Purpose:

This session will demonstrate the impact of a CNS-led intervention to change the culture in a 55-bed cardiac surgical intensive care unit.

Significance:

The culture of the ICU is fraught with technology and the overwhelming goal of saving lives, with the underlying presumption that patients want everything done. Families are captivated by massive efforts to save their loved one, similar to the heroic dramas played out weekly on the television, where almost everyone lives. In reality, the burden to save a life at all costs is often too great. Complicating the situation is an unspoken taboo against even considering the possibility that a patient may not survive or will survive with devastating consequences inconsistent with his or her values and preferences.

Background/Design:

Bedside caregivers identified a need for clinically relevant information and skill building regarding their ability to cope with situations where patients' response to surgery was not as hoped.

Methods:

The CNS for the ICUs, the medical director, and a CNS with expertise in ethics collaborated to develop a 4-part series for nursing and medical staff to address the issues encountered in the ICU setting when surgical interventions did not produce the hoped-for results. The series offered an opportunity for practicing the skills needed to have a caring conversation with patients and families to assess their wishes when the plan and goals of care shift.

Findings:

This program will provide an overview of the development, implementation, and outcomes to date for this project, including examples of behavioral changes that altered patient trajectory at the end of life.

Conclusions:

Clinical Nurse Specialists are key figures in the development and implementation of change within their practice environment.

Implications for Practice:

Altering the "way things have always been done" in regards to patients, families, and their expressed or implied wishes is not as easy as updating a technical procedure. But, if a process must be improved to provide better care to populations, it is the CNS who has the innovative skills and passion to bring about the change.