Development of Competency Guidelines for End-of-life Nursing Care Utilizing a Modified Delphi Process

Abstract

Background: Most acute care hospitals are increasingly facing an upsurge in patients with chronic conditions as well as an aging population and thus patient hospitalization is quite common at the end of life (EOL). This study therefore, sought to understand Kenyan nurses’ perceived level of preparedness to provide EOL nursing care; identify nurses’ perceived training needs in EOL; identify and validate core & sub competencies for nurses in Kenya requisite for provision of EOL nursing care. Methods: The study was conducted in a government national referral hospital and was executed in two phases. Phase one research design was cross-sectional using self-administered questionnaires (SAQ). Simple random sampling was used to identify the 174 respondents who participated. Phase two utilized a modified Delphi process using SAQs. A total of 20 panel members responded. Ethical approval was obtained from the National Council of Science and Technology (NACOSTI) and Kenyatta National Hospital/ University of Nairobi Ethics and Research Committee (KNH/UON-ERC). Results: Findings: a) Phase I: The overall mean score was 2.7 in a scale of 4 with 4 being ‘no knowledge’; In the attitudes dimension, participants indicated that they were somewhat effective (mean<2/3) in provision of EOL nursing care; and finally, in the practice dimension, it was observed that all the items examined were identified as barriers to provision of good quality EOL nursing care; and b) Phase II: two rounds of the modified Delphi process were conducted and consensus reached. Conclusion: Nurses had deficiencies in the level of EOL care knowledge, attitudes and practice. Further, the existing basic nursing curricula was noted to have gaps pertaining to nursing students’ clinical experience for dying patients. Finally, the study identified eight core competencies and 92 sub competencies. Recommendations: This study provides a starting point for understanding EOL care clinical competencies for nurses in Kenya. The competencies identified in this study need further examination in practice and in actual educational settings. Finally, a large-scale survey to examine the appropriateness of the identified competencies during clinical application; as well as the relationship among these competencies, ongoing evaluation of competence, and the actual performance of nurses.