Fuoto Abby, Turner Kathleen M
Abby Fuoto, DNP, ANP-BC, AOCNP, ACHPN, is nurse practitioner, Banner University of Arizona Cancer Center, Tucson, AZ. Kathleen M. Turner, DNP, RN, is associate professor of nursing, Duke University, Durham, NC.
J Hosp Palliat Nurs. 2019 Apr;21(2):124-130. doi: 10.1097/NJH.0000000000000493.
Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between-subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care.
尽管护士、患者及其家属之间的沟通频繁、复杂且密集，但姑息治疗护士在临终沟通方面常常面临困难。这个质量改进项目的主要目标是在实施COMFORT模型后，提高护士在临终沟通方面的信心和满意度；次要目标是提高患者家属对姑息治疗病房所提供护理的满意度。14名姑息治疗护士参加了一个为期4小时的课程，学习COMFORT模型的原则并通过角色扮演练习进行实践。采用重复测量设计来测量护士在课程前、课程后以及课程后3个月时的信心和满意度。采用组间前后设计来比较实施前3个月与实施后3个月期间的家属满意度调查得分。分析显示，从课程前到课程后以及从课程前到课程后3个月，护士信心和满意度的所有测量指标均有统计学上的显著提高。培训前后的家属满意度调查得分没有统计学差异，尽管调查结果在基线时总体较高，且大多数受访者对姑息治疗服务给出了最好的评价。该项目表明，COMFORT模型培训提高了从事临终沟通的姑息治疗护士的信心和满意度，并展示了在其他并非专门从事临终护理的临床领域（如重症监护）使用该模型的潜力，这些领域也需要沟通技巧来处理临终护理问题。
