| Description |
In oncology intensive care units (ICUs), patients are critically ill and often face pain and suffering from their cancer diagnosis or treatments. Patient deaths in the oncology-ICU can be emotionally distressing for patients, families, and clinicians. Oncology nurses frequently experience compassion fatigue, burnout, and secondary traumatic stress, leading to attrition from oncology settings. The 3 Wishes Project (3WP) is a palliative care initiative where clinicians explore and implement the final wishes for dying critically ill patients. The 3WP aims to dignify death, celebrate the patient's life, and facilitate patient-centered end-of-life care. Local Problem: A local 16-bed oncology ICU includes patients, families, and caregivers who frequently encounter death without the additional resources of the 3WP. Methods: This Doctor of Nursing Practice (DNP) project examined and modified a recently adopted 3WP and implemented this system at the Huntsman Cancer Hospital's ICU (HICU). Project measures included pre- and post-REDCap surveys and HICU Mortality data to evaluate end-of-life (EOL) care in the HICU and the usability, feasibility, and accessibility of the 3WP and the educational toolkit. Analyses included descriptive and change statistics, including the Mann-Whitney U. Interventions: The first steps of this project included evaluating the current practices of EOL care in a local Medical ICU that adopted the 3WP to determine the usability and accessibility of the current 3WP education toolkit and identify opportunities for improvement. Phase two used the data to develop a plan to sustainably expand the 3WP into the oncology ICU by increasing the accessibility and feasibility of the educational toolkit, modifying the content for unit-based needs, utilizing ‘nurse champions,' and offering continued education. The final phases of the project included implementing it in the oncology unit and evaluating project outcomes. Results: Eleven patients received the program during implementation, with participants fulfilling forty-nine wishes. Sixty-five healthcare workers completed the pre-survey, and fifty- two completed the post-survey. Measures that suggested a statistically significant increase (p <0.01) in the post-survey participant responses related to their perceptions of the end-of-life care provided, end-of-life services offered, inter-professional EOL care communication, and prognosis discussion by the ICU team. Additionally, 61% (n=32) of respondents felt the 3WP increased professional morale, and 100% (n=52) respondents found the 3WP valuable to patients and families. Over half of the respondents found the educational materials useful and easy to navigate. Conclusion: These DNP project findings suggested that the 3WP created a system and structure to enhance the end-of-life care provided to patients in a local oncology ICU. Through promoting interdisciplinary communication, honoring the patient and family, and personalizing end-of-life care, this program can decrease clinicians' vocational distress and enhance patient and family experience, even at the end of life. Further expansion of the 3WP to the ICU cluster or acute care units within the local health system could expand the impact of this project on patients, families, and clinicians. |
