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An educational intervention to increase advance directive completion in the intensive care unit
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Awad, Nancy. An educational intervention to increase advance directive completion in the intensive care unit. Retrieved from https://doi.org/doi:10.7282/t3-v6cp-hx76

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TitleAn educational intervention to increase advance directive completion in the intensive care unit
NameAwad, Nancy (author); DiGiulio, Mary (chair); Miley, Helen (internal member); Rutgers University; School of Nursing - RBHS
Date Created2020
Other Date2020-05 (degree)
SubjectAdvance care planning, Adult-Gerontology Acute Care Nurse Practitioner
Extent1 online resource (94 pages) : illustrations
DescriptionAdvance care planning (ACP) enables and empowers individuals to drive their medical care, especially once they become incapacitated by disease or terminal illness. Advance directives (ADs) have proven to decrease end-of-life expenditures by Medicare. In addition, completion of an AD increases the probability of medical care that coincides with the patient’s wishes and decreases decision-making burden for the family and physicians.

Purpose of Project
The purpose of this quality improvement project is to assess the effectiveness in increasing advance directive completion rates by offering an educational intervention for healthcare providers about advance care planning.

Methodology
This quality improvement project was designed with implementation of a pre- and post-test survey design to measure healthcare provider knowledge on proper ACP approaches. Thirty healthcare providers (internal medicine residents and advanced nurse practitioners) that rotate through the intensive care unit (ICU) were offered education on advance care planning utilizing conversation guides and a presentation developed by the head of palliative care at Johns Hopkins Hospital. The number of ADs on file in the ICU pre-implementation and post-implementation was evaluated by counting the number of ADs on file 3 months prior to implementation compared to the number of ADs on file over a 3-month period after implementation.

Results
A paired-samples t-test was used to compare the pre- and post-test survey results in order to determine the association between reinforced healthcare education and AD completion over a 6-month period. The findings revealed a statistically significant difference in the pre- and post-test scores, with an overall increase in scores post educational sessions. The paired-samples t-test indicated that scores were significantly higher post-implementation (M = 39.5, SD = 7.5) than pre-implementation (M = 30.5, SD = 5.8), t(29) = -6.8, p < .05, d = 1.34. In addition, a clinical significance was noted in the number of ADs on file prior to and after implementation. The number of ADs on file increased from 3 to 7 after implementing this quality improvement project.

Implications for Practice
Based on the findings of this project, interventions to inform healthcare providers about the ACP process should be considered as part of clinical practice. It is strongly suggested that healthcare providers receive periodic updates regarding the ACP process in addition to receiving conversation tools for guidance. If the findings of this intervention could be applied to the overall hospital population, then this simple intervention would likely result in a significant increase in completed ADs overall. Thus, the objective of providing medical care that coincides with ones’ wishes and improved outcomes at the end of life would be a closer reality.
NoteDNP
NoteIncludes bibliographical references
Genretheses, ETD doctoral
Persistent URLhttps://doi.org/doi:10.7282/t3-v6cp-hx76
LanguageEnglish
CollectionSchool of Nursing (RBHS) DNP Projects
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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