| 1 | An evidence-based practice approach to End-Of-Life nursing education in intensive care units | Shifrin et al.(2016), USA | One-group pretest posttest/quasi-experimental study | N=46 | To increase knowledge regarding evidence-basedpractices in management related to EOLC | The EBP change project1) Method: lecture2) Time: 3.5 hr | | 1) The definitions of terms used in EOL ICU management, barriers to EOL ICU management, the role of the palliative care team and hospice in inpatient settings, pain assessment of verbal and nonverbal patients in the ICU, and pain management strategies.2) Symptom recognition and management in ICU EOL patients, legal considerations for management, and ethical decision making.3) Communication and provider self-care | Knowledge | Statistically significant differences (p<.05) between mean scores on the pretest and posttest.Statistically significant improvements in pharmacological knowledge. |
| 2 | Communicating with patients’ families and physicians about prognosis and goals of care | Milic et al.(2015), USA | One-group pretest double posttesst/quasi-experimental research design | N=43 | To improve critical care nurses’ skills and confidence to engage in discussions with patients’ families and physicians about prognosis and goals of care by using a focused educational intervention | The communication workshop1) Method: lecture, discussion, role-play2) Time: 8 hr | | 1) Didactic session: on the roles and responsibilities of bedside nurses to patients and patients’ families 2) Role-play session: nurse-family conversation, nurse-physician conversation, family meeting3) Reflection session: coping with the daily stressors about discussion, learner can write an encouraging message to oneself | Communication skillCommunication confidence | Compared with before the workshop, after the workshop, nurses reported greater skill and confidence (p<.001), including assessing families’ understanding of prognosis and goals of care, addressing families’ emotional needs, and contributing to family meetings. Increases were sustained 3 months after the workshop. |
| 3 | Effect of an teaching program on critical care nurses’s performance about End Of Life care for hepatic patients | Nasr et al. (2018), Egypt | One-group pretest posttest/quasi-experimental study | N=40 | To evaluate the effect of teaching program on critical care nurses Performance about EOLC for hepatic patients | EOLC for Hepatic Patients1) Method: lecture, discussion2) Time: 3 session (30 min per one session) | | 1) Anatomy and function of liver, definition of hepatic coma, causes of hepatic coma2) Causes of hepatic coma, sign and symptoms of hepatic coma, stages of hepatic coma, complication in end stage of hepatic coma, and management of hepatic coma3) Definition of EOLC, sign and symptoms of EOLC, and management of patient in EOLC | Knowledge Practice | Very highly statistical difference between nurses’ knowledge in Pre &Post test program (p<.05).Very highly statistical difference between nurses’ pre & post practice according to total degree (p<.0001). |
| 4 | Effect of End-Of-Life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study | Ghaemizade et al. (2022), Iran | Nonequivalent control group pretest posttest/quasi-experimental study | N=80 -Exp: 40 -Cont: 40 | To determine the effect of nursing care education based on ELNEC on the knowledge and performance of nurses working in the intensive care unit | ELNEC1) Method: lecture2) Time: 5 session (60-90 min per one session) during 35 days | no intervention | 1) Nursing care at the EOL2) Pain management3) Symptom management4) Ethical/legal Issues5) Cultural considerations6) Communication7) Grief, loss,bereavement8) Achieving quality care at the EOL9) Preparation and care for the time of death | Knowledge Practice | A significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules of ELNEC (p<.001).The average performance score of nurses in the fields of preparation for providing palliative care, ability to communicate, knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (p<.001).Attitudes towards palliative care, no significant improvement was observed in the nurse’s performance (p=.943). |
| 5 | Effect of implementing geriatric palliative care guideline on nurses knowledge and practices | Abd Elhameed et al. (2016), Egypt | One-group pretest double posttest/quasi-experimental study | N=68 (one year of experience) (ICU nurse=31) | To determine the effect of implementing geriatric palliative care guideline on nurses’ knowledge and practices | The developed palliative care guideline1) Method: lecture, discussion2) Time: three sessions within one week (30-40 min per one session).3) Teaching materials included: PPT, illustrated picture, video. | | Not described | Knowledge Practice | Total knowledge and practices scores increased significantly immediately and 2 months after guideline implementation (p=.000).Total knowledge score was correlated significantly with their total practices score 2 months after the guideline implementation (p=.000). |
| 6 | Effect of palliative care guideline on nurses’ knowledge, attitude, and practice at intensive care unit | Mohamed et al.(2021) , Egypt | One-group pretest posttest/quasi-experimental study | N=100 | To evaluate the effect of palliative care guideline on nurses’ knowledge, attitude, and practice at ICU | The palliative guideline1) Method: lecture, group discussion, demonstration, and re-demonstration2) Time: two sessions for knowledge (between 45-60 min) four sessions for the practice (between 60-90 min) | | 1) Palliative care as definition, benefits, principles, aspect and philosophy 2) Knowledge about pain symptom and management3) Knowledge related to nursing care of dying patients4) Knowledge relate to psychosocial and spiritual care | Attitude Knowledge Practice | Increase in mean score of total knowledge with statistical significant post palliative care guideline implementation (p=.000)Improvement in nurses’ practices post palliative care guideline implementation (p<.001).A highly statistical significant Improvement in nurses’ attitude post palliative care guideline implementation (p<.001). |
