Purpose:
This session will review the content of a CNS-led intervention in an ICU. This program will provide an overview of the content for this 4-part series, including suggestions for implementation in other organizations.
Significance:
The culture of the ICU is first and foremost about saving people's lives under challenging situations. The overwhelming presence of technology and the often miraculous recoveries we see are off set by those times when the burden of survival is more than some patients or families can bear. The culture of many ICUs include an unspoken taboo against 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:
Our 5 cardiac surgery ICUs with a worldwide referral base provide abundant opportunity for nurses to encounter challenging ethical patient care situations. 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. The series covered the topics of role definition, moral distress, and legal issues and offered an opportunity for practicing the skills needed to communicate with patients and families on these difficult topics.
Findings:
Attendance for the programs was less than anticipated; however, we have seen the beginnings of culture change as evidenced by how often the CNS is approached regarding involvement in end-of-life discussions and in physician orders regarding DNR details.
Conclusions:
Culture change is slow: one nurse, one patient at a time.
Implications for Practice:
Collaboration with physicians and colleagues with expertise in other areas can have a positive impact on changing the culture of a unit.