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Improving Long-Term Care Residents’ Outcomes by Educating Nursing Staff on End-of-Life Communication

Kunte, Vera DNP, APN-C, CNE; Johansen, Mary L. PhD, NE-BC, RN; Isenberg-Cohen, Shari DNP, APN-C

Journal of Hospice & Palliative Nursing: December 2017 - Volume 19 - Issue 6 - p 550–555
doi: 10.1097/NJH.0000000000000386
Feature Articles

This project aimed to examine whether improvement in end-of-life knowledge of long-term care nursing staff, especially nursing assistants, increases the rate of long-term care residents with advance directives and decreases the rate of their hospital transfers.

Nurses and nursing assistants in long-term care facilities are inadequately prepared to provide quality end-of-life (EOL) care. Few studies focus on improving EOL education of nursing assistants who are closest to the residents, providing most of their care. Eleven nurses and 18 nursing assistants from 1 urban and 1 suburban long-term care facilities received education based on the End-of-Life Nursing Education Consortium Geriatric curriculum separately and together. Pre-education and posteducation, knowledge of nursing staff was assessed and records of 139 residents were examined for advance directives and hospital transfers.

Posteducation, EOL knowledge of nursing assistants showed greater improvement than that of nurses; all nursing staff rated their knowledge higher. Documentation of resident EOL preferences improved minimally, but the rate of transfers to the hospitals was dramatically reduced.

Nursing staff education on EOL care reduces the number of long-term care residents’ hospital transfers leading to improved quality of EOL care. Nursing assistants benefit from combined education sessions with the nurses.

Vera Kunte, DNP, APN-C, CNE, is advanced practice nurse, Department of Clinical Education, Capital Health, Trenton, NJ.

Mary L. Johansen, PhD, NE-BC, RN, is clinical associate professor, Rutgers, The State University of New Jersey School of Nursing, Newark.

Shari Isenberg-Cohen, DNP, APN-C, is clinical services manager, Optum, Bernards Township, NJ.

Address correspondence to Vera Kunte, DNP, APN-C, CNE, 750 Brunswick Ave, Trenton, NJ 08638 (

The authors have no conflicts of interest to disclose.

© 2017 by The Hospice and Palliative Nurses Association.