Nurses' Perceptions of Educational Gaps in Delivering End-of-Life Care

Kenneth R. White

Patrick J. Coyne

nursing education, competency, end of life, end-of-life, end-of-life care, palliative care
ONF 2011, 38(6), 711-717. DOI: 10.1188/11.ONF.711-717

Purpose/Objectives: To assess end-of-life (EOL) care core competencies deemed most important with corresponding educational needs from oncology nurses and to describe the characteristics of the respondents that are associated with selection of the top-ranked core competencies.

Design: Descriptive, cross-sectional study.

Setting: Mailed and online surveys.

Sample: 714 members of the Oncology Nursing Society from Georgia, Virginia, Washington, and Wisconsin.

Methods: Responses to a mailed or e-mailed researcher-developed questionnaire during a six-month period were collated and analyzed.

Main Research Variables: Ranking of EOL care core competencies and perceived gaps in EOL continuing education.

Findings: Almost all of the respondents indicated that EOL care was a part of their practice and that continuing education was important, but more than half of the respondents had fewer than two hours of continuing education regarding EOL care in the past two years. Twenty-five percent of the respondents do not believe they are adequately prepared to effectively care for a dying patient. Symptom management was the top-rated core competency, consistent across age, education level, practice role, and practice setting. How to talk to patients and families about dying and what comprises palliative care also was selected frequently.

Conclusions: Symptom management is the number one core competency, and the quantity and quality of EOL continuing education is inadequate. Educational gaps exist in EOL nursing care.

Implications for Nursing: Assessing what nurses believe to be leading EOL core competencies is useful in improving educational curricula along with considering characteristics of nurses when planning EOL educational programs.

Jump to a section


    Coyle, N. (2010). Introduction to palliative care nursing. In B.R. Ferrell & N. Coyle (Eds.). Oxford textbook of palliative nursing (3rd ed., pp. 1-13). New York, NY: Oxford University Press.
    Cummings, I. (2008). The interdisciplinary team. In D. Doyle, G. Hanks, & N. MacDonald (Eds.), Oxford textbook of palliative medicine (2nd ed., pp. 19-28). Oxford, UK: Oxford Medical Publication.
    Ersek, M., & Ferrell, B.R. (2005). Palliative care nursing education. Journal of Gerontology Nursing, 31(7), 45-51.
    Ferrell, B., & Winn, D. (2006). Medical and nursing education and training opportunities to improve survivorship care. Journal of Clinical Oncology, 24, 5142-5148. doi:10.1200/JCO.2006.06.0970
    Ferrell, B.R., & Coyle, N. (2008). The nature of suffering and the goals of nursing. Oncology Nursing Forum, 35, 241-247.
    Ferrell, B.R., Dahlin, C., Campbell, M.L., Paice, J.A., Malloy, P., & Virani, R. (2007). End-of-Life Nursing Education Consortium (ELNEC) training program: Improving palliative care in critical care. Critical Care Nursing Quarterly, 30(3), 206-212.
    Goldsmith, B., Dietrich, J., Du, Q., & Morrison, R.S. (2008). Variability in access to hospital palliative care in the United States. Journal of Palliative Medicine, 11, 1094-1102. doi:10.1089/jpm.2008.0053
    Health Resources and Services Administration. (2010). The registered nurse population: Findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from
    Mahon, M.M., & McAuley, W.J. (2010). Oncology nurses' personal understandings about palliative care [Online exclusive]. Oncology Nursing Forum, 37, E141-E150. doi:10.1188/10.ONF.E141-E150
    Malloy, P., Paice, J., Virani, R., Ferrell, B.R., & Bednash, G.P. (2008). End-of-Life Nursing Education Consortium: 5 years of educating graduate nursing faculty in excellent palliative care. Journal of Professional Nursing, 24, 352-357. doi:10.1016/j.profnurs.2008.06.001
    Malloy, P., Sumner, E., Virani, R., & Ferrell, B.R. (2007). End-of-Life Nursing Education Consortium for Pediatric Palliative Care (ELNEC-PPC). American Journal of Maternal Child Nursing, 32(5), 298-302. doi:10.1097/
    Martensen, R. (2008). A life worth living: A doctor's reflections on illness in a high-tech era. New York, NY: Farrar, Straus, and Giroux.
    Matzo, M.L., Sherman, D.W., Sheehan, D.C., Ferrell, B.R., & Penn, B. (2003). Communication skills for end-of-life nursing care. Teaching strategies from the ELNEC curriculum. Nursing Education Perspectives, 24(4), 176-183.
    Meier, D.E. (2010). The development, status, and future of palliative care. In D.E. Meier, S.L. Isaacs, & R.G. Hughes (Eds.), Palliative care: Transforming the care of serious illness (pp. 4-76). San Francisco, CA: Jossey-Bass.
    Morrison, R.S., Meier, D.E., Fischberg, D., Moore, C., Degenholtz, H., & Litke, A. (2006). Improving the management of pain in hospitalized adults. Archives of Internal Medicine, 166, 1033-1039.
    Morrison, R.S., Penrod, J.D., Cassel, J.B., Caust-Ellenbogen, M., Litke, A., & Spragens, L. (2008). Cost savings associated with US hospital palliative care consultation programs. Archives of Internal Medicine, 168, 1783-1790. doi:10.1001/archinte.168.16.1783
    Murray, M.A., Wilson, K., Kryworuchko, J., Stacey, D., & O'Connor, A. (2009). Nurses' perception of factors influencing patient decision support for place of care at the end of life. American Journal of Hospice and Palliative Care, 26(4), 254-263. doi:10.1177/1049909108331316
    National Consensus Project for Quality Palliative Care. (2009). Clinical practice guidelines for quality palliative care. Retrieved from
    Oncology Nursing Society. (2010). Meet the membership. Retrieved from
    Paice, J.A., Ferrell, B.R., Virani, R., Grant, M., Malloy, P., & Rhome, A. (2006). Graduate nursing education regarding end of life care. Nursing Outlook, 54, 46-52.
    Pan, C.X., Morrison, R.S., Meier, D.E., Natale, D.K., Goldhirsch, S.L., & Kralovec, P. (2001). How prevalent are hospital-based palliative care programs? Status report and future directions. Journal of Palliative Medicine, 4, 315-324. doi:10.1016/j.outlook.2005.04.003
    Quest, T.E., Marco, C.A., & Derse, A.R. (2009). Hospice and palliative medicine: New subspecialty, new opportunities. Annals of Emergency Medicine, 54, 94-102. doi:10.1016/j.annemergmed.2008.11.019
    Schulman-Green, D., McCorkle, R., Cherlin, E., Johnson-Hurzeler, R., & Bradley, E.H. (2005). Nurses' communication of prognosis and implication for hospice referral. American Journal of Critical Care, 14, 64-70.
    Wallace, M., Grossman, S., Campbell, S., Robert, T., Lange, J., & Shea, J. (2009). Integration of end-of-life care content in undergraduate nursing curricula. Journal of Professional Nursing, 25, 50-56.
    White, K.R., & Cassel, J.B. (2009). The business case for a hospital palliative care unit: Justifying its continued existence. In A. Kovner, D. Fine, & R. D'Aquila (Eds.), Practice of evidence-based management (pp. 171-180). Chicago, IL: Health Administration Press.
    White, K.R., Coyne, P.J., & Patel, U.B. (2001). Are nurses adequately prepared for end of life care? Journal of Nursing Scholarship, 33, 147-151.
    White, K.R., Stover, K.G., Cassel, J.B., & Smith, T. (2006). Non-clinical outcomes of hospital-based palliative care. Journal of Healthcare Management, 51, 261-274.