Advance Care Planning in Rehabilitation: Training Nurses and Social Workers to Facilitate Discussions

Abstract

Practice Problem: Patients and healthcare workers fail to hold advance care planning (ACP) discussions. Social workers perceive a lack of time and feel unprepared to hold ACP conversations. PICOT: The PICOT question that guided this project was: Do patients in acute inpatient rehabilitation (P) who receive education and resources about ACP from trained nurses and social workers (I) accept and participate in ACP (O) compared to prior standards of care (C) while on the rehabilitation unit (T)? Evidence: The public and healthcare workers have limited knowledge of ACPs and their role in these discussions. People are more likely to hold ACP discussions when they are outpatients or in care transitions, such as rehabilitation. Intervention: Train a social worker and nurse champion with Respecting Choices’ “First Steps Advance Care Planning Conversations Guide: Adults with Chronic Illness.” Educate nursing staff during staff meetings and shift huddles about advance directives, advance care planning, unit processes, and their role in this discussion. Outcome: Patients were 1.5 times more likely to admit to having advance directives and 1.64 times more likely to ask for more information when asked by trained nurses than when nurses were not trained. Conclusion: Training staff and providing role clarification improved the frequency of advance care planning discussions. The project was limited by several new processes, a small sample size, and its short duration.