Publisher
The University of Arizona.Rights
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.Abstract
Purpose: The purpose of this quality improvement (QI) project was to ascertain ifimplementation of a checklist could increase the registered nurse’s (RN) confidence, competence, and performance satisfaction with patients transitioning to comfort measures only (CMO) by standardizing their care. Background: Intensive care unit (ICU) nurses must possess a vast knowledge base of patient care. When life-sustaining treatments are no longer effective or aligned with patients’ wishes, patients can be transitioned to CMO care. Nurses carry out orders and actions to achieve the philosophical shift from interventions aimed at resuscitating life to care that enables comfort for the patient with medication, respiratory adjustments, and physical adjustments such as positioning. Discordant care surrounding CMO transitions can negatively impact a nurse’s confidence, competence, and performance satisfaction. Methods: The CMO time-out with a checklist consisted of an educational session followed by a presurvey and a postsurvey design. Participants were ICU RNs working in southern Arizona. The presurvey asked demographic questions, five Likert style questions, one T/F, and three select all that apply questions. The postsurvey asked those same questions with four added Likert style questions. Results: Three presurveys and postsurveys were completed. The mean experience level was 6.9 years, and all patients took care of >six CMO patients in the past year. The five presurvey Likert questions showed neutral responses in three of the five domains including the nurse’s inclusion in conversations that lead to CMO transitions, their confidence managing CMO transition of care, and previous suboptimal CMO experiences. One domain showed the CMO order set lacked 10 clarity and usability. Another reflected a checklist to standardize the CMO transition would behelpful. The presurvey mean, 20.3, postsurvey mean, 21.7, with a standard deviation of 0.98 indicates nominal but not categorical change in score. Conclusions: The CMO time-out with a checklist neither increased or decreased nurses’ confidence, competence, and performance. However, participants revealed barriers, difficulties with the CMO order set, and ineffectively managed symptoms with CMO care.Type
textElectronic Dissertation
Degree Name
D.N.P.Degree Level
doctoralDegree Program
Graduate CollegeNursing