Critical Care Nursing Commons^™

Improving End-Of-Life Care: A Nursing Education Initiative, Spring C. Kingsley

DNP Projects

Background: This study addresses the gap in education and training for medical intensive care unit (MICU) nurses regarding the care of hospice patients. The traditional medical model of healthcare prioritizes illness treatment, often leading to inadequate end-of-life support and increased hospitalization during patients' final days. The rise of in-hospital hospice programs, or scatter-bed hospice models, highlights the need for nurses to enhance their skills in providing end-of-life compassionate care. The MICU at the University of Kentucky’s Chandler Hospital serves as a focal point for this initiative, given its role in caring for critically ill patients who require hospice attention.

Purpose: …

Improving Timely Palliative Care Consultation In The Micu: A Nurse-Driven Quality Improvement Initiative, Sandy Louise Gray

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Improving Timely Palliative Care Consultation in the MICU: A Nurse-Driven Quality Improvement Initiative

Sandy L Gray

Background: Early palliative care in intensive care units improves outcomes and reduces costs, yet referrals are often delayed. At J.W. Ruby Memorial Hospital’s medical intensive care unit (MICU), baseline median time to consultation was 112 hours (mean=246), exceeding recommended benchmarks and highlighting the need for a standardized process.

Purpose: This quality improvement project evaluated a nurse-driven screening tool to improve timeliness and consistency of palliative care consultations in the MICU.

Intervention: The tool was embedded in the electronic health record (EHR) …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

The Effect Of A Neonatal Palliative Care Education Program In Increasing Knowledge And Communication Self-Efficacy Among Nicu Nurses, Shiou-Huei Joy Wang

Doctoral Projects

Background: Neonatal palliative care is crucial to providing comprehensive, high-quality care to neonates with life-limiting or life-threatening health conditions and their families. One significant barrier to the inconsistent provision of neonatal palliative care is the lack of education. This project aimed to deliver an education training program to increase neonatal palliative care knowledge and self-efficacy in NICU nurses. Method: A pre-post-test study design was used to examine the efficacy of an educational training program on NICU nurses’ knowledge and communication self-efficacy in neonatal palliative care. A post-test was administered immediately after the training and again four weeks later to evaluate …

Palliative Care Integration Into Critical Care In People With Terminal Conditions, Arielle Westfall

Honors Undergraduate Theses

Palliative care is of value to the quality of life in people with terminal conditions when initiated early. The purpose of this literature review was to identify barriers to early initiation of palliative care consultation. The secondary purpose was to examine characteristics that prompt palliative care consultation. The TLC model of palliative care was used to explore palliative care in the critical care setting in people with terminal conditions. The concepts of the model support optimal palliative care as collaborative and comprehensive, with shared decisions made by the patient, practitioners, and loved ones. A literature review was conducted to identify …

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

The Effect Of Providing End Of Life Care On The Mental Health Of Critical Care Nurses, Christy Nelson

Master's Projects

Critical care nurses are providing care to acutely ill patients now more than ever and may experience moral or emotional distress due to providing end of life care to their patients. The purpose of this literature review is to determine the mental health effects of a critical care nurse providing palliative end of life care. A literature search using PubMed and CINHAL was conducted and fourteen published articles between 2012-2023 were included in this review. Several interventions were identified which may be useful in decreasing burnout and moral distress in critical care nurses. Overall, nurses experienced the most negative mental …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

Exploring Palliative Care Education Needs And Desires Of Advanced Practice Providers In The Critical Care Setting, Jill Marie Clemmons

DNP Projects

Background: Critical care providers in the ICU setting are discovering that their patients are living longer with more comorbid conditions. They are confronted with palliative care situations almost daily. Recently palliative care has been thrust into the forefront of critical care and is a resource critical care nurse practitioners and physicians’ assistants need to be able to utilize. A gap in the literature has been found in the overall education of critical care providers regarding palliative care.

Purpose: The purpose of this study was to determine what palliative care training trauma/cardiac/neurological, and pulmonary critical care providers had previously received …

Implementation Of Education And Use Of A Screening Tool To Assess Palliative Care Needs In The Critical Care Setting, Megan Stoeckinger

DNP Projects

Purpose: The purpose of this study was to measure palliative care knowledge, attitudes, perceived empowerment, and familiarity of the Supportive Palliative Care Indicators Tool (SPICT) among critical care nurses and advanced practice providers (APPs) before and after viewing a web-based educational video on an adult medicine intensive care unit (MICU).

