Authors: (including presenting author): :
Chau WS(1), Tsang KY(1), Wong KC(1), Wong WK(1)
Affiliation: :
(1) Medical, Yan Chai Hospital
Keyword 1: :
inpatient End Of Life Care
Keyword 2: :
nursing staff in medical ward
Introduction: :
As the population ages, more and more hospitalised patients or their relatives are choosing to let nature take its course at the end of life (EOL), opting for Do Not Attempt Cardio Pulmonary Resuscitation(DNACPR). Therefore, we hope to strengthen the awareness of our frontline staff in caring for terminally ill and imminently dying patients, so that they can better identify and take care of those patients nearing the end of their life
Objectives: :
- Increase overall knowledge and communication skills in EOL care for frontline nursing staff -Achieve better understanding and utilization of Comfort-Oriented Care Pathway Form
Methodology: :
Nursing colleagues began by completing a pre-questionnaire before engaging in a 14-minute video that covered key concepts and communication tips regarding end-of-life (EOL) care. Additionally, participants utilized a poster that summarized essential communication points for quick reference, which included the Initialism Approach to EOL Care (EOLC): Empathy, Open Dialogue, Lessen Unnecessary Interventions, and Comfort-Oriented Care Pathway. To ensure comprehensive participation, on-site briefing sessions lasting 10 minutes were conducted for all nurses in four pilot wards. These sessions were repeated until every staff member had participated. One month following the training, participants completed post-test questionnaires consisting of 10 questions—4 focused on communication and 6 on knowledge. Respondents were categorized into groups based on their years of experience: 0–2 years, 3–5 years, 6–10 years, and 10+ years. Additionally, a satisfaction survey comprising 5 questions was administered. An audit of completed Comfort-Oriented Care Pathway Forms was also conducted to assess the implementation of the training.
Result & Outcome: :
The pre-test results indicated that 78 participants completed the assessment, achieving an overall pass rate of 76%. However, there was significant variation based on years of experience: 53% for nurses with 0–2 years, 81% for those with 3–5 years, 96% for those with 6–10 years, and 74% for those with more than 10 years. The average score across all participants was 65%, with less experienced nurses scoring lower—51% for those with 0–2 years and 63% for those with 3–5 years. Importantly, communication scores were higher than knowledge scores across all groups. In the post-test, 87 participants were assessed, and the overall pass rate dramatically improved to 99%, with high pass rates noted across all groups. The average score rose to 92%, reflecting significant improvement. Both communication and knowledge areas showed substantial gains, with communication scores reaching 94% and knowledge scores standing at 85%. Regarding participant satisfaction, feedback from 87 respondents highlighted that 67% rated the program as "good" and 28% as "very good." Furthermore, 70% found the video and personal explanations satisfactory, while 65% expressed contentment with the video's duration. Despite 67% finding the Comfort-Oriented Care form useful, only 8% categorized it as "very good" regarding ease of use. An audit of 11 reviewed forms revealed that 9 patients passed away within three days, resulting in an accuracy rate of 82%; only 2 patients were discharged after seven days. While most critical points were adequately documented, half of the forms lacked records of care plan reviews, indicating a need for improvement in documentation practices. In summary, the program significantly enhanced nurses' understanding and communication skills, which was evident in the positive post-test results. Nurses with over 10 years of experience showed slight improvement in knowledge, suggesting challenges in adapting to new concepts. While participants appreciated the video and on-site explanations, feedback regarding the application of the Comfort-Oriented Care form was mixed. The audit results underscore the necessity for a greater focus on integrating documentation practices into daily routines and highlight the need for ongoing support to ensure consistent use of the form.
