Promoting Patient Preferences Through Nurse-prompted Elicitation of Daily Goals

Background: There currently exists a number of protocols and best practice guidelines that emphasize the importance of engaging patients to identify their preferences and to establish goals of care in order to improve both the patient experience and physical care. However, there are often gaps between patient and provider perceptions, as well as a lack of initiating crucial patient-centered conversations.
Purpose: The purpose of this project was to measure the effect of nurse prompts on elicitation and documentation of patients’ daily goals of care and patients’ perception, or satisfaction with, patient centered care. This project seeks to answer the following: does a nurse-prompted daily goals of care assessment improve documentation of goals, impact patient perception of care and impact nurses’ satisfaction and perceived barriers to prompting goals?
Methods: A study of the outcomes of nurse prompts to elicit patient goals and promote patient centered care was performed. Nurses on an acute cardiology unit received information regarding the implementation of nurse prompts to elicit patient goals. This intervention consisted of a brief introduction to nurse prompts at a monthly nursing meeting, a PowerPoint emailed to staff, and follow-up one-on-one reminder for nursing staff. Whiteboards were audited before and after the intervention, to compare how often patient goals were recorded. Patients were given a five question Likert survey in before and after groups to ascertain whether staff addressed patient goals and whether they were meaningful to the patients. A Likert survey was distributed to nurses to determine their satisfaction with goal prompts as well as perceived barriers.
Results: Observed whiteboard documentation of patient daily goals increased from 26.0% to 68.4%. Chi-square analysis showed a statistically significant increase in whiteboard goal documentation (p<0.001). Patient survey data was analyzed with independent t-test and showed significant increases in three questions. “How accurately did the whiteboard reflect your personal goal for this hospital stay” increased from a mean score of 3.24 to 4.53 (p<0.001). “How do you feel staff addressed your daily goals” increased from a mean score of 4.16 to 4.71 (p=0.008). “How do you feel the nurse collaborated with you concerning daily goals” increased from a mean score of 4.20 to 4.76 (p=0.008). Nurse surveys reported degree of satisfaction with prompting daily goals with a mean score of 3.57 (SD 0.738), likeliness to prompt goals with a mean score of 3.60 (SD 0.843), and reported willingness to continue to ask patients about their daily goals in the future with a mean score of 3.90 (SD 0.876).
Conclusion: This improvement project displayed an increase in whiteboard documentation and patient perceptions of accurate goal reflection, staff addressing goals, and nurse collaboration regarding daily goals. Nurses rated prompting of patient goals, with a survey range of 1 (low satisfaction) to 5 (high satisfaction) in the moderate range, which provides room for continued improvement and education regarding goal communication in the hospital. This quality improvement project lays the groundwork for future studies and investigations related to eliciting patient preferences and setting patient goals.