| 7 | Effectiveness of an End-of-Life Nursing Education Consortium training on registered nurses’ educational needs in providing palliative and EoL patient care | Manning et al. (2021), USA | One-group pretest posttest/quasi-experimental study | N=44 (ICU nurse=14) | To investigate the impact of a professional development intervention among registered nurses on their educationalneeds in providing palliative care | ELNEC Core Curriculum1) Method: lecture2) Time: 8 hr | | 1) Nursing care at the EOL2) Pain assessment and management3) Symptom management4) Ethical/legal issues5) Cultural considerations in EOLC6) Communication7) Loss, grief, and bereavement8) Achieving quality care at the EOL9) Preparation and care for the time of death | Knowledge | A significant increase in participant knowledge in providing quality palliative care to patients (p<.001). |
| 8 | Effectiveness of supporting intensive care units on implementing the guideline ‘End-Of-Life care in the intensive care unit, nursing care’: a cluster randomized controlled trial | Noome et al. (2017), Netherlands | Cluster randomized controlled trial with pretest posttest/experimental design | N=238 (12 ICU)- Exp: 147 (8 ICU)- Cont: 84 (4 ICU) | To examine the effectiveness of supportingintensive care units on implementing the guidelines | 1. The interactive supportive programme1) Participated nurse in the interactive supportive programme in the intervention group lead the implementation in the organization by planning and managing as implementation leader2) Method: workshop, meeting3) Time: 9 month2. The guideline ‘ EOLC in the intensive care unit, nursing care1) To receive a programme supporting implementation leader of the guidelines | The option was to either implement the guidelines independently or to use a standard implementation plan supplementary to the guidelines. | 1. The interactive supportive programme1) Besides education on implementation, strategies and project management, coaching and support2) The steps of Grol’s model3) Time to share experiences on the performance of different steps of implementation4) Workshops with themes introduced by implementation leaders2. The guideline ‘EOLC in the intensive care unit, nursing care1) Interdisciplinary communication2) Communication with patients and family3) Nursing care for ICU patients4) Nursing care for family of ICU patients5) Preconditions | Practice | An increase in adherence to the guidelines was found in both groups. Overall, the intervention group showed a higher use of the guidelines. However, in some aspects, the control group scored higher in planning family meetings. |
| 9 | End-Of-Life Care Mobile App for intensive-care unit nurses: a quasi-experimental study | Yang and Shin (2021), Korea | Nonequivalent control group pretest posttest/quasi-experimental study | N=44(less than three years of experience)- Exp: 23- Cont: 21 | To develop a mobile EOLC programfor intensive-care unit nurses and evaluate the effects | EOLC1) Method: the End-Of-Life Care Mobile App2) Time: around 30 min per day (total 7 days) | 1) Method: The EOL booklet | 1) An overview of the EOL care app2) Pain management3) Managing the main symptoms of EOL patients4) Therapeutic communication skills5) Decision making in ethical conflict situations6) The experience of real EOL patients | Compassion Knowledge Self-efficacy | Significant improvement in self-efficacy in EOLC and compassion in EOLC (p<.005).No statistically significant difference Knowledge between the two groups (p=.086). |
| 10 | Evidence-based End-Of-Life care education for intensive care nurses | Hare et al.(2020)*, USA | One-group pretest posttest/quasi-experimental study | N=36 | To address the lack of EOLC education among the ICU nurses by implementing and testing the efficacy of an evidence-based staff education project | An evidence-based staff education program1) Method: lecture2) Time: 90 min | | ELNEC # 8 module “Achieving quality care at the End-Of-Life” Kolcaba’s comfort theory(ease, relief, and transcendence the symptoms of a dying patient | Attitude Knowledge | 56% of the staff nurses had never received prior education on EOLC. In addition, 92% stated they had been providing care to dying patients. After receiving the educational program on EOLC, 35 participants strongly agreed, and 1 participant agreed that the program content extended their knowledge of EOLC. |
| 11 | Online End-of-Life Nursing Education Consortium core curriculum for staff nurses: an education strategy to improve clinical practice | Bishop et al.(2019), USA | Randomized control group pretest double poststtest/experimental design | N=54 (ICU nurse=13)-Exp: 28-Cont: 26 | To offer online education to nurses to evaluate whether it might improve competence and to see difference in competence if an additional face-to-face class was added to the online education | ELNEC Core Curriculum1) Method: ELNEC online, discussion2) Time: 8.5 hr during 8 weeks (online), 3 hr (In-person session) | 1) Method: ELNEC online2) Time: 8.5 hr during 8weeks (online) | 1. ELNEC Core Curriculum1) Introduction to Palliative Care Nursing2) Pain management3) Symptom management4) Communication5) Culture6) Ethics7) Loss, grief, and bereavement8) Care at the final hours of Life2. In-person session1) Communication2) Pain management3) Symptom management | Competence Practice | Significant difference (p<.05), with participants rating the importance of the competencies higher after completing the assigned education, but the effect size was small (r=0.2).Significant difference between the pre and post education assessments for individual competence (p<.001).Significant increase in the report of practice change after 3 months between the 2 educational groups, with more participants in group 2 reporting practice change (p=.01).Both groups reported statistically significant improvements in symptom management and communication skills after educationno significant difference between the pedagogical approaches. |
