Knowledge and attitudes of home care nurses toward hospice referral

Nurses and administrators are concerned with removing barriers to appropriate and cost-effective referrals between programs. The goal of this research was to describe knowledge and attitudes of home care nurses toward hospice referral.

The literature review did not identify studies related to the referral of patients from traditional home care to hospice programs. A few studies related to the hospice referral processes suggested issues with conflicts between programs, attitude barriers to open communications, issues regarding late hospice referrals, and practitioner reluctance to "give up" patients with whom they had established relationships.

This study used a descriptive, quantitative method. A 15-item, self-administered survey was developed by the investigators and hospice administrators. It was distributed to 160 registered nurses employed as full- or part-time staff in a large midwestern home care agency. Completed surveys were returned by 75 nurses, for a response rate of 46.9% (N = 75).

Nurses perceived that home care and hospice services were very similar; they resisted hospice referral as long as they felt that services could be provided adequately by home care; they desired to maintain patient continuity and special rapport and demonstrated inconsistent knowledge regarding hospice referral criteria and relative costs.

Nurses in different programs would benefit from improved communication links, accurate cross-program information, and development of increased trust relationships. Improvements in communication and transition programs for patients and families should include structural and programmatic changes.