title: Communicating with Patients' Families and Physicians About Prognosis and Goals of Care.
abstract: BACKGROUND
  Integrating palliative care into intensive care requires active involvement of bedside nurses in discussions of patients' prognosis and goals of care.
  
  
  OBJECTIVE
  To improve critical care nurses' skills and confidence to engage in discussions with patients' families and physicians about prognosis and goals of care by using a focused educational intervention.
  
  
  METHODS
  An 8-hour-long workshop was developed for critical care nurses. Key roles and skills of nurses in communication about prognosis and goals of care were defined. Participants practiced skills during facilitated role-plays. A reflection session addressed burnout, distress, and self-care. Participants completed surveys before, immediately after, and 3 months after their workshop, rating their confidence and skill in performing key tasks. Use of a participant focus group and open-response items in the surveys further elucidated the impact of the workshop.
  
  
  RESULTS
  Between March 2011 and April 2013, a total of 82 critical care nurses completed a workshop. Compared with before the workshop, after the workshop, nurses reported greater skill and confidence for 14 survey items (P < .001), including assessing families' understanding of prognosis and goals of care, addressing families' emotional needs, and contributing to family meetings. Increases were sustained 3 months after the workshop.
  
  
  CONCLUSIONS
  Defining roles and providing opportunities for skills practice and reflection can enhance nurses' confidence to engage in discussions about prognosis and goals of care.
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Milic
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Puntillo
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Turner
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Denah
authors.initials: D
authors.lastname: Joseph
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Natalie
authors.initials: N
authors.lastname: Peters
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Rio
authors.initials: R
authors.lastname: Ryan
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Cathy
authors.initials: C
authors.lastname: Schuster
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Holly
authors.initials: H
authors.lastname: Winfree
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco.
authors.forename: Jenica
authors.initials: J
authors.lastname: Cimino
authors.affiliation: Michelle M. Milic is an associate professor of pulmonary, critical care, and sleep medicine, MedStar Georgetown University Hospital, Washington, DC. Kathleen Puntillo is a professor emerita, Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California. Kathleen Turner, Cathy Schuster, and Holly Winfree are critical care bedside nurses and Denah Joseph is a chaplain and associate director of the palliative care program at University of California San Francisco Medical Center, San Francisco, California. Natalie Peters is a nurse practitioner in the interventional pulmonology service at Stanford Hospital and Clinics, Palo Alto, California. Rio Ryan is a critical care bedside nurse, University of California San Diego Medical Center, San Diego, California. Jenica Cimino is the coordinator for the IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) program, University of California San Francisco. Wendy G. Anderson is an attending physician in palliative care and an associate professor in hospital medicine and physiological nursing, University of California San Francisco. Wendy.Anderson@ucsf.edu.
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Anderson
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods*; D064648:Critical Care Nursing / Q000193:education*; D004493:Education; D017144:Focus Groups; D058015:Health Communication / Q000379:methods*; D006801:Humans; D009741:Nursing Staff, Hospital / Q000193:education; D010166:Palliative Care / Q000379:methods; D010347:Patient Care Planning; D019555:Physician-Nurse Relations; D011368:Professional-Family Relations; D011379:Prognosis; D012495:San Francisco; D013727:Terminal Care / Q000379:methods