摘要
Purpose: The purpose of this Doctor of Nursing Practice project is to increase emergency room nurses’ personal initiative to engage in EOLC discussions by utilizing the PREPARED CPG.
Background: While it is the duty of healthcare practitioners (HCP) to initiate end-of-life care (EOLC) discussions with their patients, less than one-third report receiving education in such discussions, and 46% report frequently being unsure of what to say in such discussions. Over 25% of Medicare costs occur in the last year of the patient’s life, attributable to multiple hospitalizations and medically futile, costly interventions being performed. Approximately 75% of Americans do not have an Advance Directive in place. HCP need the tools and support necessary to confidently engage in proactive discussions about EOLC with their patients, ultimately avoiding costly and unwarranted medical interventions.
Methods: A quantitative descriptive design was used to assess current personal practice of participants and factors associated with their use of the PREPARED CPG to facilitate EOLC discussions. Thirty emergency department (ED) nurses were educated on the CPG and completed a demographic survey, pre-education survey, and post-education survey. To be considered for inclusion ED nurses had to: (a) be core staff, (b) not in management or administration, and (c) consent. Exclusions included travel, float, and charge nurses. All aspects of project preparation and implementation were aligned with the Joanna Briggs Institute Model of Evidence-based Healthcare.
Results: Most participants reported that they “sometimes” educate their patients/families on the difference between “full code” status and “DNR” (n=12, 40%). The most frequently reported reason participants did not engage in EOLC discussions was difficulty with the patient’s family (n=14, 46.7%). Nearly all participants found the PREPARED acronym easy to understand and practical for use in the ED (93.3% and 76.7%, respectively). Most respondents stated they will use this information in their practice and reported a degree of increased confidence to engage in EOLC discussions (93.3% each).
Conclusion: Results may be used to identify the need for EOLC discussion education and protocols in healthcare facilities. Feedback elicited may help to identify areas of interest for future research.
摘要译文
目的：该护理实践医生项目的目的是通过利用预备CPG来增加急诊室护士个人参与EOLC的主动性。背景：虽然医疗从业者（HCP）有责任启动—与其患者进行的生活护理（EOLC）讨论中，只有不到三分之一的人报告接受了这种讨论，而46％的人报告经常不确定在这些讨论中该怎么说。超过25％的医疗保险费用发生在患者生命的最后一年，这归因于多次住院以及医疗上徒劳的，昂贵的干预措施。约有75％的美国人没有执行预先医疗指示。 HCP需要必要的工具和支持，以自信地与患者进行积极的关于EOLC的讨论，最终避免进行昂贵且不必要的医疗干预。方法：采用定量描述性设计来评估参与者的当前个人做法以及与他们使用EOLC相关的因素准备CPG以促进EOLC讨论。对30名急诊科（ED）护士进行了CPG教育，并完成了人口统计调查，教育前调查和教育后调查。要考虑纳入急诊室护士，必须：（a）是核心人员，（b）不在管理或行政部门，并且（c）同意。不包括旅行，流动护士和主管护士。项目准备和实施的所有方面均与Joanna Briggs研究所的循证医学模型相一致。结果：大多数参与者报告说，他们“有时”对患者/家庭进行“完整代码”状态与“ DNR”之间的区别教育（ n = 12，40％）。参与者不参与EOLC讨论的最常报告的原因是患者家庭的困难（n = 14，46.7％）。几乎所有参与者都发现PREPARED首字母缩略词易于理解并且在ED中实用（分别为93.3％和76.7％）。大多数受访者表示，他们将在实践中使用此信息，并报告他们对参与EOLC讨论的信心有所提高（每个人93.3％）。结论：结果可用于确定对医疗机构进行EOLC讨论教育和方案的需求。所获得的反馈意见可能有助于确定未来研究感兴趣的领域。
Taylor, Kaitlyn Elizabeth. Facilitating End-of-life Care Discussions in the Emergency Department[D]. US: The University of Arizona, 2019