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Evaluation of a Peer Nurse Coach Quality Improvement Project on New Nurse Hire Attitudes Toward Care for the Dying

Liang, Zhan RN, PhD; DiNella, Jeannine RN, DNP, CCNS; Ren, Dianxu MD, PhD; Tuite, Patricia K. RN, PhD, CCNS; Usher, Barbara M. RN, PhD, ACHPN, GCNS-BC

Journal of Hospice & Palliative Nursing: October 2016 - Volume 18 - Issue 5 - p 398–404
doi: 10.1097/NJH.0000000000000261
Feature Articles

Despite growth of hospices in the United States, there is increased use of intensive care and late referrals to hospice, and most patients die in hospitals. A national survey indicates that these patients can experience persistent pain, dyspnea, anxiety, and depression, and they and their families also have unmet needs for respectful treatment. Nursing leaders perceived that new nurse hires lacked end-of-life training and were uncomfortable caring for dying patients. Evidence from 2009 to 2011 using Frommelt Attitudes toward Care of the Dying (FATCOD) questionnaires collected during classroom exercises confirmed this and indicated areas for quality improvement. After further review, a peer nurse coach model was selected for the intervention. New nurse hire FATCOD data from 2009 to 2011 were used to design the intervention. This article examines FATCOD data collected immediately before the quality improvement project and data collected 5 months after to evaluate the impact of end-of-life peer nurse coaching on new nurse hire attitudes toward end-of-life care. The difference in total scores was not significant, although there were significant positive improvements in individual questionnaire items. Overall, the peer nurse coach model holds promise as a mechanism for engaging new nurse hires and for improving end-of-life care.

Zhan Liang, RN, PhD, is assistant professor of nursing, University of South Florida, College of Nursing, Tampa.

Jeannine DiNella, RN, DNP, CCNS, is programmatic nurse specialist, Cardiovascular Support Services, University of Pittsburgh Medical Center-Presbyterian, Pennsylvania.

Dianxu Ren, MD, PhD, is associate professor and associate director for statistical support, School of Nursing, University of Pittsburgh, Pennsylvania.

Patricia K. Tuite, RN, PhD, CCNS, is assistant professor of nursing, acute and tertiary care, School of Nursing, University of Pittsburgh, Pennsylvania.

Barbara M. Usher, RN, PhD, ACHPN, GCNS-BC, is programmatic nurse specialist, Palliative and Supportive Institute, University of Pittsburgh Medical Center-Presbyterian, Pennsylvania.

Address correspondence to Barbara M. Usher, RN, PhD, ACHPN, GCNS-BC, UPMC Palliative and Supportive Institute, 3600 Forbes Avenue, Iroquois Building, Ste 308, Pittsburgh, PA 15213 (

Funding was provided by The Beckwith Institute in partnership with the University of Pittsburgh Medical Center.

The authors have no conflicts of interest to disclose.

© 2016 by The Hospice and Palliative Nurses Association.