The purpose of this quasi-experimental study was to assess the ongoing impact of the End-of-Life Nursing Education Consortium (ELNEC) training program on registered nurses’ death anxiety, concerns about dying, and knowledge of the dying process utilizing the principles of The Comfort Theory and Practice by Kolcaba (2003) at the institutional level. The research hypothesis was upon completion of the ELNEC training, registered nurses would have decreased death anxiety, less concerns about dying, and increased knowledge of the dying process. The Revised Death Anxiety Scale (RDAS) was used to measure death anxiety which is a 25 item self-report questionnaire. The Concerns about Dying Instrument (CAD) was used to measure death attitude or concerns about dying which includes three distinct but related areas for providers: general concern about death, spirituality, and concerns about working with dying patients. Participant's perceived knowledge of dying was measured using a self report 5-point Likert format with “0“ indicating no level of knowledge to “4“ reflecting complete knowledge of death and dying. Pre-tests of all dependent variables were administered to both a treatment and control group. Post-tests were administered two weeks after the two day ELNEC training, at 6 months, and finally at 12 months to both groups in order to study its lasting efficiency upon participants at one primary care medical center. Thirty eight participants completed all four questionnaires with 27 participants in the control group and 11 participants in the experimental group. Matched pair analysis with 11 participants in each group was conducted with statistical significance found for perceived knowledge about dying at post two weeks and 12 months (p= 0.01) for the intervention group. Death anxiety and concerns about dying were not found to be statistically significant at any testing interval, but mean scores of the treatment group revealed less death anxiety and concerns about dying. Recommendations included offering the ELNEC training on a routine basis to all registered nurses who care for dying patients. Additionally, clinicians and administrators were encouraged to seek out additional funding opportunities to plan more robust studies with larger samples, incentives, and research method triangulation addressing the qualitative aspects of palliative care. / Ph. D.

Moral distress is a state of concern or anxiety that occurs when there is a correct action to take but an individual's ability to take that action is constrained in some way. Nurses, especially those who work in intensive care units (ICUs), may struggle with moral distress due to feelings of futility when caring for end-of-life patients. The purpose of this 1-group pretest-posttest quasi-experimental study, guided by Lazarus's theory of stress, coping, and adaptation, was to determine whether End-of-Life Nursing Education Consortium (ELNEC) education reduces moral distress in ICU nurses caring for end-of-life patients. A revised Moral Distress Survey (MDS-R 2017) by Hamric was given before and after ELNEC education to determine whether ELNEC reduced ICU nurses' moral distress level in relation to providing end-of-life care. Participants were 56 ICU nurses recruited from several healthcare institutions in the northeastern United States. Dependent t-test results showed that there was a significant difference (p = .002) in the intensity and frequency of moral distress in ICU nurses before versus after participating in an ELNEC education program. Recommendations for future study include investigating the potential long-term effects of ELNEC education on moral distress, using a larger sample size, and including nurses who work in areas other than ICU. This study may contribute to the development of interventions to reduce moral distress in nurses to make them less likely to leave their employers, subject to lower levels of moral distress, and able to achieve greater emotional and physical well-being. In showing that providing nurses with additional education can decrease their moral distress, this study may promote decreased job turnover and increased physical well-being for nurses, as well as improved nursing care at the end of life which may affect positive social change.