Izumi Shigeko, Burt Malinda, Smith Jennifer, McCord Keren, Fromme Erik K
Oregon Health and Science University.
Dana Farber Cancer Institute.
Oncol Nurs Forum. 2019 May 1;46(3):288-297. doi: 10.1188/19.ONF.288-297.
To describe the impact of advance care planning (ACP) education on nurses' confidence in ACP knowledge and practice and to identify barriers to facilitate ACP conversation in a bone marrow transplantation unit.
SAMPLE & SETTING: 60 nurses working in the bone marrow transplant unit at Oregon Health and Science University, an academic medical center.
METHODS & VARIABLES: The aim of this quality improvement project was to increase ACP conversations by nurses. The authors used a single-group pre-/post-test design to assess the effectiveness of a 30-minute educational intervention in changing nurses' confidence and practice. Group interviews were conducted to identify barriers to ACP.
The educational intervention increased nurses' confidence in knowledge about ACP. The number of nurses who discussed ACP with patients also increased, but it was not statistically significant. Lack of time, inefficient workflow, and concerns about questioning providers' understanding of patient preferences were identified as barriers for nurses engaging in and documenting ACP conversations.
In addition to appropriate education, strategies that help tailor ACP practice to fit into nurse workflow and promote collaboration with other healthcare team members are needed to change nurses' ACP practice.
描述预先护理计划（ACP）教育对护士在ACP知识和实践方面信心的影响，并确定在骨髓移植病房促进ACP沟通的障碍。
俄勒冈健康与科学大学（一所学术医疗中心）骨髓移植病房的60名护士。
这个质量改进项目的目的是增加护士进行的ACP沟通。作者采用单组前后测试设计，以评估30分钟教育干预在改变护士信心和实践方面的有效性。进行小组访谈以确定ACP的障碍。
教育干预增强了护士对ACP知识的信心。与患者讨论ACP的护士人数也有所增加，但无统计学意义。时间不足、工作流程效率低下以及对质疑医生对患者偏好的理解的担忧，被确定为护士参与和记录ACP沟通的障碍。
除了适当的教育外，还需要采取有助于使ACP实践适应护士工作流程并促进与其他医疗团队成员协作的策略，以改变护士的ACP实践。
