Training Nurses for Interdisciplinary Communication with Families in the Intensive Care Unit: An Intervention

Abstract

Background: Critical care nurse communication training has largely been limited to didactic materials, interactive training for nurse supervisors, or brief participatory learning programs within the context of comprehensive end-of-life care educational seminars. Preliminary evidence suggests that an interactive approach can also be effective in communication skills training for intensive care unit (ICU) nurses. Methods: We implemented a 1-day educational intervention in five acute care hospitals within Veterans Integrated Service Network (VISN) 3 (New York-New Jersey region) of the Department of Veterans Affairs and focused solely on communication skills and targeted specifically to nurses providing bedside care for critically ill patients. A ''learner centered'' approach to skills training that has several integral components was employed. Among these are: a cognitive, evidence-based foundation upon which to build new skills; a method such as roleplay that allows participants to practice newly learned skills; and an affective component, during which trainees can freely discuss their impressions of the exercise or explore difficulties that may have been encountered. Before and after the program we conducted a detailed assessment of participants' self-rated communication skills and of the techniques and materials we used. Results and conclusions: Post-program responses documented significant improvement in self-evaluated skills for each of the core tasks we assessed. Evidence suggests that communication with patients and families in the ICU can be most effectively approached in an interdisciplinary way. For nurses to fully realize their potential for optimal communication as members of the multidisciplinary team, they must be equipped with the necessary skills. We believe this new program helps to expand the range of approaches for training nurses in essential communication skills.

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

“…Our program, IMPACT-ICU, was designed to address identified barriers to integration of palliative care into the ICU and to increase bedside nurses' engagement in palliative care. 3,17,18,21,[25][26][27][28][29] A combination of learner-centered communication training workshops and bedside coaching rounds led by advanced practice palliative care nurses and nurse educators helped bedside nurses to feel more skilled to engage in palliative care communication, as well as to be more involved in identifying and addressing palliative care needs.…”

“…26 We organized factors found in previous work to influence bedside nurses' involvement in palliative care 17,18,21,25,[27][28][29] on the basis of whether they predisposed, enabled, or reinforced bedside nurses to perform daily palliative care assessments and develop plans to address identified needs (Table 1). An overview of the initiative follows.…”

“…30 This program began with an in-person 3-day training session, the length and content of which were informed by prior experience of the coordinating center in training faculty to facilitate use of role playing in communication skills training. [31][32][33] In the 3-day session, the leaders learned skills training theories and processes, 21,25,[31][32][33] observed a communication workshop for bedside nurses conducted by the coordinating center faculty, and practiced role-play facilitation under the direction of the coordinating center faculty. After returning to their centers, the nurse leaders assembled local leadership teams at Predisposing: stages of precontemplation and contemplation www.ajcconline.org their site, which included bedside and advance practice nurses, managers, educators, social workers, chaplains, and physicians who assisted them in implementing the initiative.…”

“…The survey was based on instruments developed for our needs assessment 18 and ICU nurse communication trainings. 21,25 Next was a survey designed by the authors that nurse leaders (n = 8) completed before and after the 3-day train-thetrainer session and at the end of the 2-year training, rating on Likert-type scales their skill level in key elements of small-group facilitation and role-playing for communication skills training. 33 Last, records were kept of the coaching rounds in the ICUs (1110 patients, Appendix 1), including information from patients' medical records about hospital length of stay, whether palliative care was consulted, and discharge disposition.…”

“…Our program, IMPACT-ICU, was designed to address identified barriers to integration of palliative care into the ICU and to increase bedside nurses' engagement in palliative care. 3,17,18,21,[25][26][27][28][29] A combination of learner-centered communication training workshops and bedside coaching rounds led by advanced practice palliative care nurses and nurse educators helped bedside nurses to feel more skilled to engage in palliative care communication, as well as to be more involved in identifying and addressing palliative care needs.The initiative was focused on nurses, to address the gap between their actual and potential involvement in palliative care communication. [15][16][17][18][19]21,24 Our findings indicate that IMPACT-ICU prepared nurses As a result of the training received through the IMPACT-ICU program, a nurse in one of our ICUs facilitated a family meeting that allowed a patient to make a decision to go home instead of continuing therapy in the ICU.…”