WASHINGTON, DC, April 2, 1998 -- Undergraduate nursing students not only should be skilled at addressing physical, psychological, social, and spiritual needs of patients at the end of life, but should have the ability to implement an overall plan for improved end-of-life care within today's complex health system, says a major new document by the American Association of Colleges of Nursing (AACN).

Moreover, with such care likely to be given by a variety of health professionals, it is essential that nursing and other health professions students be prepared for end-of-life practice in an interdisciplinary approach, the document urges.

The document, Peaceful Death, is the outcome of a two-day invitational roundtable conference sponsored by AACN in Washington, D.C., in November 1997 and supported by a grant by the Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and health care. The roundtable assembled practitioners, researchers, educators, health care ethicists, and other experts from academia and clinical settings who identified educational content and issues central to preparing nurses who can provide high-quality and appropriate end-of-life care for dying patients and their families.

Peaceful Death incorporates the roundtable's two major products -- a statement detailing End-of-Life Competencies, or skills, that every undergraduate nurse should attain, as well as recommendations for including these skills in the content of nursing curricula.

"Because nurses spend more time with patients and their families than do any other health professionals, they are in the most immediate position to provide care, comfort, and counseling at the end of life when critical decisions must be reached and compassionate and often highly specialized care provided," says AACN President Andrea R. Lindell, DNSc, RN. "The roundtable's range of expert nurses -- representing such areas as pain management, palliative care, and care involving such major sources of morbidity as AIDS, cancer, and kidney disease -- illustrates the complexity of concerns that RNs must address in responding comprehensively to end-of-life needs of patients and their families."

However, "educational preparation for end-of-life care has been inconsistent at best, and sometimes neglected within nursing curricula. This document is intended to address these deficiencies," the experts note in Peaceful Death. Among its recommendations, the document calls for nurses to promote the provision of comfort care to the dying "as an active, desirable, and important skill, and an integral component of nursing care." While nurses should respect the patient's views and wishes during care at the end of life, RNs should recognize their own attitudes, values and expectations about death and the "individual, cultural, and spiritual diversity" existing in these beliefs and customs, the AACN document urges.

Moreover, nurses should use state-of-the-art traditional and complementary approaches to manage pain, anxiety, and other symptoms in patients at the end of life, while at the same time, assisting patients, families, colleagues, and one's self to cope with suffering, grief, loss, and bereavement. In addition, the experts call for nurses to use legal and ethical principles in analyzing complex issues surrounding end-of-life care and to recognize the "influence of personal values, professional codes, and patient preferences." Acknowledging that few nursing schools would offer a distinct course in end-of-life care, the AACN document recommends several ways that nursing educators can incorporate key content in existing curricula. For example, students in health assessment courses should be taught to use standardized tools, such as numeric rating scales, to quantify pain, breathlessness, and other common symptoms at the end of life. Pharmacology courses not only should include the assessment and management of side effects of pain-relieving drugs, but also discuss the negative impact of myths and misconceptions surrounding the use of analgesics. In addition, faculty covering ethical-legal content could include coursework on relevant state and federal laws regarding informed consent and advance directives.

Another Robert Wood Johnson Foundation-supported project, "Strengthening Nursing Education to Improve Pain Management and End of Life (EOL) Care," will be using Peaceful Death as a reference for its work.

For a copy of Peaceful Death, click here or write AACN at 1 Dupont Circle, Suite 530, Washington, DC 20036; telephone 202-463-6930.

The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing -- the nation's largest health care profession. Representing more than 500 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.

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EDITORS: News media can obtain a copy of Peaceful Death by clicking here.