Brenda Gomez, DNP, FNP-C, CCRN

Abstract:

Background: Hispanic patients in California experience significant disparities in end-of-life (EOL) care. As the Hispanic population ages, these disparities are expected to worsen without targeted interventions. Nurses working in intensive care units (ICUs) are well-positioned to address these gaps through culturally competent, patient-centered EOL care. Objective: The project sought to identify the knowledge and education needs of ICU nurses to promote sensitive and effective EOL conversations with Hispanic patients and families in the ICU context. Method: The project was a cross-sectional survey to conduct a needs assessment of knowledge and skills related to EOL care in the ICU for Hispanic patients. A one-time electronic survey of ICU nurses was administered from November 2024 to April 2025 to evaluate and rank education needs numerically. The final sample size included 102 ICU nurses. The survey consisted of four sections: a 10-item knowledge and skill ranking, following the CDC framework for a needs assessment, a 5-item assessment of preferences for educational training on this topic, a demographic and clinical experience section, and a 23-item Attitudes Toward Implicit Bias instrument.  Results: Of the 921 invited nurses, 102 completed responses (11% response rate), with respondents predominantly female (90.2%) and White (41.2%) and a median age of 39.5 years. Most participants (63.6%) reported prior EOL training; the median ICU experience was 8 years. Results identified critical gaps in EOL care knowledge, skills, and training preferences for culturally competent care for Hispanic patients. Pain and symptom management (M = 2.68) and communication with patients (M = 2.61) were top priorities, while medical mistrust (M = 8.03) and power dynamics (M = 8.24) were the lowest priority knowledge areas. Nurses preferred brief, embedded learning formats such as unit rounds (M = 2.23) and ongoing education (M = 2.18). Implicit bias scores were moderately high (M = 4.40, α = .93), indicating awareness of bias. Correlational analyses revealed that prior EOL training was linked to a greater emphasis on grief content (ρ = –.39, p = .001), preference for ongoing learning (ρ = –.45, p = .001), and lower preference for retreats (ρ = .42, p = .001). More ICU experience correlated with less preference for brief trainings (ρ = .34, p = .005). Discussion: This project identified critical gaps in ICU nurses’ knowledge and communication skills related to culturally competent end-of-life (EOL) care for Hispanic patients, particularly in pain management and patient-family communication. Although nurses showed moderate awareness of implicit bias, topics like medical mistrust and power dynamics were deprioritized—despite being known barriers to equitable care. Nurses favored concise, practical training formats embedded in clinical workflows, such as unit rounds and interactive workshops. These findings highlight the need for targeted, accessible education addressing clinical and cultural competencies to improve EOL care for diverse populations.

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