Special program enables nurses to better prepare for providing palliative care

Critical care nurses at five University of California medical centers are better prepared to lead primary palliative care at the bedside after participating in a special training and mentoring program.

The system-wide professional development initiative increased nurses' ratings of their palliative care communication skills and provided ongoing support and mentoring to help them identify and address palliative care needs for patients and their families. These patients have serious and complex illnesses.

The Integrating Multidisciplinary Palliative Care into the ICU (IMPACT-ICU) program was designed to address barriers to integrating palliative care into critical care and to increase nurses' engagement in palliative care.

Often confused with hospice care or end-of-life care, the palliative care specialty aims to improve the quality of care for seriously ill patients and is often provided along with life-sustaining therapies. Palliative care needs include emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that align with their goals.

The IMPACT-ICU team shares results from the three-pronged professional development initiative in the September 2017 issue of American Journal of Critical Care (AJCC). The article, "Palliative Care Professional Development for Critical Care Nurses: a Multicenter Program," reviews the design, implementation and evaluation for each phase of the two-year initiative.

"Through a combination of communication workshops and bedside coaching rounds, bedside nurses feel more skilled to engage in palliative care communication and be more involved in identifying and addressing palliative care needs," said co-author and principal study investigator Wendy G. Anderson, MD, MS, associate professor at the University of California San Francisco (UCSF) Schools of Medicine and Nursing. "This is a crucial step toward overcoming barriers to integrating palliative care into ICUs."

Anderson worked with fellow faculty, researchers, nurse leaders, physicians and palliative care providers at medical centers associated with the University of California health system in Los Angeles, San Diego, San Francisco, Irvine and Sacramento to develop and implement the IMPACT-ICU initiative.

The program began with a three-day train-the-trainer session for nurse leaders at each center, who were palliative care advanced practice nurses and nurse educators. The nurse leaders then returned to their centers to provide intensive training and mentoring to bedside nurses from two intensive care units (ICUs) at their centers. Over two years, mentoring and networking across centers was facilitated by site visits, monthly phone calls and yearly in-person meetings.

The nurse leaders conducted eight-hour palliative care communication workshops for bedside nurses in the selected ICUs. Each facility held at least six workshops, resulting in a total of 428 nurses trained over an 18-month period.

The number of participants reporting a very good or excellent level of skill was significantly higher in post-workshop surveys for all 15 palliative care communication tasks assessed.

After the workshop, the nurse leaders continued to mentor the bedside nurses through structured coaching rounds in their units to help them identify and address palliative care needs for patients who were seriously ill.

For 82 percent of 1,110 patients discussed in rounds, staff nurses identified palliative care needs and created plans to address them.

A July 2015 article in AJCC, "Communicating With Families and Physicians Regarding Prognosis and Goals of Care: An Education Initiative for ICU Nurses" provides additional information about the initial UCSF palliative care communications skills workshop that led to this multicenter initiative.

The IMPACT-ICU initiative was supported by the University of California Center for Health Quality and Innovation Quality Enterprise Risk Management program, a joint venture of the University of California Center for Health Quality and Innovation and the Office of Risk Services.

Online-only appendices to the article provide additional information and resources to journal subscribers, including a two-page form developed to guide the rounding process and track nurse and patient data. Videos depicting the core concepts and skills from the IMPACT-ICU program, as well as downloadable materials, are available online at http://vitaltalk.org/resources/impact-icu/.

The American Association of Critical-Care Nurses, which publishes AJCC, offers additional 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.