title: The effect of a care bundle on nursing staff when caring for the dying.
abstract: BACKGROUND
  Most Australians die in acute hospital settings. Despite this, hospitals remain ill-equipped to care for dying patients with hospital deaths not uncommonly perceived as distressing by both patients and their families. As a quality improvement project, a care bundle for the dying was developed and piloted on two medical wards. The aim of this study was to examine whether or not the quality initiative had any effect on the ward nurse's attitudes and self-assessed competency to care for dying patients.
  
  
  METHODS
  A pre- and post-survey using self-administered questionnaires were given to nursing staff who voluntarily completed these before and after implementation of the caring for the dying bundle.
  
  
  RESULTS
  Over the 6 months the bundle was piloted, 74.5% of people who died did so with the bundle in place. While this was seen as clinically useful by nearly half the nurses who responded, there was not a significant change in the staff's attitudes or self-assessed competency to care for dying patients. There was a minor change in the Thanatophobia Scale (pre 18.2: SD±9.0 versus post 16.8: SD 7.8; P=0.53), the Self-efficacy in Palliative Care Scale for communication (pre 47.4: SD ±17.4 versus post 54.7:SD±17.9; P=0.11) and patient management respectively (pre 54.3: SD ±12.9 versus 59.1: SD ±12.6; P=0.15).
  
  
  CONCLUSIONS
  This work highlighted that at least in the short term, that a quality initiative had only a modest impact on nursing attitudes to caring for dying patients. However, as a collection of clinical tools grouped as a care bundle, a proportion of nursing staff acknowledged this initiative as useful.
  
  
  CONCLUSIONS
  Further research is required to understand if such an initiative approach may, in the long term, positively impacts attitude. This is highly relevant given the increasing numbers of people likely to die in acute care.
authors: Medical Director, at Palliative Care Services, Calvary Mater Newcastle, Australia.
authors: Katherine
authors: K
authors: Clark
authors: Clinical Nurse Educator, Palliative Care Services, Calvary Mater Newcastle, Australia.
authors: Therese
authors: T
authors: Curry
authors: Research Coordiantor, at Palliative Care Services, Calvary Mater Newcastle, Australia.
authors: Naomi
authors: N
authors: Byfieldt
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001315:Australia; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D064872:Patient Care Bundles / Q000523:psychology*; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
keywords: Acute hospitals; Care bundle; Dying patients; Pre- and post-study design