Casas Crescenti, Katherine P.. Advance care planning in the intensive care unit: a quality improvement project. Retrieved from https://doi.org/doi:10.7282/t3-7kq8-gm88
DescriptionPurpose of the Project: Advance Care Planning (ACP) is an essential component in the delivery of high-quality nursing care. Due to current gaps between knowledge and practice, nurses’ involvement in ACP is low. The purpose of this project was to improve nurses’ knowledge about ACP processes while increasing the number of Pastoral Care referrals.
Methodology: This project consisted of a one-group pretest-posttest interventional design using a convenience sample of nurses. One intervention was an educational program that involved a lecture presentation and a case study. The outcome for this intervention was to improve nurses’ knowledge regarding ACP. A second intervention was to implement the ACP bedside assessment checklist for two months. Effectiveness of the checklist was measured with retrospective and prospective data collection of Pastoral Care referrals.
Results: A total of 26 nurses participated in this project, which represented 87% of the total population of nurses at the site. The results demonstrated a significant improvement in knowledge as indicated by the 24% increase in the posttest scores after the educational program (p < 0.05). There was also a significant increase in the number of Pastoral Care referrals from seven to 18, with a mean improvement of 1.57 (p = 0.03).
Implications for Practice: Participants’ knowledge improved, as determined by a comparison of their average pre and posttest scores. Nurses can benefit from a standardized educational program and periodic education about ACP practices. The bedside assessment checklist was a useful intervention because it empowered nurses to ask about ACP and make referrals early. The number of Pastoral Care referrals increased after the conclusion of the project, which reflected active ACP participation. This project reinforced the need for a change in current practice because ACP should be initiated at any time and revisited periodically as patients’ health status changes.