Advancing Compassionate, Patient/Family-Centered Care

Topic: Education

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I. Background and problem statement

Upon development of a collaborative practice model (CPM) to provide best practices for the delivery of bad news (DBN), oncology nurses reported feeling inadequately prepared to provide support that patients and families need when receiving bad news. This staff education program supported the patient during and after DBN, an essential component of a CPM. 

II. Goals and objectives

Provide staff communication skills for supporting patients during DBN.

Increase staff satisfaction and comfort in discussions when providing support to patients after DBN.

III. Setting

54 staff members working on 31-bed adult medical-oncology unit participated and included nurses, occupational and physical therapists, dietitians, social workers, and discharge planners.

IV. Model or program description

A 3-hour education program developed through collaboration between a palliative care physician and nursing staff.  Participants were provided communication skills to assist with DBN and responding to emotion. Patient and physician actors demonstrated a bad news conversation scenario. Participants learned how to be “present” for conversations by observing cognitive and affective elements of scenario.  Using simulated skills practice, participants engaged in follow-up conversations with patient. Time-outs allowed for discussion with facilitator and peers. Participants were given opportunities to try skills again.

V. Evaluation

Using pre-post education surveys modeled after work culture surveys, participants reported increases in physician-nurse collaboration and their ability to support patients during DBN (p p<0.05).

VI. Discussion

Simulated skills practice was a new modality for educating our nurses. While the education program was primarily designed for nursing staff, interdisciplinary team inclusion was requested because of their interactions with patients in the wake of DBN.  Initial grant funding provided actors and paid participant time away from work. Although funds for this level of support are no longer available, this successful program has been requested across the health system.  Thus, training staff educators to facilitate and “act the parts” are the biggest barriers to broader implementation.

Author

  • Lynn Bunch O'Neill, MD
  • Associate Professor & Associate Director, Emory Palliative Care Center
  • Atlanta VA Medical Center & Emory University SOM
  • 1185 The By Way
  • Atlanta, GA 30306
  • 919-699-0880

Co-authors

  • Deborah Allen, PhD, RN, CNS, FNP-BC, AOCNP
  • Pamela Bowman, BSN, RN, OCN

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