Jamesetta A Newland

Abstract

Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe. Methods: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement. Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

Abstract

One method of developing clinical scholars in nursing who then become leaders is through effective mentorship relationships. The purpose of this paper is to define scholarship according to Boyer's Model, using as an example the roles of faculty and students in the Doctor of Nursing Practice program in the United States. The expectedcompetencies of graduates from this clinical doctoral nursing program are modifiable and can be applied to nurses at all levels of educational preparation. Productivity through clinical scholarship empowers nurses with the skills and confidence they need to become leaders who will engage in change based on scientific evidence to improve patient care and health care outcomes. Facilitating clinical scholarship is the responsibility of all nursing faculty, administrators, practicing nurses, and organizations in which nurses are employed. The culture within an organization is important in encouraging and providing opportunities for scholarship and mentorship. Research findings are used to define mentorship, and strategies are discussed to implement mentorship programs on different levels in various settings, from individual to institutional. Every nurse has the potential to be a mentor. Clinical scholars are leaders by the nature of the way they approach the work they do. Nurses can make a difference in practice, education, research, and policy if given the necessary tools and support.