| Popis: |
An increasing number of deaths in the United States are taking place in post-acute and skilled nursing facilities (SNF) and the trend is expected to continue. Demand for higher quality care at the end-of-life (EoL) calls for improvements in bedside nursing related to palliative care (PC) including advance care planning (ACP). In the state of California, a centerpiece of ACP is the completion of the Physician’s Orders for LifeSustaining Treatment (POLST) form. The purpose of the project was to improve ACP activities in a large post-acute care facility located in Southern California. The aims were (1) to describe the current state of ACP practices, (2) to develop and implement a PC-centered training program for licensed and non-licensed nurses, and (3) to evaluate the effectiveness of the intervention on ACP. The project employed an observational pre-posttest design. Nurses (licensed and non-licensed) were provided a class on PC concepts including EoL care and documentation. A tool modified from the literature measured PC and ACP knowledge, skills and attitudes (KSA) of nurses (28 items, Likert scale, range 1-5). Pre-postintervention chart audits evaluated POLST completeness. POLST forms from patient’s charts (n = 60), licensed registered nurses (n = 10), licensed vocational nurses (n = 26), and non-licensed clinical nursing assistants (n = 50) comprised the sample for this project. Post-intervention chart audits for POLST completeness increased from 52% to 62% (a 10-percentage point increase). Licensed nurses and unlicensed CNA’s post-test mean scores on PC knowledge, skills and attitudes improved (mean 3.71 [SD .43] to mean 4.17 [SD .49], mean 3.76 [SD .65] to mean 3.90 iv [SD .70], respectively). In addition, aggregated post-test scores for both groups improved (3.74 [1-5, SD .57] to 4.02 [1-5, SD .63], t- = 5.63, p = < .001). Twenty-two percent (n = 19) of the participants showed marginal KSA decrements (range differences -1.11 to - 0.04). Implementation of PC-based trainings improves nursing KSA related to palliative and EoL care across nursing levels. PC trainings may improve completeness of POLST documentation. The decrements in KSA scores suggest that trainings may sensitize nurses to challenges in providing palliative and EoL care. This project demonstrates the feasibility of implementing a facility wide PC educational program to a population who frequently lack access to evidence-based PC and EoL information. |
