Authors (including presenting author) :
Pong Y.K., Fung T.H., Leung K.Y., Kwong K.Y., Cheng S.Y., Wong W.H., Tam Jeannie, Ip W.L., Cheung P.H., Lee S.Y., Yau M.W., Fong S.Y., Leung K., Ling P.C., Chan K.
Affiliation :
Department of Tuberculosis and Chest (DTBC) , TWGHs Wong Tai Sin Hospital. Hong Kong Hospital Authority
Introduction :
Many critically ill patients who die in non-palliative ward may receive unwanted distressing treatments and have prolonged pain. Hence, End-Of- Life(EOL) care was instilled in Respiratory ward, WTSH.
Objectives :
1)To provide individualized & dignity care for terminally ill patients in dying phase & their families/ caregivers
2)To adopt a team approach on managing the needs of dying patients & their families/ caregivers.
3)To provide a framework for evaluation of practice on care of dying patients in DTBC.
Methodology :
EOL program was instilled in June 2023. Patients who had DNACPR orders and were in dying phase, would be recruited into the program. Doctor would review patients and reduced futile treatments. Nurses provided symptom control, comfort care, psychosocial, spiritual & bereavement support for patients & relatives. An EOL Program Questionnaire was conducted to assess nurses’ perspective, competency level, challenges and preferred training content related to EOL care.
Result & Outcome :
From June to October 2023, a total of 29 patients were recruited into the program. Fifty-four nurses (APNs/RNs/ENs) returned the EOL Program Questionnaire. Over 90% nurses agreed that EOL care could be provided to patients in non-palliative wards. Senior & junior nurses felt partially competent to provide psychological support to patients & relatives & answering relatives’ questions about the dying process. Junior nurses felt partially competent to explain what DNACPR means to patient & relatives.
Meanwhile, lack of EOL care skills, communication skills & professional knowledge related to palliative care were experienced challenges for both senior and junior nurses when providing EOL care. Nurses expressed that communication skills, assisting patients & their families through the dying process & death, ethical decision making for DNACPR were the preferred contents for future training.
Conclusion:
Patients with terminal illness facing complex symptoms & psychological problems, especially for non-cancer patients. Futile treatment should be eliminated to promote comfort. All nurses should be competent to provide “good & dignity death” for dying patients in non-palliative area. A series of training program of EOL care will be organized for our nurses to ensure best practice in EOL care wherever the dying person is cared for.
