Palliative and end-of-life care
Nurse-driven palliative care screening
Palliative care (PC) aims to improve quality of life for patients with a life-threatening illness, providing holistic patient-centered support along the continuum of the disease process. Although frequently implemented in critical care settings, integrating PC in the neuro ICU has been difficult to adopt in practice due to the uncertainty in prognostication of definitive outcomes and practice culture beliefs such as the self-fulfilling prophecy (Frontera, et al. Crit Care Med. 2015;43:1964; Rubin, et al. Curr Opin Crit Care. 2017;23:134; Knies, et al. Semin Neurol. 2016;36:631).
At our institution, a nursing education project was conducted to pilot nurse-driven PC screenings on admission to the neuro ICU. The project evaluated nurse comfort and knowledge with identifying and recommending PC consults. Pre- and post-intervention surveys revealed that education and introduction of a PC screening tool significantly increased nurse comfort and knowledge of PC eligibility.
PC in the neuro ICU can exist to contribute to successful outcomes in patient and family care. Within neurocritical care, incorporating PC is essential to provide extra support to patients and families (Frontera, et al. 2015).
For these reasons and data from the project, nurse-driven screening may encourage appropriate early PC consults. Patient-centered care is the ultimate goal in the management of our patients. Nurse-driven PC screening can help bring various unmet PC needs to the health-care team for opportunities that might not have been met or otherwise assessed. Consider implementing nurse-driven PC screening protocols at your institution to aid in collaborative and proactive interdisciplinary care.
Danielle McCamey, ACNP
Steering Committee Member