View
213
Download
1
Category
Preview:
Citation preview
To improve the quality of the dying experience for patients and their families
Overall Goal of The 3 Wishes Project
3 Specific Objectives
• For patients, to dignify their death and celebrate their life
• For family members, to humanize the dying process and create positive memories
• For ICU clinicians, to foster patient and family-centered care and inspire a deeper sense of our vocation
Rationale• this individualized approach to end of life
care acknowledges that the dying person and their family members are uniquely human
Design• mixed-methods demonstration project Setting• 21-bed closed university-affiliated medical-
surgical ICU
Premise of the 3 Wishes• Bringing a set of 3 wishes to fulfillment in
the hope of bringing peace to the final days or hours of a patient’s life
Wishes may be those of – the patient– their family members– ICU clinicians– 3 Wishes team
Inclusion Criteria1) Patients with >95% probability of dying during
the ICU stay
2) Decision made to withdraw or withhold advanced life support in anticipation of death
Exclusion Criteria1) Serious psychological, psychiatric or language
issue precluding engagement
2) Patient admitted to ICU for <12 hours
3) Patient or family declines
Mixed-Methods Design
QualitativeData
Family & Clinician
Interviews
Letters & Field Notes
Wish Interpretation
QuantitativeData
PatientDemographics
& Life Supports
Family &Clinician
Demographics
FamilyQEOL-10Survey
What is a Wish?
A wish is a Process…. And a Product• A means to recognize the patient• An example of dignity-conserving care• A tangible expression of empathy• An opportunity for reflection• A vehicle for inter-professional care• A manifestation of hope• A therapeutic connection• A transitional activity• An expression of spirituality• A secular prayer
Qualitative Results:Personalizing Dying in the ICU
DignifyingThe
Patient
Giving VoiceTo The Family
Calling ForthClinician
Compassion
Humanizingthe
Environment
Tributes
Rituals Paying ItForward
Connections
Humanizing the Environment
Tributes Connections Rituals Paying It Forward
Favourite music
Final toast Finding a lost relative
Movie night Hospital volunteer position
Using patient’s nickname or preferred name
Word cloud Skype reunion Renewal of wedding vows
Family & friend donations to 3 Wishes
Personal keepsakes in the room
Tea party Pet visitation Wedding Contribution to charity important to the patient
Flowers for the room
Birthday cake Hosting final supper
Firework display
Organ donation
A special collaboration
Spiritual CarePalliative CareCritical Care
Recommended