Nurses' perceptions and experiences with end-of-life communication and care.

PURPOSE/
OBJECTIVES: To characterize oncology nurses' attitudes toward care at the end of life (EOL) and their experiences in caring for terminally ill patients, hospice discussions with patients and families, and the use of palliative care practices.
DESIGN: Descriptive correlational survey study.
SETTING: A Magnet®-designated hospital in southern California with more than 500 beds. SAMPLE: 31 oncology nurses.
METHODS: Nurses completed the adapted version of the Caring for Terminally Ill Patients Nurse Survey. MAIN RESEARCH VARIABLES: Attitudes toward care at EOL and care experiences with terminally ill patients.
FINDINGS: Despite having fairly positive attitudes toward hospice and having discussions about prognosis with terminally ill patients, nurses reported missed opportunities for discussions and patient referrals to hospice. On average, nurses cared for more than seven terminally ill patients during a three-month period while only discussing hospice care with a third of these patients and their family members. Most nurses acknowledged that patients would benefit from earlier initiation of hospice care. Specific palliative care practices used by nurses in the past three months varied, with active and passive listening and requesting increased pain medications used most frequently and aromatherapy and guided imagery used least.
CONCLUSIONS: Missed opportunities may reflect nurses' attitudes. However, lack of patient and family member acceptance was the most important barrier to discussion of hospice. IMPLICATIONS FOR NURSING: Strategies to enable nurses to have a stronger voice during this critical time for their patients are needed and, when developed, supported in practice to ensure that they are used.