title: The care of the actively dying in an academic medical center: a survey of registered nurses' professional capability and comfort.
abstract: BACKGROUND
  Care of the dying is a significant component of nursing practice particularly in hospitals. Nurses who work in certain areas like oncology, intensive care unit (ICU) face the care of the dying, more so than other units.
  
  
  OBJECTIVE
  The survey was conducted to assess nurses' self-perception of their professional capability and comfort in the care of the actively dying. Determine if professional capability and comfort was associated with any of the six demographics characteristics (age, gender, clinical experience, education level, nursing unit, continuing education). Identify areas of clinical challenge to promote educational initiatives to stimulate best nursing practice in the actively dying.
  
  
  METHODS
  The survey comprised of two parts: Part I with demographic characteristics and a single open-ended question, Part II with twenty questions on the domains recommended by the NCP.
  
  
  RESULTS
  Older age and greater clinical experience were associated with greater levels of capability/comfort. Most nurses felt professionally capable and comfortable in domains such as knowledge, physical and psychosocial care but bioethics, communication, cultural, spiritual and bereavement issues challenged ≥ 40%.
  
  
  CONCLUSIONS
  Nurses self-perceived professional capability and comfort levels in caring for the dying were positively influenced by older age, greater clinical experience and extensive continuing education. Bioethics, communication and grief impacted nurses personally and emotionally. Continuing education, organized debriefing, grief-counseling, and preceptors support should be routine for nurses who work in units with predictable high mortality.
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Powazki
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA The Harry R. Horvitz Chair in Palliative Medicine and Supportive Oncology, Cleveland Clinic Tausigg Cancer Institute, OH, USA walsht@ccf.org.
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Cothren
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: Thomas
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Morgan
authors.affiliation: Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Karius
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, OH, USA*† Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, OH, USA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Shrotriya
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002983:Clinical Competence; D003142:Communication; D054521:Cultural Competency; D026690:Ethics, Clinical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology*; D012737:Sex Factors; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology*
keywords: death; education; end of life; hospital; nursing; palliative