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Browsing by Author "Wocial, Lucia"
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Item Improving Patient-Health Care Provider End-of-Life Communication Using Improvisational Theater Techniques: Outcome of a Workshop(Office of the Vice Chancellor for Research, 2015-04-17) Tang, Chia-Chun; Wocial, LuciaBackground Communication plays a significant role in health care. While evidence showed the strong relationship between good communication and better patient outcomes including emotional health, symptom resolution, function, physiologic measures, pain control and adherence, miscommunication can results in medical errors, extra financial cost and negative attitude of health care providers. Health communication can be particular challenging in palliative care given the fact that palliative care is often link to poor prognosis, end of life and increased emotionally laden. Although more and more studies and programs were developed to teach health care providers communication skills, few of them provided interdisciplinary education despite the increasing emphasis of teamwork in health care. This project focuses on improving health care providers’ communication ability by using an innovative teaching method and emphasizing on teamwork through a 2-phase workshop. Method In the first phase, medical teams that have a goal to improve palliative and end of life care were recruited to a two part immersion workshop. Teams consisted of nurses, physicians and a chaplain, social worker or equivalent. During phase one of the workshop, these teams were exposed to a nationally-recognized lecturer and engaged in learning medical improv techniques. After 6 months, the teams were invited to complete a 2 day long update workshop including additional training using Vital Talk techniques and principles from Team STEPPs. Outcomes such as communication behavior, confidence and workshop evaluation were measured pre and post workshop. Results 14 participants included nurses, physicians, social workers and patient navigators completed the 2-phase workshop and outcome evaluation. The results showed that participants’ communication skills and confidence both improved. The self-identified weakest behavior and confidence improved the most compared to other types of behavior and confidence. In addition, this improvement is cross professions. In general, participants thought that the workshop was very valuable. Conclusion Both the workshop content and instructors received extremely positive feedback regarding interactive presentation, involvement, quality of scientific content and content appropriateness for target audience. This innovative workshop offered a promising way to teach health care providers how to communicate with terminal patients and enhance their confidence. More studies are needed to evaluate long-term and clinical outcomes.Item Nurse to Family Communication in Intensive Care Units(2024-05) Dees, Mandy Lynn; Carpenter, Janet; Levoy, Kristin; Longtin, Krista; Reising, Deanna; Wocial, LuciaNurse to family communication is a crucial aspect of high-quality care delivery in adult intensive care units (ICU). Adult ICU nurses hold a unique position to engage in meaningful communication with families, often being the most accessible healthcare team members to family. However, these nurses frequently express a sense of ineptitude in their nurse to family communication skills. Simultaneously, families often find themselves unprepared for these adult ICU interactions yet are regularly tasked with the responsibility of surrogate decision-making when patients are incapacitated. Despite the successful utilization of the COMFORT (Connect, Options, Making meaning, Family caregivers, Openings, Relating, and Team) communication intervention in other settings, its implementation in the adult ICU has not been realized. Exploring the perspectives of adult nurses and nurse leaders on the COMFORT intervention topics could enhance the success of its implementation and sustainability in clinical practice. The overall goal of this three-paper dissertation was to advance scientific knowledge about nurse to family communication in the adult ICU setting. An integrative review was conducted to systematically assess available research evidence on enhancing communication between adult ICU patients/families and nurses. Using qualitative focus group approach, the aims of the next two studies were to gather participants’ perspectives of the practicability, appeal, and relevance of each COMFORT communication intervention topics and strategies for its implementation among adult ICU nurse leaders (second paper) and ICU nurses (third paper). Results of these studies indicate the importance of nurse to family communication in adult ICU environments and nurse leaders’ and nurses’ enthusiasm for the implementation of the COMFORT intervention in the ICU setting. Recommendations emerging from the focus group interviews include providing adult ICU nurses dedicated time to complete training during work hours, allowing early adopters to use the COMFORT app before expanding it to the entire unit staff nurse population, making the app accessible on unit computers, providing training suitable for nurses at all experience levels (from early career to seasoned staff), adopting a phased approach to implementation, and offering education on the COMFORT topics in quick, digestible learning tools suitable for a fast-paced nursing unit.Item Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU(Springer, 2017-03) Wocial, Lucia; Ackerman, Veda; Leland, Brian; Benneyworth, Brian; Patel, Vinit; Tong, Yan; Nitu, Mara; School of NursingThis paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings (PEACE rounds) to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer (MDT) scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised (MDS-R), were lower for respondents in all categories (non-significant), and on three specific items (significant). Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS (4.94 control vs 3.37 PEACE, p = 0.015), a statistically significant increase in both code status changes DNR (11 % control, 28 % PEACE, p = 0.013), and in-hospital death (9 % control, 25 % PEACE, p = 0.015), with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients.