title: Nurses' identification of important yet under-utilized end-of-life care skills for patients with life-limiting or terminal illnesses.
abstract: BACKGROUND
  This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in end-of-life care.
  
  
  METHODS
  A 45-item survey was administered to nurses (n = 717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of end-of-life care skills including practice settings, years of experience, and end-of-life care education. Content analysis was used to examine nurses' responses to open-ended questions.
  
  
  RESULTS
  Nineteen items were endorsed as extremely important and also ranked as under-utilized. These end-of-life care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered care systems. Four complementary themes emerged from qualitative analysis of nurses' comments, which supported the quantitative findings.
  
  
  CONCLUSIONS
  This study provides a summary of skills nurses feel are important and under-utilized in their care of patients with life-limiting illnesses. The findings support the need to target both nursing education and healthcare system interventions to improve the use of practical end-of-life care skills by nurses with a focus on communication and symptom management skills.
authors.affiliation: Department of Veterans Affairs, VA Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington 98195, USA. reinkl@u.washington.edu
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Reinke
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Shannon
authors.forename: Ruth
authors.initials: R
authors.lastname: Engelberg
authors.forename: Danae
authors.initials: D
authors.lastname: Dotolo
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Silvestri
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff; D013727:Terminal Care; D014481:United States