Lee Chen Na, Lee Guozhang, Aw Fung Chee, Zulkifle Nuraishah Binte, Tan Yih Shan, Amanulla Marianah, Chua Esther Hui Hui, Koh Wei Zhi, Lee Jolin Er Huan, Woong Natalie Liling
Nursing Division, Singapore General Hospital, Singapore
Internal Medicine, Singapore General Hospital, Singapore.
BMJ Open Qual. 2025 Feb 18;14(1):e003228. doi: 10.1136/bmjoq-2024-003228.
End-of-life care is a fundamental aspect of nursing that significantly affects patient outcomes and family well-being. Despite its importance, nurses in non-palliative care settings often lack relevant training and confidence to provide high-quality end-of-life care, resulting in suboptimal patient experiences. This paper presents a quality improvement initiative at Singapore General Hospital, the nation's largest tertiary acute hospital, aimed at addressing this critical gap.We conducted a targeted educational needs assessment using a modified Palliative Care Quiz that showed a low pass rate of 15% among medical ward nurses. In response, we designed and implemented a structured training programme that integrated lectures with interactive case-based discussions, focusing on practical, real-world applications of end-of-life care. Our findings demonstrate a significant increase in knowledge proficiency, with the pass rate improving to 53% post-intervention. Additionally, nurses reported significant improvements in their confidence and competence across all domains of end-of-life care. Notably, scores for non-pharmacological management increased from 49% to 86%. This domain covered non-pharmacological modalities for managing dyspnoea, secretions, delirium and nausea and vomiting.These results highlight the effectiveness of targeted educational interventions in equipping nurses with the skills and knowledge to manage the complexities of end-of-life care. Integrating targeted end-of-life training into nursing curricula and institutional practices improves nurses' confidence and competence and enhances the quality of care for patients and their families facing the end of life. This report is written based on the Standards for Quality Improvement Reporting Excellence guidelines.
临终关怀是护理工作的一个基本方面，对患者的治疗效果和家庭幸福有着重大影响。尽管其重要性不言而喻，但在非姑息治疗环境中的护士往往缺乏提供高质量临终关怀的相关培训和信心，导致患者体验欠佳。本文介绍了新加坡最大的三级急症医院新加坡总医院开展的一项质量改进举措，旨在解决这一关键差距。我们使用经过修改的姑息治疗测验进行了有针对性的教育需求评估，结果显示内科病房护士的及格率仅为15%。作为回应，我们设计并实施了一个结构化培训项目，该项目将讲座与基于案例的互动讨论相结合，侧重于临终关怀在实际中的应用。我们的研究结果表明，护士的知识水平有了显著提高，干预后的及格率提高到了53%。此外，护士们表示，他们在临终关怀各个领域的信心和能力都有了显著提升。值得注意的是，非药物管理方面的得分从49%提高到了86%。该领域涵盖了管理呼吸困难、分泌物、谵妄以及恶心和呕吐的非药物方法。这些结果凸显了有针对性的教育干预在使护士具备应对临终关怀复杂性的技能和知识方面的有效性。将有针对性的临终关怀培训纳入护理课程和机构实践中，可提高护士的信心和能力，并提升为面临生命终结的患者及其家属提供的护理质量。本报告是根据卓越质量改进报告标准指南撰写的。
