Enhancing Goal-of-Care Conversations

Submitter Information

Author: Jared Bradshaw, RN
Title: Float Nurse
Institution: Bakersfield Memorial Hospital
Email: jaredcb15@gmail.com
Coauthors: n/a

Competency Category(s)
Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Teamwork and Collaboration

Learner Level(s)
Continuing Education, New Graduates/Transition to Practice, Staff Development

Learner Setting(s)
Classroom, Clinical Setting

Strategy Type
General Strategy

Learning Objectives

KNOWLEDGE: Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends. Transition and continuity and describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.
SKILLS: Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care; Communicate patient values, preferences and expressed needs to other members of health care team and Provide patient-centered care with sensitivity and respect for the diversity of human experience.
ATTITUDES: Value seeing health care situations “through patients’ eyes”; Respect and encourage individual expression of patient values, preferences, and expressed needs; Value the patient’s expertise with own health and symptoms and Seek learning opportunities with patients who represent all aspects of human diversity.

KNOWLEDGE: Examine common barriers to active involvement of patients in their own health care processes and Describe strategies to empower patients or families in all aspects of the health care process.
SKILLS: Remove barriers to presence of families and other designated surrogates based on patient preferences; Assess level of patient’s decisional conflict and provide access to resources and Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management.
ATTITUDES: Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care and Respect patient preferences for degree of active engagement in care process.

KNOWLEDGE: Discuss principles of effective communication and Examine nursing roles in assuring coordination, integration, and continuity of care.
SKILLS: Discuss principles of effective communication.
ATTITUDES: Value continuous improvement of own communication and conflict resolution skills.

Strategy Overview

This project was intended to rectify some of the confusion pertaining to topic of goals-of-care (GOC) conversations. It has been observed that many of these conversations take to long to be addressed by busy physicians. Many of the perceptions of this topic from nursing staff are fraught with misunderstanding. Though it has been proven that families typically develop more of a rapport with the bedside nurse, the prospect of engaging a family or patient in GOC conversations is a source of anxiety. Despite the lack of formal education, nurses have many resources they may draw on in the literature to support certain interventions regarding GOC. This algorithm and presentation are effectively a condensed set of tips and methods from similar current research on the topic. It is meant to be used as a guide to the bedside nurse who sees a patient that may meet criteria for GOC conversations. It is meant to expedite this element of patient care and improve standards of advocacy in nursing. In moving nursing practice forward in this way, these resources will hopefully bring to light the pitfalls of the current system for better education in nursing and better outcomes for patients. The presentation of these materials was done in several different settings over the course of 3 months. All of the attendees were in bedside, managerial and administrative positions throughout the hospital. Everyone in attendance was a registered nurse. Each cohort received the same lecture via PowerPoint presentation and verbal instruction from the presenter on the background and purpose of the algorithm for GOC conversations. The education touched on the importance of the topic, the current failures to address goals of care early in the end-of-life process, and the mechanics of the algorithm itself. Examples and case studies were provided in the verbal instruction of the algorithm and questions were answered from the participants.

Submitted Materials

Goals-of-care-conversation-QSEN-edit.pptx
algorthim-send-.docx
Likert-scale.docx

Additional Materials

Likert scale data may be provided upon request.

Evaluation Description

A 5 question Likert scale was given before and after the presentation to attain a baseline of understanding and see how individuals felt about key issues surround goals-of-care (GOC) conversations after. Raw data showed improvements in respondents who answered the questions about whether the individual felt that they [had] “the tools necessary to at least start a conversation about goals-of-care and end-of-life with a patient.” Teach back was also used on an individual basis throughout the presentation as those in attendance were invited to give examples and feedback.