How well do intensive care nurses advocate for their patients?

In 2006, the Respecting Patient Choices Program, an advance care planning (ACP) program, implemented ACP into ICU at Austin Health. To establish a baseline, a pre-implementation survey assessed ICU nurse knowledge, confidence, personal experience and skills regarding ACP.

The questionnaire was based on a published survey of ICU nurses, and included 30 questions on their knowledge (10), attitude (7), professional experience (9) and confidence (4) in ACP. Staff demographics were also recorded.

Ninety five percent of staff felt it was important to know patient wishes when deciding medical treatment and 79% felt that health professionals should uphold patient’s wishes even if it conflicted with the health professionals’ own views and even if that decision may lead to death. Forty nine percent did not believe health professionals knew the wishes of their patients and only 35% believed that patients received the treatment that they would have wanted.

Less than 50% of staff had sufficient knowledge of the law regarding ACP. Although 39% of staff usually initiate end-oflife discussions with patients or their families, < 20% had any experience with advance care planning. Although 55% felt confident to advocate for patients, < 35% felt confident to facilitate ACP.

Although ICU nurses strongly defended patient autonomy and supported the role of ACP, they lacked the knowledge, experience and confidence to facilitate ACP.