The University of North Carolina School of Nursing prepared a monograph on state-of-the-art nursing care of dying patients, and considered how to disseminate its ideas.

Key Results
Under the first grant, the researchers:

• Created a monograph, "Notes on a Peaceful Death," building upon chapters on "Death and Dying" and "Pain" from a major earlier text (Virginia Henderson's "Principles and Practice of Nursing—6th Edition," 1978).
• Hosted a meeting of 30 experts, including members of the clergy and the medical and pharmacy professions, December 2–4, 1998, in Chapel Hill, N.C., to review the monograph and to advise on its dissemination. Institutions and organizations represented included: the American Nurses Association, the National League for Nursing, the American Association of Colleges of Nursing, several university schools of nursing (including University of North Carolina, Yale School of Nursing and the University of Michigan), the Midwest Bioethics Center and the Robert Wood Johnson Foundation (RWJF).

Under the second grant, which was intended to promote and disseminate the ideas generated at the meeting of experts, the researchers:

• Worked with state nurses associations (in particular, North Carolina and Massachusetts) and the American Nurses Association, which ultimately endorsed the idea of pain as a fifth vital sign, and the concept of promoting pain assessment.
• Conducted a survey of all health care facilities in North Carolina and identified six institutions as models for the routine assessment of patients' pain. (Following the grant, information about these model programs was distributed to all North Carolina health facilities.)
• Established a closed listserv (a restricted email forum) for symposium participants to assist in promoting the monograph, "Notes on a Peaceful Death," and started a second closed listserv with a local (N.C.) end-of-life coalition group for discussion of end-of-life care, including promotion of a painless death.

Key Findings
Findings from the meeting of experts included:

• There was an unmet need to address the great majority of nurses who only infrequently care for a dying patient (as opposed to nurses specializing in patients near the end of life). Subsequently, the project director revised the monograph for a general nurse readership based upon the input received during the meeting.
• Participants addressed the idea of adding a fifth vital sign, pain assessment, to the set of vital signs (temperature, pulse, respiration and blood pressure) traditionally in use among nurses, agreeing to advance this idea within their organizations.
• Participants unanimously endorsed the notion that nurses—because they are often the first to identify a patient as dying—have a special responsibility for instituting a plan of care in support of a peaceful death.

Other Activities

• The project director for the second grant participated in the RWJF-sponsored American Association of Colleges of Nursing Roundtable that produced the document Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care.
• Attendees at the meeting of experts wrote editorials on the issue of pain assessment in the American Journal of Nursing, Hospital Pharmacy Times and Nursing Outlook, and articles on the subject have appeared elsewhere.
• During the time of both grants, project staff participated in workshops and meetings, both nationally and internationally, to promote the concept of the nurse's role in improved care of the dying. These included the National Conference for Medical Humanities, the National Conference on Nursing Administration Research, the European Union WISECARE Project meetings and RWJF Last Acts regional workshops, among others.

Afterward
The closed listserv for discussion of end-of-life care started with a North Carolina end-of-life coalition group grew into Project Compassion, with its own website. This project received a Faith in Action grant from RWJF. Faith in Action® is a national network of local interfaith coalitions of volunteers who provide a wide range of support services to persons who are chronically ill and living at home.