UCSF workshop helps improve palliative care communication skills among critical care nurses

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.