1. Ferraro, Cathleen B. BA, RN, CGRN

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To the Editor:


Recently, I represented SGNA at the End-of-Life Nursing Consortium (ELNEC) conference. The principal goal of this training program is to provide continuing educator providers in nursing with information on end-of-life care and resources to integrate end-of-life content into their in-services programs or courses. At this course, I learned nurses spend more time with patients and families facing the end of life than any other health professionals. And nurses address a myriad of needs facing individuals at this time. Expert nursing care can greatly reduce the burden and stress for those facing life's end and can provide support for many physical, emotional, and spiritual needs of patients and families.


Sadly, recent investigation done from 1997 to 2000 by researchers at the City of Hope National Medical Center showed that nursing education is extremely deficient in end-of-life care concerns. The investigation demonstrated major deficiencies including gross lack of content in nursing texts in end-of-life care, minimal content with the nursing curriculum, reported inadequacy of nursing faculty knowledge related to end-of-life content, and many other educational barriers. Conclusively, nurses were not prepared to provide optimal end-of-life care.


Further activities done by the American Associations of Colleges of Nursing (AACN) resulted in a document titled "Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Care," which has become recognized as a key statement describing the knowledge and skills needed by nurses to provide quality care and opportunities for this content to be integrated into nursing curriculum. In 1999, the American Colleges of Nursing joined forces with the City of Hope National Medical Center to propose a national effort to correct these deficiencies and to create nursing education that would meet the recommendations of the "Peaceful Death" document. Thus, ELNEC was launched in February, 2000. A curriculum was developed that addresses critical aspects of end-of-life care. ELNEC is, in fact, a consortium of many organizations to ensure the ELNEC project brings together important nursing entities for a collaborative professional approach to improved care. It is developed as a "Train the Trainers" course with the intention that those trained in ELNEC curriculum will be effective in its dissemination.


The ELNEC training program was conducted by a distinguished faculty of researchers, educators, authors, and leaders in the field of palliative care. Topic areas included nursing care at the end of life; pain and symptom assessment and management; cultural considerations; ethical/legal issues; communication; grief, loss, and bereavement; preparation and care for the time of death; and achieving quality care at the end of life.


The SGNA Board of Directors recognizes the importance of providing end-of-life educational opportunities to its members to compliment and enhance the GI nurse care provider. My attendance at the ELNEC training program was a direct result of that support. In fact, ongoing end-of-life care topics will be accessible in various SGNA presentations to reach this commitment.


I admit I didn't often think about end-of-life care as I hurried though another outrageously busy day at work. Now, I think of it all the time as I care for my patients with esophageal cancer, end-stage liver disease, and pancreatic cancers. I believe as other GI nurses learn more about end-of-life care, their lives will change. We are extremely fortunate to be nursing at a time when end-of-life care is becoming a strong part of our nursing practice. I encourage gastroenterology nurses to become knowledgeable about end-of-life issues in order to assure the needs of all gastroenterology patients are met.


Cathleen B. Ferraro, BA, RN, CGRN