TY - JOUR
T1 - Integrating palliative and critical care
T2 - Description of an intervention
AU - Treece, Patsy D.
AU - Engelberg, Ruth A.
AU - Shannon, Sarah E.
AU - Nielsen, Elizabeth L.
AU - Braungardt, Theresa
AU - Rubenfeld, Gordon D.
AU - Steinberg, Kenneth P.
AU - Curtis, J. Randall
N1 - Funding Information:
Supported, in part, by a grant from the Robert Wood Johnson Foundation and a grant from the National Institute of Nursing Research (RO1NR05226).
PY - 2006/11
Y1 - 2006/11
N2 - A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.
AB - A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.
KW - Critical care
KW - Death
KW - Dying
KW - End-of-life care
KW - Intensive care
KW - Palliative care
KW - Withdrawing life support
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U2 - 10.1097/01.CCM.0000237045.12925.09
DO - 10.1097/01.CCM.0000237045.12925.09
M3 - Article
C2 - 17057602
AN - SCOPUS:33750291178
SN - 0090-3493
VL - 34
SP - S380-S387
JO - Critical care medicine
JF - Critical care medicine
IS - 11 SUPPL.
ER -