Abstract

Purpose and Rational

Intensive Care Unit (ICU) patients often receive aggressive medical treatment with advanced illness or injury, and frequently have unmet palliative care (PC) needs. ICU nurses bear witness to the suffering of their patients and in turn, suffer a disproportionate amount of moral distress. The purpose of this clinical scholarship project is to empower nurses with knowledge and skills to advocate for PC for critically ill patients within the ICU setting at a Midwestern, urban, academic medical center. This will be achieved by providing education to nurses about PC and its utilization in the ICU setting and implementing a criteria-based screening tool that will be used during daily interdisciplinary rounds to assist nurses in advocating for PC when it is clinically indicated by evidence-based triggers.

Synthesis of Evidence

Evidence supports PC as an essential component of comprehensive, quality care. However, the culture of the critical care environment is one of aggressive, curative-focused measures, and there are many barriers to PC in this setting. Many strategies have been suggested to combat these barriers. The most widely supported strategy in the literature about increasing PC utilization in the ICU is the use of trigger-based tools to indicate which patients may have unmet PC needs.

Furthermore, ICU nurses suffer high rates of moral distress, directly related to the lack of control they have over patient outcomes and a stressful work environment. Increasing nurse empowerment has been shown to directly reduce moral distress. Education has been identified as a useful tool to increase nurse knowledge and empowerment.

Practice Change and Implementation Strategies

This will be achieved by providing education to nurses about PC and its utilization in the ICU setting and implementing a criteria-based screening tool that will be used during daily interdisciplinary rounds to assist nurses in advocating for PC when it is clinically indicated by evidence-based criteria. Nurses will participate in an online learning module about the provision of PC in conjunction with ICU care, as well as how to use a trigger-based screening tool to identify patients with unmet PC needs. A nurse-led screening tool for PC will be completed daily for every patient by nurses during a 4-week period of time and presented during daily interdisciplinary rounds. A survey will be used pre-implementation and post-implementation to assess nurses’ knowledge and comfort advocating for PC use in the ICU.

Evaluation

The pre-and-post implementation mean scores from the surveys will be used to evaluate a change in the comfort, knowledge, and empowerment levels of nurses advocating for PC after the screening phase. The completed PC screening tools will be used to evaluate screening feasibility, and if the nurses felt more empowered to advocate for a PC consult for patients meeting triggers.

Conclusions and Implications for Practice

Given the supported benefits of PC, increased utilization in the ICU will have better outcomes for patients and their quality of life. If the outcomes show that nurses feel more empowered after the interventions, a long-term goal would be a decrease in moral distress. Additionally, if the screening tool is successful in identifying patients with unmet PC needs, then a process for sustainability of the nurse-led screening tool can be established to allow continued use beyond the intervention phase of this project.

Date of Project Completion

Spring 3-17-2021

Document Type

Project Paper

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Kimberly Langer

Location

Winona State University

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