Care for the COVID In-patient: Common Practices in End-of Life Care

Submitter Information

Author: Kathy Jo Meyers, Ph.D., RN., ACNS-BC
Title: Post-doctoral Fellow
Institution: Veteran Administration Quality Scholars
Email: kathy.meyers@va.gov
Coauthors: Davico Smith-Washington, RN

Competency Category(s)
Evidence-Based Practice, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
Advanced Practice Providers, Faculty Development Strategies, Interprofessional, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development

Learner Setting(s)
Clinical Setting

Strategy Type
General Strategy

Learning Objectives

The interdisciplinary team will be able to verbalize common end-of-life practices.

The interdisciplinary team will have increased knowledge of common medications used to improve symptomatic care at end-of-life in the in-patient.

The interdisciplinary team will state the improvement in one outcome in end-of-life care through the use of the evidence-based end-of-life resource sheet.

Strategy Overview

Due to the COVID pandemic, staff of all disciplines was reassigned to the acute COVID units. Many staff had no prior exposure to potential traumatic incidences and end-of-life care. Through focused questionnaires, knowledge deficits were identified. A subsequent multi-week educational series based on the End-of-Life Nursing Education Consortium (ELNEC) curriculum as well as a Resource Sheet was created to guide clinical practice at end-of-life for the COVID in-patient.

Submitted Materials

Meyers_EOL-Meds-Practice_03.24.2021-1.pdf
Meyers_EOL-Practice_03.24.2021-1.pdf

Additional Materials

Evaluation Description

In the pre-implementation phase, open-ended questions were used to identify areas of need for the staff. After an educational series, an End-of-Life Resource Sheet was designed based on the needs assessment and the ELNEC curriculum. The accuracy of the resource sheet was confirmed with experts in the field. Resources used included the End-of-Life Nursing Education Consortium (ELNEC) curriculum, the American Association for Hospice and Palliative Medicine, the Hospice and Palliative Nurses Association, National Hospice and Palliative Care Organization, and the Veterans Administration Evidence-Based Practice Committee. This validity of the practice strategy was assessed via interviews with various interdisciplinary stakeholders including physicians, managers, nurses, and patient caregivers. Continual staff evaluation of the resource during development included statements that the resource would be a helpful refresher of end-of-life content.

The final evaluation of the End-of-Life Resource Sheet included interviews with staff nurses and nursing assistants. There was confirmation that staff was able to verbalize end-of-life common practices and common medications used for various symptoms such as dyspnea, pain, and nausea. After the occurrence of five patient deaths, comfort with using the tool will be measured via focused inquiries with the staff regarding the use of the resource sheet and any further recommendations for education.

The End-of-Life Resource Sheet was laminated and placed in the Unit Procedure Binder as a quick reference for the staff when caring for an in-patient at end-of-life. The interdisciplinary team plan is to revisit the effectiveness of the resource yearly to determine if updates are needed in protocols or medications. This End-of-Life Resource Sheet is specific to the campus of origin; however, it can be replicated for use to suit the needs of outside sources.