| 12 | Impact of implementing a designed intervention palliative care program on critical care nurses’ knowledge and practice | Abd-Elaziz et al. (2014), Egypt | One-group pretest double posttest/quasi-experimental design | N=30 (two years of experience) | To evaluate the impact of implementing a designed intervention palliative care program on critical care nurses’ knowledge and practice | Palliative care program1) Method: lecture, booklet2) Time: 3 sessions per one week (30–40 min per one session) during 8 weeks | | 1. Theoretical content 1 Pain and symptoms control2) Psychological, social, spiritual, religious and cultural aspects of care3) Care of the imminently dying patient4) Ethical aspects of care2. Practical session1) Pain assessment, comfort measures for pain and symptoms relief2) Psychological support3) Communication skills in ICU4) Care after death and strategies to deal with loss and grief | Knowledge Practice | A highly statistical significant difference p=.000 were found between total score of knowledge and total score of practice of critical care nurses in relation to pre /post program and pre /two months post program implementation. While there was a statistical significant difference p=.04 regarding total score of knowledge as compared to a highly statistical significant difference p=.000 regarding total score of practice in relation to post and two months post program implementation. |
| 13 | Improving critical care nurses perceived self-efficacy in providing palliative care: a quasi-experimental study | DeFusco et al. (2022), USA | One-group pretest posttest/quasi-experimental study | N=40 | To determine if an online palliative care educational program improves critical care nurses’ self-efficacy in providing palliative care | The Vital Talk education1) Method: video, handout2) Time: about 25 min3) Web Adress: (https://www.vitaltalk.org/topics/nurses-role/) | | 1) Palliative care: a bedside nurse’s perspective2) Palliative care and ICU nurses’ scope of practice3) Communication about prognosis and goals of care: the nurse’s role4) Nurses are the bridge: a family perspective5) Supporting each other: a physician’s perspective | Self-efficacy | The overall palliative care self-efficacy Scale showed a median score of the Palliative care self-efficacy scale increased from preeducation (Md=38) to post-education (Md=43.5), z=-4.868, p<.001, with a large effect size (r=-.76). |
| 14 | Increasing knowledge and comfort levels of ICU nurses in goals of care discussions through palliative care education | Harrison et al. (2022)*, USA | One-group pretest posttest/quasi-experimental study | N=25 | To implement an education program using the IMPACT-ICU toolkit to ultimately increase intensive care nurses’ knowledge, comfortability, and involvement in goals of care discussions | The IMPACT-ICU toolkit1) Method: webinar, the optional in-person educational sessions2) Time: 75 min (online),four 1-hour (in-person session) | | A project focused on integrating multidisciplinary palliative care into the intensive care unit using a communication skills training program. | Communication skill | The educational intervention was effective in educating the bedside intensive care nurse role on identifying their role in prognosis, goals of care, and palliative care discussions(p=.02).Although not statistically significant, there was an increase in reported involvement of bedside nurses in prognosis and goals of care conversations with patients and families. |
| 15 | Palliative care professional development for critical care nurses: a multicenter program | Anderson et al. (2017), USA | One-group pretest double posttesst/quasi-experimental research design | N=428 | To implement and evaluate a palliative care professional development program for ICU bedside nurses | IMPACT-ICU1. Train-the-trainer program for nurse leaders1) Method: lecture, workshop, role-play, mentoring2) Time: 3-day2. Communication skills training workshop for bedside nurses1) Method: role-play2) Time: 8-hour3. Palliative nursing coaching rounds1) Method: coaching | | 1. Train-the-trainer program for nurse Leaders1) Skills training theories and processes2) Observed a communication workshop3) Practiced role-play facilitation2. Communication skills training workshop for bedside nurses1) Didactics about palliative care2) Nurse’s role in prognosis and goals of care communication3) A reflection session: skills for coping with the stress of working3. Palliative Nursing coaching rounds1) Guided the bedside nurse through the process of identifying the patient’ and the family’s support needs2) Coached the bedside nurse to develop a plan to address the identified needs | Communication skill | The percentage of nurse leaders who reported excellent level of skill to conduct communication skills training sessions for bedside nurses was higher after program than at the beginning of the program for all skills assessed.The percentage of nurses reporting excellent level of skill was significantly higher in surveys completed after the workshop for communication tasks assessed (p<.01 compared with surveys completed before the workshop).Bedside nurses’ identification of family distress(R2=0.67, p=.03) and concerns about family-clinician communication(R2=0.79, p=.007) about prognosis and goals of care during coaching rounds increased. |