Methods: This study was a one group pre- and post- implementation assessment using a web-based educational video and electronic surveys. The population included critical care nurses and advanced practice providers (APPs). This study spanned the timeframe between January 2022 and March 2022.

Results: Paired t-tests comparing pre-intervention …

End-Of-Life Nursing Consortium To Improve The Gap In Palliative Care, Emma Kroger

DNP Projects

Abstract

Objective: The purpose of this project is to implement a palliative care education intervention with a pre- and post-survey to assess knowledge, emotional preparedness, and confidence in undergraduate nursing students at the University of Kentucky.

Aim: The aim of this project is to address the gap in palliative care education by increasing professional knowledge, emotional preparedness, and confidence levels in regards to palliative care of future nurses at the University of Kentucky.

Background: The terms “hospice” and “palliative” are often used interchangeably in the healthcare setting. However, palliative care focuses on symptom management in all stages of acute, chronic, …

Transitioning With Grace: Improving Quality Of Life For Comfort Care Patients In The Intensive Care Unit, Melissa Ashley

Doctor of Nursing Practice Projects

The primary aim of this project was to develop and execute a standard protocol of interventions for comfort care patients on a medical intensive care unit. Staff at a 15 bed MICU at a Midwest urban teaching hospital from June 1 until August 11, 2018 were trained to execute a standardized protocol of interventions for comfort care patients. Seventeen MICU patients who transitioned to comfort care were offered a standardized set of evidence-based interventions, after staff attended educational in-services on providing high quality end of life (EOL) care. Checklists were used to determine intervention compliance. Pre-project and post-project surveys were …

Evaluation Of Self-Efficacy And Confidence Levels Among Newly Graduated Nurses Exposed To An End-Of-Life Simulation: A Comparison Study, Catherine Edwards

DNP Projects

Purpose: The purpose of this project is to compare self-efficacy and confidence levels among a cohort of newly graduated nurses (defined as nurses who have had no nursing experience and are participating in a new graduate nursing residency) who will participate in an EOL simulation with another cohort of nurses who have been practicing for a year or more, but have not participated in an end-of-life simulation.

Methods: The study included two parts. The first portion included a pre and post-test evaluation of an end-of-life (EOL) simulation intervention with newly graduated nurses (Group One, n= 22), as part of their …

Gadgets And Grieving: A Chronological Analysis On The Ways In Which Advancements In Medical Technologies Have Altered The Grieving Process, Grace Mcnair

Dialogue & Nexus

Since the 1940s, both end-of-life care and advancements in medical technologies have expanded exponentially. This article explores the advancements in medical technologies and how these have altered the way that Western society grieves death. With the capabilities to prolong life, the family, the patient, and the medical team, all grieve the end of life in different ways. This article provides a chronological analysis of palliative care, hospice care, and various medical advancements. These changes in medicine are then paralleled with alterations in the bereavement process. This article explores historical narratives of Western society’s transformation of grief through the lens of …

End Of Life Care Practices For Patients Who Die In Intensive Care Units (Icu), Jila Ghabeljoo

Doctoral Projects

Today, one in five hospital deaths happens in the intensive care unit with the expectation of twice as many by 2030. Increasing, mortality has triggered a growing attention to end-of-life (EOL) care in the ICU. However, the lack of coveted EOL and palliative care skills creates a challenge for ICU nurses. The aim of this study was to assess the current practices of EOL care in the ICU. In this quantitative research, a retrospective chart review method was employed to analyze the collected data from a population 60 EOL patients who died in the ICU of a Southern California hospital. …

Parent Involvement In End-Of-Life Care And Decision Making In The Newborn Intensive Care Unit: An Integrative Review, Lacey M. Eden, Lynn Clark Callister

Faculty Publications

Survival rates for very preterm and critically ill infants are increasing, raising complex ethical issues for health-care providers and parents who face the challenge of making end-of-life decisions for newborns. The purpose of this integrative literature review was to evaluate parental involvement in end-of-life care and decision making for their infant in the newborn intensive care unit. Findings revealed that establishing good relationships and clear communication between health-care providers and parents builds trust and eases stress placed on parents making decisions about the care of their infant. Palliative care programs provide support for parents and facilitate their decision making. Parents …