Enhancing Advance Care Planning Conversations by Nurses in a Bone Marrow Transplantation Unit

Izumi, Shigeko; Burt, Malinda; Smith, Jennifer; McCord, Keren; Fromme, Erik K.

doi:10.1188/19.onf.288-297

Cited by 2 publications

(16 citation statements)

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“…12 Thus, encouraging discussions ahead of potentially high-stakes situations that often lead to pressured decision-making. This project's identified barriers to engaging in ACP are underscored by existing findings 1,11 which assert that a lack of training and familiarity with relevant materials compound the discomfort that nurses may feel about undertaking the practice. Documentation of ACP has also been found to be misaligned with the usual nursing workflow and is attributed to the scarcity of ACP notes.…”

Section: Discussionmentioning

confidence: 99%

“…Documentation of ACP has also been found to be misaligned with the usual nursing workflow and is attributed to the scarcity of ACP notes. 11 Clinical needs took precedence over writing ACP notes, which was perceived as a time-consuming task with low priority; nurses also believed that other team members did not read their notes. These concerns have been reflected in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Keeping in line with past efforts, this project suggests that incorporating ACP must first be addressed by informing nurses of their role and scope of practice. 1,4,5,11 A review by Chan et al identified that few studies measured how frequently ACP conversations were initiated after training programs 4 : this project has done so. Along these lines, Schichtel et al discovered that a limited body of work focuses on interventions for ACP uptake by HCPs 15 : this project helps fill that gap.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical needs took precedence over writing ACP notes, which was perceived as a time-consuming task with low priority; nurses also believed that other team members did not read their notes. These concerns have been reflected in other studies 4,11,12,15 . To this end, examples of deidentified ACP notes with some depicting physician responses to nurses’ ACP notes were posted to motivate the staff (Appendix XI, http://links.lww.com/IJEBH/A129).…”

Section: Discussionmentioning

confidence: 99%

“…Knowledge gaps revealed by the initial findings guided the project team to search for methods of ACP-focused education and narrow the topics that would be taught. 4,6,7,[11][12][13] Change strategies were developed in response to follow-up surveys using the GRiP matrix. 14 This facilitated the group process to explore barriers to best practices and to identify, develop, and implement strategies to increase compliance with audit criteria.…”

Section: Phase 2: Design and Implementation Of Strategies To Improve ...mentioning

confidence: 99%

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Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project

Garcia

Kim

Barbour

et al. 2023

JBI Evidence Implementation

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Introduction and objective: Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients’ preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses’ capacity to engage in ACP. Methods: This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability. Results: Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients’ treatment preferences. Conclusions: Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%