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Development, implementation and evaluation of an intervention

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Diane Guay
added 2 research items
Background Despite considerable collective improvement efforts and clinical initiatives to integrate palliative and end-of-life care the intensive care unit (ICU), few patients are currently receiving palliative care in this particular setting as promoted by the World health organisation (WHO). Aim Our first study showed that three conditions promote the integration of palliative care in the ICU: sharing a common vision, a concerted decision-making process and a proper environment. In light of these findings, we developed, implemented and evaluated an intervention integrating these previously identified conditions. The purpose of this communication is to present our research process and its main results. Method and discussion An action research design was chosen for this study because this method is highly collaborative, values consensual decision-making process and provides an organisational structure allowing success and sustainability. Results The first phase of this study led to the development of a two component communication intervention: an interactive educational workshop and an interdisciplinary component, making the entire team and the patient active participant in the decision making. This intervention was implemented in the ICU and evaluated with a constructivist approach through a pilot-case study which offered an operational illustration of palliative care in the ICU through an integrative model. Conclusions This study clearly demonstrates that changing the culture of the ICU is a collective endeavour that could be empowered by action research process. Early proactive interdisciplinary rounds and regular patient-family meeting, improves successful goal-directed care, quality end-of-life care and satisfaction.
Introduction: Although the ultimate goal of the intensive care unit (ICU) is to save and prolong human life, the integration of palliative care approach in this fast-paced highly technologic environment is increasingly recognized as a means of restoring the global nature of care and enhances the integrity of the person. In this perspective, a recent study showed that three conditions promote the integration of palliative care in the ICU: sharing a common vision, a collaborative decision-making process and a proper environment.Objective: In light of these findings, this study proposes to develop, implement and evaluate an intervention to integrate these previously identified conditions. The purpose of this communication is to present our approach and its main results.Method: Based on the premise that research and action can coexist to improve practice, a qualitative inquiry of action research was chosen for this study. Valuing the consensual decision-making process, this research method provides an organizational structure allowing success and sustainability of this intervention.Results: The intervention aims to improve the quality of interdisciplinary communication and consisted of two main components. The first propose to enhance the skills and leadership of nurses through interactive training and the second focused on the improvement of intra and inter disciplinary intervention plan.Conclusions: The integration of the palliative care approach in the ICU is definitely an innovative strategy to transform the mission of the ICU caregivers and improve the care of the whole person.