Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Abstract

Background Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. Objective To implement and evaluate a palliative care professional development program for ICU bedside nurses. Methods From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Results Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Conclusions Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. (American Journal of Critical Care. 2017; 26:361-371) by AACN on May 12, 2018 http://ajcc.aacnjournals.org/ Downloaded from P alliative care is a specialty and focus of care that aims to improve quality of care for patients who have serious and complex illnesses and their families. [1][2][3] Patients in intensive care units (ICUs) and their families have palliative care needs, including emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that are consistent with their goals. [3][4][5][6][7][8][9][10][11][12][13] AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2017, Volume 26, No. 5 www.ajcconline.orgIn the ICU, palliative care is provided along with life-sustaining therapies and may be delivered by the ICU team (primary palliative care), a palliative care consult service (specialty palliative care), or both. 2,3,14 A number of barriers to integrating palliative care into the ICU have been identified, including inadequate training of clinicians and misperceptions that such treatment is the same as hospice, comfortfocused care, or end-of-life care. 3 Families, physicians, and nurses identify involvement of bedside nurses as a key factor in the quality of ICU palliative care. [15][16][17][18][19][20] Nurses' training and constancy at the bedside position them to identify palliative care needs, coordinate communication among families and an array of clinicians, and support and educate families. 15,16,19...

Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review

“…(3) Encouraging EOL dialogue and reflection, assisting residents to react in a palpable manner and employing role modelling allows the project to subscribe to experimental education. *Difficulties in communication with dying patients related to ICU culture * Inadequate education and palliative care skills *Facilitate palliative care dialogue *Facilitate family engagement learning Low Anderson WG [ 39 ] 2017/USA To implement and evaluate a palliative care professional development programme for ICU bedside nurses. Nurses ( n = 428) Nurse leaders (n = 8) Mixed methods A survey was completed by bedside nurses Qualitative data notes taken by nurses’ leaders It was encouraging to learn that nurses assessed their EOL skill level to be significantly higher post-workshop; they identified 15 tasks such as making sure the family fully understood the situation when convening a family meeting and helping to alleviate family distress ( P < 0.01 vs. pre-workshop) care needs.…”

“… - Involving training teams in specialized palliative care while providing care for patients in ICU [ 25 ]. - Hospital training and the development of a palliative nursing programme [ 39 ]. - Specialist palliative nursing coaching [ 39 ].…”

“…- Hospital training and the development of a palliative nursing programme [ 39 ]. - Specialist palliative nursing coaching [ 39 ]. - Training workshop communication programme for bedside nurses [ 39 ].…”

Training Clinicians with Communication Skills Needed to Match Medical Treatments to Patient Values

“…Data for nurses are equally fragmentary. There are more studies describing communication skills training for serious illness involving nurses than physicians, especially in intensive care units, and in general there is more inclusion of communication in basic nursing skills. However, we are not aware of a national estimate involving all nurses who are involved in serious illness care.…”

Aggressive Care AND Palliative Care

“…11 The IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the ICU) Project is a successful system-wide model for involvement of bedside nurses in palliative care in the ICU. 12 We have a beginning foundation of knowledge about palliative care for critically ill patients. We Palliative care is holistic, dealing with physical, psychosocial, and spiritual problems associated with any life-threatening illness.…”