Abstract| Volume 61, ISSUE 3, P658-659, March 2021

Caring for The Dying Patient: A Quality Improvement Project on Nursing Education and Confidence Regarding Comfort Measures Only (CMO) Patients in the Hospital Setting (QI709)


      • 1.
        Identify nursing barriers to providing End-of-Life (EOL) care.
      • 2.
        Design education programs to improve nursing confidence when caring for CMO patients.
      • 3.
        Increase nursing staff engagement with palliative care issues throughout the hospital.


      Most nursing schools provide little to no education on end-of-life care. Due to staffing changes and the closure of a local hospice unit there was an increase in CMO patients dying at the hospital on specialty floors. Hospital leadership requested palliative care education to be provided to nursing staff.

      Aim Statement

      The goal of this QI project was to increase the confidence of registered nurses providing end-of-life care by 10% through the implementation of palliative care education.


      A palliative care presentation was developed and presented to nursing units throughout the hospital. A brief survey was conducted pre/post presentation which focused on background, education, and confidence regarding CMO care.
      Presentation topics included CMO orders, inpatient hospice, the CARES Tool, common nursing concerns, nursing position statements, and available hospital resources.


      16 education sessions were conducted, and the survey was completed by 121 nurses. Years of experience: <1 (48%), 1-3 (25%), 4-7 (24%), 8-12 (7%), >12 (17%). 90.9% had cared for a CMO patient. 49.6% had received any education/training on end-of-life care.
      The most reported concerns about providing end-of-life care were:
      • (*) Not being able to answer family members questions (62%).
      • (*) Not being able to control the patient’s symptoms (60%).
      • (*) Being blamed by family for the patient’s death (33%).
      • (*) Staff reported a mean score of 6.52 out of 10 for confidence in caring for a dying patient. The mean post presentation score increased by 21.8% to 7.95.

      Conclusions and Implications

      Nurses continue to feel ill-prepared to provide care to a dying patient in the hospital. Palliative specific training on end-of-life care can reduce moral distress and improve confidence in nurses with/without prior education about CMO. Palliative care training needs to be integrated into new nursing orientation in the hospital setting. Interest from staff lead to the formation of a palliative care committee at the hospital.