Registed Nurses' Association of Ontario

To Develop Expertise in Facilitating Advance Care Planning with Heart Failure Patients

Fissan Lau
UHN - Toronto General Hospital

The Advanced Clinical Practice Fellowship Program has provided me the opportunity to expand my knowledge and skill in advance care planning. I have learnt more about facilitators, barriers, challenges in the patient, provider and system level in facilitating advance care planning in the heart failure population through my literature review. I was able to be familiar with the legal and ethical aspects of advance care planning in Ontario. I also had the opportunities to shadow various healthcare practitioners to discuss end of life care planning and advance care planning in the heart failure population such as the congenital heart defect, heart failure team and the palliative team. These opportunities were usually missed during busy clinical hours, but it was extremely valuable to learn different communication strategies in these discussions. I appreciate the willingness of various healthcare providers to share their time, knowledge and expertise with me. Throughout the fellowship experience, my mentors would provide different opportunities for me to improve communication skills and my confidence in advance care planning conversations. In retrospect, I have realized that developing expertise is not an ideal goal as communication skill development is an ongoing journey. Therefore, I do not feel that I have reached my initial goal of being an expert at this point; I do plan to continue to improve my skill by incorporating my fellowship experience into my clinical practice and hope to be an expert in these discussions one day.

For the last part of the fellowship, my manager was able to provide the resource and the opportunity to allow me to facilitate two, four-hour pilot educational session with my primary mentor. I also had the opportunity to develop knowledge and skills related to all aspects of program planning and evaluation. I was able to adopt a similar communication skill training program that has been evaluated for effectiveness from my literature review. In each educational session, I have shared the summary of my literature review on advance care planning for heart failure patients and communication strategies that could be implemented easily onto our clinical practice. I was able to invite guest speakers for each session from my shadowing experience which nurses felt that they really benefited from. I was also able to incorporate different real case scenarios for everyone to practice. I have received positive feedback on written evaluation for the program from nurses; and the nurses also felt encouraged to promote advance care planning for their own families and friends as well. Through verbal and written evaluation, my fellow nurses also felt that I had facilitated the sessions well and they strongly encouraged me to do similar sessions with other nurses.

At the organizational level, I am able to sustain the learning through the educational session to all the nurses on the In-Patient Cardiology as they are now familiar with advance care planning and the tools we use at this organization and across Canada. We have developed recommendations as a team to encourage facilitation of advance care planning for all our cardiac patients. It is a priority for the unit. These recommendations are written in a separate document and have been reviewed by our unit manager.

At the personal level, I have become an advocate for advance care planning to all patients that are admitted to the floor. I will continue to promote advance care planning as part of standard of care at current practice setting. Overall, I have achieved all the clinical outcome indicators of my objectives from my learning plan. Most importantly, I have also experienced quality leadership skills that my manger and my mentors have demonstrated throughout this fellowship. They were motivated, enthusiastic and supportive of me to the entire fellowship process which allowed me to complete the fellowship successfully. Finally, I am grateful for RNAO and UHN as they have provided the capacity to allow me to peruse my professional interest in advance care planning. I strongly recommend that all nurses at point-of-care to apply!

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