| Description |
General Inpatient (GIP) Hospice services consist of pain and symptom management in the acute care setting, with high symptom burden requiring more intense management than can be offered at home. GIP hospice promotes better end-of-life (EOL) management and increases access to hospice services for rural or low socioeconomic patients. Formal and academic nursing preparation focuses on life-sustaining and curative services, leaving some acute care nurses underprepared to provide GIP hospice services. This lack of competency may lead to nurse anxiety, ineffective communication, poor symptom management, and medication errors when caring for inpatient hospice patients. Local Problem: A Mountain West urban acute care hospital recently designated three medical/oncology unit beds for GIP hospice patient services. The acute care nurses are generally not trained to treat GIP hospice patients' significant symptom burden and communication needs. An evidence-based GIP hospice clinical pathway for nurses in the acute care setting may increase nurse knowledge and confidence, decrease anxiety, and promote quality care among GIP hospice populations. Methods: We collected baseline data on the number of patients utilizing GIP hospice services for the preceding three months. We developed and distributed a pre-implementation survey to assess nurse and patient care technician (PCT) knowledge, comfort level, and anxieties in caring for patients utilizing inpatient hospice services. Using these findings and evidence-based recommendations, we developed and implemented a GIP hospice training and clinical pathway for acute care nurses, including simulation training, process checklist, and resource materials. We distributed a post-implementation survey four weeks after implementation to reevaluate nurse knowledge, comfort level, and anxieties while assessing their satisfaction with the project and perceptions about usability and feasibility. We analyzed pre and post-implementation data using descriptive statistics and the Mann-Whitney U (alpha 0.05). Interventions: Evidence-based GIP hospice training was developed and offered to acute care nurses and PCTs. Pre- and post-surveys helped us evaluate learning gaps, comfort levels, anxieties, satisfaction, usability, and feasibility of the training sessions and materials. Results: The pre (n = 52) and post (n = 30) survey samples were about two-thirds nurses and one-third patient care technicians, with most participants identifying as female, white, non- Hispanic, and 18 to 35 years old. The comparative analysis of survey findings suggested with statistical significance an improved understanding of hospice care, the GIP hospice admission process, appropriate escalation of symptom management, and increased comfort level with communicating with dying patients and their loved ones, with unremarkable differences related to pre/post perceptions of death anxiety. Post-implementation participant comments suggested the usability and feasibility of the project. Conclusion: The enhanced GIP hospice training and clinical pathway may have promoted caregiver understanding of hospice care, including appropriate symptom management and comfort in communicating with dying patients and loved ones. GIP hospice programs centered on clinician competencies and clinical pathways may promote employee satisfaction and positive patient outcomes. Possible next steps include ongoing GIP hospice training focusing on communication tools and death discussions to promote caregiver wellness and burnout prevention. |
