Many Critical Care Nurses Unprepared to Provide Palliative Care

Critical care nurses say they feel unprepared to provide palliative care or hospice care, according to a recent study, underscoring the need to address growing clinical staff shortages in those fields. 

More than 500 critical care nurses across seven intensive care units in a Virginia-based academic health center responded to a survey designed to measure participants’ perceptions of palliative care in their practice setting.

Researchers analyzed responses to a total of 167 completed questionnaires, with fewer than 40% of respondents reporting that they were being highly competent in any palliative care domain. About 38% responded that they had received no palliative care education within the previous two years.

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Most respondents reported moral distress during the study period, and moral distress levels differed significantly on the basis of perceived use of palliative care. Respondents who perceived less frequent use of palliative care tended to experience higher levels of moral distress.

“There was a gap between how they found the different realms of palliative care to be and how confident they felt to provide it. Most respondents didn’t feel confident providing care in any [palliative care] domain,” said Alexander Wolf, lead researcher and palliative care nurse practitioner at the Ohio-based health system TriHealth. “That tells us is that nurses in the critical care setting at least at this institution — as well as others according to other research — really are not getting enough palliative care education and training.”

The findings point to the need to address industry-wide clinician staff shortages across all hospice and palliative care disciplines.

The number of hospice and palliative care physicians and members of other disciplines will drop precipitously during the next two decades, largely due to retirements and staff leaving the field due to burnout, recent research has found. Among U.S. physicians, 40% are 56 or older and incoming palliative care and hospice specialists will not be enough to replenish the ranks. By 2045, only one physician will be available for every 808 patients, according to the same study.

“Most patients who are critically ill have some kind of palliative care need; of course we now know that palliative care extends way beyond the end of life, whether it is more specialized symptom management or sensitive discussions about their goals of care or what the future may hold,” Wolf told Hospice News. “We have weeks where we are just saturated with consults because the need is so high, and that indicates that we need to do a better job of having other specialists, nurses and other health care providers trained to be able to provide basic palliative care, or what we call integrative palliative care or generalized palliative care.”

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