Congress Abstracts 2004

67

END-OF-LIFE NURSING CARE ON AN INPATIENT ONCOLOGY UNIT: A TOOL TO FACILITATE THE TRANSITION FROM CURE TO COMFORT CARE. Shirley Edwards, MSN, AOCN^®, RN, CNS, and Christina Maupin, MN, CCRN, RN, CNS, Saint John’s Health Center, Santa Monica, CA.

Oncology nurses are challenged to coordinate care for patients receiving aggressive curative measures while also providing care for dying patients and their families. As the balance of care needs transition from curative to comfort care, the nurse is expected to shift paradigms. Assessments and interventions move to aggressive symptom management to promote comfort and facilitate a peaceful and dignified death. This process was facilitated by the Comfort Care of the Dying Patient Task Force chartered by the health center’s bioethics committee.

The purpose of this project was to improve the care of the dying patient through provision of comfort care focused on pain and symptom management, staff education, and patient/family advocacy. The pilot project was conducted jointly in the critical care and oncology units through the collaboration of the critical care and oncology clinical nurse specialists. The interdisciplinary task force established clinical practice guidelines for the management of dyspnea, agitation, and pain. Additional tools to facilitate comfort care of the dying patient included physician orders, an interdisciplinary teaching record, nursing management protocol, and a family support and resource folder. Prior to implementation of the pilot project, extensive staff education was provided.

Data regarding oncology staff knowledge and perceptions was collected prior to and after project implementation. During the pilot, the oncology staff identified a need to have a documentation tool that clearly addressed symptom assessment and management of the dying patient. A focused symptom assessment and management documentation form, based on staff and oncology physician input, was drafted. The form was utilized by the staff and improved as nurses and physicians provided feedback as to its effectiveness.

Outcomes of the project include improved staff perceptions of end-of-life care effectiveness, support, and facilitation of communication with the interdisciplinary team and families.

Additionally, the identification and development of the focused documentation tool provided the oncology nurses with a framework of practice guidelines for the transition from cure to comfort care. This concept has now been implemented “housewife” as a component of the Comfort Care of the Dying Project.