Abstract 379: Nursing Perspectives on Neuro-Prognostication for Post-Cardiac Arrest Patients and Their Integral Role in Supporting Surrogate Decision Makers

Introduction: Post cardiac arrest patients frequently rely on surrogate decision makers (SDM) for critical decisions during their hospitalization. Our prior research has shown that bedside nurses are key resources for SDMs. Nurses’ understanding of post-arrest guidelines is therefore crucial if post-arrest care is to be concordant with guidelines. Objective: To explore critical care nurses familiarity with neuroprognostic guidelines and learn how they support families with decision making in the ICU. Methods: This inductive qualitative study consists of interviews with critical care nurses at an urban academic hospital. Subjects were identified by reviewing the care team of recent cardiac arrest patients. Nurses were invited by email to participate. Using a standardized interview guide, one on one interviews were conducted, audio recorded, and transcribed. Transcripts were read in entirety and thematically coded by two investigators. Results: Seven critical care nurses participated in this study. The participants were predominately female (6/7), mean age 32.4 years and had worked in critical care nursing from 1 year to 16 years. The nurses interviewed were based in the medical (3), cardiac (2) and neuro (2) ICUs. Major themes identified were: 1) discussion regarding prognosis is a team approach; 2) interpretation of neuroprognostic guidelines by nurses is variable; 3) communicating uncertainty to families and setting expectations is challenging. Excerpts to support these themes are identified in the table. Conclusion: Nurses are critical stakeholders in supporting surrogate decision makers in their decision-making. Ensuring that they are supported in relaying similar messages as the physician team, provided with more information regarding neurologic prognostication and supported in how to communicate uncertainty/set expectations will assist nurses in the integral and unique roll they play at the bedside of the post-cardiac arrest patient.