model for end-of-life education starts with pre-education Health stream learning modules on palliative medicine, pain management, symptom management and end-of-life care. These foundational computer modules then continue into an engaging didactic classroom setting which further expands on these concepts. Additionally, self-care was introduced as a topic.  In the last phase, the learners progressed to an interprofessional standard patient and family simulation training consisting of APPs, MDs, SW, chaplains, and nursing staff who were able to teach and share their experiences and expertise. Topics included communication, medication equivalency, and safety, ethics, pain and symptom management.

The standard patient and family simulated case scenarios brought up memories and emotions for the trainees, who were overwhelmed at times by the remembrances of both peaceful and difficult deaths. The participants provided both articulate and extensive dialogue about their experiences and interactions with members of the team. The nurses had the opportunity to debrief and discuss their anxiety, fears and the witnessed pain and suffering of dying patients. Nurses recognized the cues sent and received between the nurse the standard simulated patient and family.  In the post-survey nurses showed increased knowledge with this multitiered educational program. The surveys strongly suggested continued use of open discussion and standard patient simulation in further education.

Incorporating this basic end-of-life course is just the beginning to improving care for they dying. This course will help to prepare nurses at all levels to be change agents within the prevailing health care culture (Ladd et al, 2013). There were many nurses from this initial course who showed interest in becoming end-of-life champions. Teaching in this manner breaks down barriers and allows for a safe environment for learning as well as a culture of openness, curiosity, and commitment to evidence-based care for patients at the end of life (Gillan, Jeong, Van Der Riet, 2014).  



  • Judy Passaglia, CNS, RN, ACHPN
  • Karla m. Schroeder, DNP, MHA, ANP-BC

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