Date of Graduation

Summer 8-8-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Dr. Liesel Buchner

Abstract

Abstract

Problem: Critically ill patients in the intensive care unit (ICU) frequently experience unmet palliative care needs due to inconsistent identification processes and delayed goals‑of‑care (GOC) discussions. Prior to this project, palliative care consultation practices were highly variable and lacked standardized criteria, resulting in missed opportunities for early communication and symptom management. This gap underscored the need for a structured, nurse‑driven approach to improve timely palliative care integration.

Context: This quality improvement project was conducted in a 20‑bed adult ICU within a large community‑based hospital system where palliative care integration was inconsistent and not systematically monitored.

Interventions: A nurse‑driven palliative screening protocol using the validated “Surprise Question” was implemented to identify high‑risk patients at ICU admission and prompt early GOC discussions and palliative care consultation.

Measures: Outcome measures included the proportion of eligible patients receiving palliative care consultation within 48 hours of admission. The project goal was to increase early palliative care consultations from 0% to 25% and achieve ≥80% screening completion within 48 hours. Process measures included screening completion rates and documentation of goals‑of‑care discussions. A balancing measure—ICU readmission rates—was monitored to ensure that earlier palliative involvement did not negatively affect patient stability or discharge planning.

Results: Following implementation, the nurse‑driven protocol was not successful despite multiple Plan–Do–Study–Act (PDSA) cycles. Pre‑intervention surveys revealed that most ICU nurses were uncomfortable discussing death or initiating GOC conversations. Education delivered through staff meetings did not sufficiently increase comfort or buy‑in, and screening completion remained low. However, inviting palliative care team members to daily multidisciplinary rounds improved collaboration and understanding of patient needs.

Conclusions: The nurse‑driven protocol was not feasible without foundational staff education and cultural readiness. A formal ELNEC‑based educational program will be implemented to build staff confidence in initiating GOC conversations, with anticipated long‑term benefits including reduced ICU length of stay, fewer ICU upgrade transfers, and improved patient and family engagement in decision‑making.

Keywords: palliative care, intensive care unit, goals of care, nurse‑driven protocols, quality improvement

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