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End-of-Life Care

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Seminars can improve nurses' skills in discussing end-of-life issues with heart failure patients and their families

About half of people diagnosed with heart failure die within 5 years, but the trajectory is unpredictable. Thus, it is important for nurses to communicate with these patients and their families about advanced planning and end-of-life issues. A new study showed that a pilot 1-hour educational seminar significantly increased the ability of hospital inpatient nurses to discuss advance care issues (as self-reported 2 months later). The seminar helped normalize the topic of dying for nurses, encouraged discussion, and validated nurses' concerns. It also modeled communication strategies and prompted shared experiences between older and younger staff.

After taking the seminar, nurses felt more confident in their ability to manage pain, shortness of breath, or respiratory distress in heart failure patients. They also felt more competent to break bad news to patients about illness, to manage patients' emotional suffering, and to discuss end-of-life issues with patients and families. However, communicating with heart failure patients about end-of-life issues is complicated by a workforce of relatively young nurses and doctors' overly optimistic views about the prognosis of heart failure patients.

Of the 37 nurses who attended the seminar and completed a postseminar test, about one-third had a year or less of nursing experience and 58 percent had 2 to 6 years of experience. One-fifth reported that none of their patients had died over the past 6 months. Nurses also found it difficult to approach the topic of end-of-life care with physicians, who may not view heart failure as a terminal illness. Unlike cancer patients, heart failure patients can have constant periods of stability or erratic functional status, periodic crises, and recovery, yet the patient and family must cope with the threat of sudden death. The pilot study was supported by the Agency for Healthcare Research and Quality (HS10871).

See "End-of-life communication and hospital nurses: An educational pilot," by Jane G. Zapka, Sc.D., Winnie Hennessy, R.N., M.S., Rickey E. Carter, Ph.D., and Elaine J. Amella, Ph.D., A.P.R.N., B.C., in the May/June 2006 Journal of Cardiovascular Nursing 21(3), pp. 223-231.

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