Workshop Improves Critical Care Nurses’ Confidence in Palliative Communication
American Journal of Critical Care article describes design, implementation and evaluation of a workshop on palliative care communication skills
ALISO VIEJO, Calif. — July 1, 2015 — A workshop at the University of California San Francisco (UCSF) helped critical care nurses improve their palliative care communication skills, according to an article in the July issue of the American Journal of Critical Care (AJCC).
The article, “Communicating With Families and Physicians Regarding Prognosis and Goals of Care: An Education Initiative for ICU Nurses,” describes the design, implementation and evaluation of an educational intervention to enhance bedside nurses’ communication skills in addressing patient and family goals of care, communicating with physicians regarding the needs of family members and participating in a family meeting.
Overall, workshop participants reported greater awareness of their roles and responsibilities related to palliative care, and measurable improvements to skill and confidence levels for engaging in discussions of prognosis and goals of care with families and physicians. Qualitative analysis indicates it also helped empower nurses and created a culture of support in the intensive care unit (ICU).
Principal investigator for the article Wendy Anderson MD, MS, is associate professor in the Division of Hospital Medicine and Palliative Care Program and the Department of Physiological Nursing at UCSF.
“Communication is an essential part of quality care within all areas of healthcare and especially in the ICU. The bedside nurse provides not only physical care to their patient, but also informational and emotional support of patient, family and colleagues,” Anderson said. “This evidence-based educational workshop provides tools nurses need to be a respected part of an interdisciplinary team helping families navigate palliative care discussions and decisions.”
The education initiative was developed at the request of critical care nurses and designed by an interdisciplinary working group within the ICU-Palliative Care Committee, a special-interest group focused on improving palliative care in the ICU at UCSF Medical Center.
The resulting curriculum is an eight-hour communication skills workshop with up to 15 nurse learners.
Each workshop began with a discussion of the roles and responsibilities of bedside nurses related to the patient and family and within the healthcare team, including:
- Convening: identifying family needs for communication and bringing the healthcare team together to discuss concerns at a family meeting
- Checking: assessing the informational needs of the family and clarifying information exchanged between the healthcare team and the family
- Caring: assessing the emotional needs of the family and responding with empathy
- Continuing: following up with the family after the meeting to address questions and provide support
Three role-play sessions of 60-70 minutes each allowed participants to practice their communication skills during mock discussions with a family member, a physician and within a family meeting.
The workshop concluded with an interactive session led by the palliative care chaplain about the daily stressors that impact ICU bedside nurses. The discussion focused on compassion fatigue, burnout and personal practices of self-care to combat these effects.
UCSF conducted the workshop six times over two years, with 82 nurses participating from medical-surgical, cardiac and neurological ICUs, as well as rapid response teams and the emergency department. The workshop was offered free to nurses, and participants received continuing education hours.
Participating nurses reported greater skill and confidence, including assessing family understanding of prognosis and goals of care, addressing family emotional needs and contributing to family meetings. Increases were sustained three months following the workshop.
Based on the local success and support of this workshop, the team has expanded it to four additional hospital centers within the University of California system. They implemented a train-the-trainer program to teach teams at each center, and more than 500 nurses have completed the workshop so far.
The American Association of Critical-Care Nurses, which publishes AJCC, offers resources and tools to help nurses care for patients and their families at the most difficult times of their lives, including an e-learning course and a free, online self-assessment tool. For more information on palliative and end-of-life care, please visit www.aacn.org/palliativeedu.
To access the article and its full-text PDF, visit the AJCC website at http://www.aacn.org/education/publications/ajcc.
About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based practice applications. Established in 1992, it includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 101,000 acute and critical care nurses and can be accessed at www.ajcconline.org.
About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 235 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.
American Association of Critical-Care Nurses
Aliso Viejo, CA 92656-4109
Phone: (949) 362-2000
Fax: (949) 362-2020