ICU bedside nurses see their involvement in discussions of prognosis, goals of care, and palliative care as a key element of overall quality of patient care. Based on the barriers participants identified regarding their engagement, interventions are needed to ensure that nurses have the education, opportunities, and support to actively participate in these discussions.

Background Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. Objective To implement and evaluate a palliative care professional development program for ICU bedside nurses. Methods From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Results Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Conclusions Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. (American Journal of Critical Care. 2017; 26:361-371) by AACN on May 12, 2018 http://ajcc.aacnjournals.org/ Downloaded from P alliative care is a specialty and focus of care that aims to improve quality of care for patients who have serious and complex illnesses and their families. [1][2][3] Patients in intensive care units (ICUs) and their families have palliative care needs, including emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that are consistent with their goals. [3][4][5][6][7][8][9][10][11][12][13] AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2017, Volume 26, No. 5 www.ajcconline.orgIn the ICU, palliative care is provided along with life-sustaining therapies and may be delivered by the ICU team (primary palliative care), a palliative care consult service (specialty palliative care), or both. 2,3,14 A number of barriers to integrating palliative care into the ICU have been identified, including inadequate training of clinicians and misperceptions that such treatment is the same as hospice, comfortfocused care, or end-of-life care. 3 Families, physicians, and nurses identify involvement of bedside nurses as a key factor in the quality of ICU palliative care. [15][16][17][18][19][20] Nurses' training and constancy at the bedside position them to identify palliative care needs, coordinate communication among families and an array of clinicians, and support and educate families. 15,16,19...

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sound, light, and touch, have proved to be asymmetrical under certain c~nditions.')-~r Correlation has been found to exist between the initial head-turning responses of infants two days post-partum and maternal holding preference two to three weeks later.16 This could mean that right-holding is appropriate in normal newborns showing left-side preference in their behavioural reactions. In sick, premature, and/or separated newborns this could be a sign of disturbed neonatal behaviour, as the percentage of asymmetrical responses to stimuli increases. Maternal and paternal handedness has been shown to have no influence on side preference for holding newborns.1.3.sJ1 Whether the holder's handedness fits in with the infant's asymmetrical behaviour and is indirectly correlated with side preference, is currently under investigation in our unit. ReferencesI SALK L: The effects of the normal heartbeat sound on the behaviour of the newborn infant. Implications for mental health. World Ment Health 1 2 : 168, 1g60 2 WEILAND JH: Heartbeat rhythm and maternal behaviour. J Am Acid Child Psychiatr 3 : 161, 1964 3 DE CHATEAU P. HOLMBERG H. WINBERG J: Left-side preference in holding and carrying newborn infants. 1. Mothers holding and carrying during the first week of life. Acta Paediatr Scand 67: 169, 1978 4 DE CHATEAU P. ANDERSON s: Left-side preference in holding and carrying newborn infants. 11. l+ll-holding and carrying from 2 to 16 years. DevMed Child Neurol 1 8 : 738, 1976 5 DE CHATEAU P, DELLERUD I. MEZAN s et al: Left-side preference in holding and carrying newborn infants. IV. Fathers holding and carrying during the first week of life. Manuscript 6 SALK L: The critical nature of the post-partum period in the human for the establishment of the mother-infant bond: a controlled study. Dis Nerv Syst, Supp I I : I 1 0 , I970 haviour one year after delivery and extended postpartum contact. Dev Med Child Neurol16: 172, 1974 8 KLAUS MH, KENNELL JH: Mothers separated from their newborn infants. Pediatr Clin North Am 17: 1 0 1 5 , I970 g NILSSON A: Paranatd emotiond adjustment. Acta Psychiatr Scand, Suppl: 2 2 0 , 1970 10 KAPLAN D. MASON E: Maternal reactions to premature birth viewed as an acute emotional disorder. Am J Orthopsychiatty 30: 539, 1g60 I I DE CHATEAU P , WIBERG B: Long-term effects on motherinfant behaviour of extra contact during the first hour post-partum. 111. Follow-up at one year. Early Hum Dev: in press 1 2 WEILAND I H . SPERBER z: Patterns of mother-infant contact. The significance of lateral preference. J Gen Psy-chol117: 157, 1970 13 MIRANDA SB: Visual abilities and pattern preferences of premature infants and full-term infants. J Erp Child Psychol 1 0 : 189. 1970 14 TURKEWITZ G , MOREAU 1. DAVIS L et al: Factors affecting lateral differentiation in the human newborn. J E r p Child Psychol 8 : 483, 1969 15 TURNER s. MACFARLANE A: Localisation of human speech by the newborn baby and the effects of pethidine (Merepidine). D e v Med Child Neurol 2 0 : 727, 7 KENNELL JH, JERAULD R. WOLFE H et d: Maternal be-I978...