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J Palliat Med. 2010 Jun;13(6):753-9. doi: 10.1089/jpm.2009.0423.

Nurses' identification of important yet under-utilized end-of-life care skills for patients with life-limiting or terminal illnesses.

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Department of Veterans Affairs, VA Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington 98195, USA.



This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in end-of-life care.


A 45-item survey was administered to nurses (n = 717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of end-of-life care skills including practice settings, years of experience, and end-of-life care education. Content analysis was used to examine nurses' responses to open-ended questions.


Nineteen items were endorsed as extremely important and also ranked as under-utilized. These end-of-life care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered care systems. Four complementary themes emerged from qualitative analysis of nurses' comments, which supported the quantitative findings.


This study provides a summary of skills nurses feel are important and under-utilized in their care of patients with life-limiting illnesses. The findings support the need to target both nursing education and healthcare system interventions to improve the use of practical end-of-life care skills by nurses with a focus on communication and symptom management skills.

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