Date of Award

5-11-2015

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Carole A. Pepa

Abstract

Medicare-certified hospice home care agencies must provide a 24/7 on call system for after business hours patient concerns. An agency identified a problem with a high volume of after-hours hospice calls for symptom management. How these calls are handled impact patient and family outcomes and satisfaction. A literature review provided evidence that hospice nurse education and appropriate telephone support improves symptom management, enhances family support, provides a sense of security, reduces anxiety, and promotes comfort. Providing hospice nurse education on symptom management supported the goal of this evidence based practice (EBP) project to reduce the family/caregiver need for frequent on-call after-hour calls. Three modules from the End of Life Nursing Education Consortium (ELNEC) were presented with case studies to address pain and symptom management. Benner’s model From Novice to Expert and Larrabee’s Model for Evidence-Based Practice Change guided this EBP project. Twelve nurses started the EBP project, and six nurses completed all educational sessions and the pre and post quizzes. Questions were taken from ELNEC and the Hospice and Palliative Nurse Association Core Curriculum exams. Six hundred and sixty after-hours calls were analyzed before, during, and for three months after the educational sessions were completed. Five hospice nurses managed 90% of the 660 calls that were analyzed. All of them started the educational intervention; four of them completed the sessions and the post quiz. A paired-samples t test found no significant statistical difference between the pre and post quizzes (t(5) = 0.00, p > .05). However, the mean number of after-hours phone calls decreased 22% with a 7.4% decrease in calls for symptom management after the educational initiative. Further application of this EBP project includes support for hospice nurse education for improving caregiver satisfaction on the new Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

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