A Multisite Survey of Critical Care Nurses' Perspectives of Their Clinical Involvement in Palliative Care Communication (TH331D)

Abstract

•Comprehend ICU nurses’ perspectives of their role in palliative care communication.•Identify two barriers to ICU nurses’ involvement in PC communication. The intensive care unit (ICU) is increasingly becoming a setting of care for chronically ill patients with life-limiting illness. Nurses, spending the most time with patients and families, highly value their roles as liaison and advocate. Successful and sustained integration of palliative care (PC) into the ICU requires the active engagement of bedside nurses. To describe perspectives of ICU bedside nurses on their involvement in PC communication. We designed a 46-item survey, based on prior work, to assess nurses’ perspectives on palliative care communication, namely, the importance and frequency of their involvement, their confidence specific to these discussions, and barriers to their participation. The survey was distributed via email to 1791 bedside ICU nurses who worked in the five academic medical centers of the University of California. 598 nurses completed the survey (33% response rate). Most participants (88%) reported that their engagement in discussions of prognosis, goals of care, and PC was very important to the quality of patient care. However, a minority noted that they often discussed PC consultations with physicians (31%) or families (33%). Nearly half of the nurses (45%) confirmed that they rarely or never participated in family meetings. Confidence was also lowest for these behaviors. The three most frequent barriers to nurses’ involvement in PC communication were: need for more training (66%), physicians not asking nurses’ perspectives (60%), and concern over the emotional toll of PC communications (43%). ICU nurses perceive their involvement in discussions of prognosis, goals of care, and PC as a key element of high quality patient care. Based on the identified barriers, efforts to promote education, team building, and self-care can reduce obstacles that deter optimal PC communication.