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Current nursing textbooks pay little attention to the care of the dying, including pain and symptom management, according to a new study published in the June 1999 issue of the Oncology Nursing Forum.
Only 2% of the content contained in the 50 widely used nursing texts in the United States address end-of-life care, yet nurses provide most of the hands-on care for people near death, said the study’s author Betty R. Ferrell, PhD, RN, a grantee of the Robert Wood Johnson Foundation in Princeton, NJ.
"It’s true that care of the dying receives a lot of media attention — partly as a result of the 1997 Supreme Court ruling and the antics of Jack Kevorkian — but if we really want to improve the situation, we have to get back to fundamentals," Ferrell said. "We have to be sure we are teaching our health care professionals what they really need to know about state-of-the-art care. Sadly, we are not, as this study shows."
The study reviewed 50 textbooks frequently used in nursing undergraduate schools, including 45,683 pages within 1,750 chapters. The texts were analyzed in depth using an analysis framework with consultation from end-of-life care experts. The findings revealed that only 2% of content and 1.4% of chapters were related to any end-of-life care topic.
The nine critical areas of end-of-life issues examined in the textbook process were: Palliative Care Defined; Quality of Life; Pain; Other Symptom Management; Communication with Patients and Family Members; Role/Needs of Family Caregivers; Death and Dying Process; Issues of Policy, Ethics, and Law; and Bereavement.
Other key findings reported in the Oncology Nursing Forum include:
• Compared to content regarding non-drug interventions for pain (44 pages), there was far less (25 pages) for pharmacologic interventions for pain.
• Quality-of-life issues and role/needs of family caregivers received the smallest amount of coverage.
• The pharmacology books reviewed were weak and often had outdated or incorrect information regarding pain and symptom management.
• Information about sharing bad news or communicating among interdisciplinary health professionals was lacking.
• The issues of assisted suicide and euthanasia were discussed in only 17 texts, with 4 texts devoting only one paragraph to this topic.
• Only one text mentioned regulatory barriers to effective pain management.
• Overall, 74% of critical end-of-life content was found to be absent from the texts.
"Our team is hard at work to address the deficiencies noted in the textbook review. We’ve teamed up with Stephen McPhee, MD, a professor of medicine at the University of California, San Francisco, and held a very successful conference that brought together publishers, authors, and editors to discuss our results. We were heartened by their interest," Ferrell said. McPhee is also conducting a review of medical textbooks with similar results.