Training Nurses for Interdisciplinary Communication
with Families in the Intensive Care Unit: An Intervention
Nina S. Krimshtein, M.D.,1Carol A. Luhrs, M.D.,2Kathleen A. Puntillo, R.N., DNSc, FAAN,3
Therese B. Cortez, M.S.N., N.P., ACHPN,2Elayne E. Livote, M.P.H., M.S., M.A.,4
Joan D. Penrod, Ph.D.,4and Judith E. Nelson, M.D., J.D.1
Background: Critical care nurse communication training has largely been limited to didactic materials, inter-
active training for nurse supervisors, or brief participatory learning programs within the context of compre-
hensive end-of-life care educational seminars. Preliminary evidence suggests that an interactive approach can
also be effective in communication skills training for intensive care unit (ICU) nurses.
Methods: We implemented a 1-day educational intervention in five acute care hospitals within Veterans In-
tegrated Service Network (VISN) 3 (New York-New Jersey region) of the Department of Veterans Affairs and
focused solely on communication skills and targeted specifically to nurses providing bedside care for critically ill
patients. A ‘‘learner centered’’ approach to skills training that has several integral components was employed.
Among these are: a cognitive, evidence-based foundation upon which to build new skills; a method such as role-
play that allows participants to practice newly learned skills; and an affective component, during which trainees
can freely discuss their impressions of the exercise or explore difficulties that may have been encountered. Before
and after the program we conducted a detailed assessment of participants’ self-rated communication skills and
of the techniques and materials we used.
Results and conclusions: Post-program responses documented significant improvement in self-evaluated skills
for each of the core tasks we assessed. Evidence suggests that communication with patients and families in the
ICU can be most effectively approached in an interdisciplinary way. For nurses to fully realize their potential for
optimal communication as members of the multidisciplinary team, they must be equipped with the necessary
skills. We believe this new program helps to expand the range of approaches for training nurses in essential
has come to represent a standard of quality care in the in-
tensive care unit (ICU).1Prior studies highlight the impor-
tance of collaborative care by physicians, nurses, and other
members of the health care team.2,3Such care has been shown
to improve patient outcomes as well as patient and family
satisfaction in the ICU.4-8To optimize effectiveness, commu-
nication with ICU families should include nurses as active
participants. Yet few interventions have been specifically
designed to educate ICU nurses in skills needed for this role.
imely and effective performance of an interdisci-
plinary meeting with the family of a critically ill patient
Critical care nurse communication training has largely
been limited to didactic materials, interactive training for
nurse supervisors, or brief participatory learning programs
within the context of comprehensive end-of-life care edu-
cational seminars.9-11For physicians at every level, skills
training programs have shown the importance of active
participation by learners, which is associated with im-
proved skill and increased retention of information.12-15
Preliminary evidence suggests that an interactive approach
can also be effective in communication skills training for
ICU nurses. However, to our knowledge, no previous
study has evaluated an intervention using this approach
specifically to train bedside nurses for participation in
1Mount Sinai School of Medicine, Division of Pulmonary and Critical Care, New York, New York.
2Department of Veterans Affairs–New York Harbor Healthcare System, Brooklyn, New York.
3University of California San Francisco, Department of Physiological Nursing, San Francisco, California.
4James J. Peters VA Medical Center, Bronx, New York.
Accepted July 18, 2011.
JOURNAL OF PALLIATIVE MEDICINE
Volume 14, Number 12, 2011
ª Mary Ann Liebert, Inc.
Example of representative case for group role-play
Mr. F. is a 57-year-old man who had a subarachnoid
hemorrhage due to a cerebral aneurysm; he underwent sur-
gical clipping 3 days ago. The neurosurgeon was satisfied
with the result and assured the spouse on the day of surgery
that her husband would soon be neurologically intact. He
was slowly regaining consciousness and opened his eyes by
the third postoperative day. On postoperative day 4, how-
ever, he developed vasospasm and lost consciousness. The
patient’s wife is angry. She thinks that all the doctors lied
about her husband’s condition and that they continue to
conceal the truth. She is convinced that her husband’s dete-
rioration is due to improper care. The nurse informs the
physician of the wife’s position, noting that the wife is
threatening litigation. The physician and nurse then meet
with Mr. F.’s wife.
1332 KRIMSHTEIN ET AL.