"I Don't Know What to Say": A Multimodal Educational and Environmental Intervention to Improve Bedside Nursing Communication at End of Life.

The American Association of Colleges of Nursing identifies palliative and hospice care as one of 4 core spheres of nursing in its new Essentials outcomes. However, research shows inpatient medical-surgical nurses are not adequately trained to deliver end-of-life (EOL) care. This lack of foundational learning leads to gaps when communicating with patients and families and negatively impacts quality of care. When a large urban hospital opened a specialty unit for comfort-focused EOL care, nurses felt unprepared to communicate effectively with patients and families. A literature review and staff interviews identified barriers to communication, such as lack of formal education and experience; personal, cultural, and emotional challenges; and high workload. A multimodal intervention focusing on improving staff nurse communication skills was designed. It included environmental cues, engaging pocket cards, and an education module on communication techniques. Data were collected on nurses' confidence and competence in EOL communication, and qualitative feedback on the usefulness of the interventions was obtained. Nurses demonstrated increased confidence and competence immediately following the education session, enduring at 4 weeks. Nurses reported pocket cards and posters were helpful clinical reminders. Innovative, clinically relevant interventions can positively impact communication skills without requiring increased time commitments or high cost.