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

• Published in: JBI evidence implementation
• Main Authors: Garcia, Philip, Kim, Hannah Jang, Barbour, Susan, Cooper, Adam
• Format: Journal Article
• Language: English
• Published: United States 01.12.2023
• ISSN: 2691-3321
• DOI: 10.1097/XEB.0000000000000373

Advance care planning (ACP) communication and documentation are often inadequate, leading to care 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 was to increase nurses' capacity to engage in ACP. 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 promote incorporation of ACP into nursing workflow. Eight audit criteria were created based on an 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. 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 twelve ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences. Development of an integrative nursing education plan for ACP empowers nurses to engage 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.