The Palliative Medicine-Surgery Interface—“How To Effectively Work with Your Surgery Colleagues on Complex Cases” (FR409)

Abstract

Objectives 1. To understand and list three gaps in intensive care unit (ICU) family meeting conduct from the perspective of ICU nurses. 2. To list two actionable opportunities for improving nurse involvement in family meetings. Background. Although multidisciplinary family meetings (FMs) are associated with shorter lengths of stay, fewer non-beneficial interventions, and improved caregiver emotional wellbeing, they do not occur routinely. Nurses frequently interact with family members of intensive care unit (ICU)patients, so we sought to characterize nursing experience in order to identify actionable opportunities to increase routine FMs. Research Objectives. To characterize ICU nurses’ perspectives, experiences, and roles regarding FMs. Methods. We conducted focus groups with nurses in a medical ICU at a single veterans administration hospital using a semi-structured guide to query existing practices around FMs, including scheduling, attendance, content, and documentation; nursing roles regarding FMs; and barriers and facilitators to conducting FMs. We audiotaped, transcribed, and qualitatively analyzed FGs into categories and themes using constant comparison. Results. Thirty ICU nurses attended six focus groups. Three key themes emerged: 1) Ad-hoc physician-family communication occurring outside a structured FM is common, poorly documented, and does not normally include a nursing presence; 2) nurses’ role as a patient/ family advocate at the bedside does not transfer into the FM context, where they commonly fill more limited roles of scheduler, coordinator, or observer; and 3) documentation of FM’s is often pro forma and variably completed or reviewed. Conclusions. Family meetings in the ICU often occur outside structured and inclusive settings. Such ad-hoc communication may benefit from regular inclusion of nurses and better documentation to improve care continuity and ICU team collaboration. Efforts to increase nurse self-efficacy in FMs in addition to formalizing a process for nurse engagement during FMs might further enhance communication in the ICU. Greater attention to the content and process of documenting FMs, particularly within the electronic medical record, is necessary. Implications for research, policy, or practice. Nurses can and should feasibly be included as routine, involved participants in FMs.