Building Palliative Care Communication Skills for Registered Nurses

Registered Nurses (RNs) in critical care play a pivotal role in identification and management of palliative care needs, providing an essential link between patients, their families, and physicians. As nurses are the health care professionals who spend the most time at the bedside of hospitalized critically ill patients, they have a unique opportunity to elicit patient values, understand priorities and goals of care, and provide emotional support to patients and families during the challenge of critical illness.

A needs assessment at our facility was consistent with researchers' findings that many nurses report low confidence with these interpersonal skills and worry about how to effectively communicate their findings and concerns to other members of the health care team, particularly physicians. Lack of confidence in these skills puts patients at risk for suboptimal care, and increases stress and job dissatisfaction for nursing professionals.  Researchers have demonstrated that communication skills training for RNs produced measurable improvements in patients' symptom management and palliative care communication effectiveness between patients, families, and the health care team, yielding better outcomes for patients and reduced work stress for nurses.

The proposed project will provide expert mentoring and guidance for implementation of a previously published, evidence-based, multi-disciplinary communication workshop for critical and acute care nurses. Through the combination of didactic and role-playing sessions, nurses will gain the knowledge and skills to promote better patient outcomes, be more effective team members, and better manage the stresses of caring for seriously ill and dying patients. By offering a one-day workshop six times per calendar year, this project will faciliate a more rapid training of all critical care staff nurses, enabling a more consistent approach to palliative care throughout the critical care areas.

Further, the proposed program formalized a role for advanced practice nurses to coach and mentor staff in these skills. The use of a “train the trainer” model will facilitate embedding these enhanced skills in the target facility and throughout the military health system when trained personnel transfer to other facilities.

Critically ill and dying patients and their families depend on effective communication with ICU staff to meet their needs for both information and emotional support. Staff nurses can play a vital role in ensuring these needs are met, but require advanced communication skills to do so. Multi-disciplinary, focused communication skills training improves registered nurses’ ability to meet this patient need. Older patients in military ICUs is creating an acute need for nurses with expert palliative care communication skills.