Facilitating Evidence-Based End-of-Life Care: A Collaborative Model Utilizing Clinical Nurse Specialist Expertise

To deliver evidence-based, high-quality end-of-life care through a collaborative initiative led by geriatric and palliative clinical nurse specialists in partnership with an interdisciplinary team and hospital administration.

After identifying inconsistent end-of-life care within an academic medical center, geriatric and palliative clinical nurse specialists synthesized best practices to develop a "comfort care" initiative. Operating across the 3 clinical nurse specialists' spheres of influence, the team collaborated with administrative and interdisciplinary stakeholders to pilot the model on a specialized geriatrics unit.

Implementation led to consistent use of individualized care plans, accurate pain assessments, and timely execution of EOL orders. In the designated unit, nurses achieved compliance rates of 80% to 100%, significantly outperforming other system settings. This successful pilot served as a catalyst for system-wide improvements, including the standardization of evidence-based nursing care plans, comfort care code status protocols, and end-of-life order sets throughout the hospital system.

This project demonstrates that clinical nurse specialists-led interdisciplinary collaboration can drive sustained, significant improvements in end-of-life care quality and system-wide practice standardization.