Enhancing end-of-life care nursing competency: a nursing education quality improvement project in general medical wards.

Abstract

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.