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25 A mixed-methods study to investigate nursing attitudes towards administration of ‘as required’ prescribed symptom control medication at end of life in a hospital setting
  1. Elke Hall,
  2. Fiona Dakin,
  3. Christine Hirsch,
  4. John Speakman and
  5. Jon Tomas
  1. University of Birmingham, University Hospital Birmingham NHS Trust


Background Anticipatory drugs for symptom control in dying patients are commonly prescribed in the acute hospital setting. The decision to administer ‘as required’ drugs usually lie with the ward nursing team who may have varied experience in end of life care. A previous survey informed changes to end of life care training offered within the Trust. This prompted the team to undertake a follow-up survey to determine whether the adapted training provision was meeting the needs of nursing staff administering ‘as required’ drugs at the end of life and to aid understanding of nurse decision making in this area of drug administration in the hospital setting.

Methods A questionnaire based on the previous survey was developed and piloted. A range of question styles were used including Likert scale, two ranking scales based on scenarios, and free text responses. Ethical approval was gained. Hard copies of the questionnaire were distributed to nurses on wards with the highest death rates together with elderly care wards. 100 copies of the questionnaire were distributed. Completed anonymous responses were coded and statistically analysed using SPSS 26.

Results The response rate was 62%. Just under 50% respondents reported being ‘very confident’ in recognising symptoms at the end of life. This was similar across the wards surveyed (oncology, acute medical, elderly care). Scenario ranking questions based on treatment of pain and agitation resulted in appropriate responses. 39% of respondents had undertaken the Trust palliative care training. Five respondents (8%) expressed fears around administration of medication at end of life.

Conclusion Most hospital nurses reported confidence in recognising end of life symptoms. Preliminary results have been shared with the specialist team, awaiting the final report to inform further development of training to improve the confidence and decision making of newly qualified nurses in this area of drug administration.

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