Date of Conferral

2023

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Mary Catherine Garner

Abstract

Over the last decade, patients who remain critically ill but in the chronic stage have become a subset of patients who often remain in the cardiac intensive care unit (CICU) for many months. Palliative care in the ICU has an important role and is well recognized by various studies to alleviate physical symptoms due to invasive treatments, to set patient-centered goals of care, and to provide end-of-life care. This acute care facility does not have guidelines for clinicians to use when introducing and managing palliative care for terminal heart failure patients during long term stays in the ICU. The clinical practice question is: Will an interprofessional team reach agreement on the guidelines for introducing and managing palliative care for terminally ill heart failure patients. The synergy model for patient care was the theoretical framework used to guide the literature review and first draft of the guideline. An interprofessional team used the modified delphi model to review and revise the guidelines. Once consensus was reached, the AGREE II tool demonstrated agreement in all seven domains. The clinical practice guideline empowers any member of the clinical team to initiate palliative care discussions and formally consult palliative care experts. Daily multidisciplinary rounds occur in this unit. If the patient meets the clinical criteria, the team can follow the algorithm in the guideline to support the involvement of palliative care providers. Empowering nurses to initiate this process allows the professional to practice to the extent of their education and experience. The introduction of a palliative care clinical practice guideline in the cardiac surgery ICU can improve the quality of life for patients and support family members in end-of-life care.

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