general nursing journals) and 2,033 oncology nurses solicited directly (out of 5,000 who were mailed the survey), so the results should be considered descriptive only. They were asked about nine aspects of nursing education:

  1. pain management,

  2. overall content,

  3. role and needs of family caregivers,

  4. other symptom management,

  5. grief and bereavement,

  6. understanding the goals of palliative care,

  7. ethical issues,

  8. care of patients at time of death, and

  9. communication with patients and families.

Less than 13 percent of those responding rated their education in all nine aspects as adequate. Most frequently rated as not adequate were pain management (71 percent), overall content (62 percent), and roles and needs of family caregivers (61 percent), but more than half reported “not adequate” education in each of the nine areas.

Most other relevant studies have focused on nurses’ knowledge in the area of cancer pain management and palliative care, and these have found major deficiencies, most likely resulting from deficiencies in training (see, e.g., Ferrell and McCaffery, 1997; McCaffery and Ferrell, 1995).

End-of-Life Care in Nursing Textbooks

A major review of nursing textbooks for end-of-life content was completed recently (Ferrell et al., 1999b). Fifty current nursing textbooks, both general and specialty, used heavily in nursing programs were selected for analysis (Table 9-7). “Critical content areas” were identified as key items that should appear in complete discussions of each content area (the pharmacology texts were treated somewhat differently, appropriate to their different scope), and included:

  • Palliative care defined

  • Quality of life

  • Pain

  • Other symptom assessment and management

  • Communication with dying patients and their family members

  • Role/needs of caregivers in end-of-life care

  • Death

  • Issues of policy, ethics, and law

  • Bereavement



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