Here is the PICO analysis for the twenty-fourth uploaded article (abstract):
✅ PICO Analysis
Full Article Title:
Leadership Collaborative Education Intervention to Enhance the Quality of End-of-Life Care in Nursing Homes: The IMPRESS Project
Type of Study:
Quality improvement intervention with pre–post design using self-reported measures
Journal and Year:
Poster Abstract, Journal of the American Medical Directors Association (JAMDA), 2010
Authors: Maung Tin, Gregory Gatchell, Yukako Tachibana, Jeannette Koijane, Kenneth Zeri, Christina Bell, Kamal Masaki, Aida Wen
P – Population
- Setting:
- 5 community nursing homes in Honolulu, Hawaii
- Participants:
- Nursing home leadership and senior clinical staff (n = 18)
- Including Directors of Nursing, charge nurses, social workers, and administrators
I – Intervention
- Program Name: IMPRESS (IMproving PRofessional Education and Sustaining Support)
- Design:
- 1-year leadership collaborative
- Quarterly educational sessions on evidence-based strategies for end-of-life (EOL) care
- Open discussion forums during each session to facilitate experience sharing and reflection
- Topics Covered:
- Advance directive discussions
- Policy and form reviews
- Communication with hospice and palliative care services
- EOL identification and respectful death facilitation
- Satisfaction survey integration
- Measurement:
- Pre- and post-session self-assessment on 8 EOL implementation practices (1–4 scale)
C – Comparison
- Comparator:
- Baseline self-reported ratings of EOL care practices by each participant prior to education sessions
- Post-intervention ratings used for within-subject pre–post comparisons
O – Outcomes
Quantitative Results (Statistically Significant Improvements):
- Identification of limited life expectancy: +1.25 (p < 0.0001)
- Advance directive discussions: +0.91 (p = 0.002)
- Reviewing policies and forms: +1.08 and +0.75 (p = 0.0006 and p = 0.002)
- Communication with physicians and nurses: +1.17 (p < 0.0001)
- Facilitating respectful death: +1.0 (p < 0.0001)
- Communication with hospice/palliative providers: +0.75 (p = 0.006)
- Inclusion of EOL questions in family/patient satisfaction surveys: +0.5 (p = 0.05)
Barriers Reduced After Intervention:
- Time constraints (initially cited by 50%)
- Knowledge deficits (33%)
- Competing priorities (25%)
Outcome Classification
- Person-centred outcomes: Indirect – aimed at enhancing respectful death, family communication, and satisfaction through system improvements
- Process outcomes: Strong evidence of increased staff readiness and system implementation of EOL care strategies
- Health system outcomes: Not directly measured, but likely positive implications for care quality, advance directive use, and reduced crisis transfers
Summary Conclusion
The IMPRESS project demonstrates that leadership-focused collaborative education significantly improves nursing home staff implementation of evidence-based end-of-life care practices. The intervention enhanced communication, policy review, and advance directive use across five facilities. Reported barriers—like lack of time and knowledge—were reduced post-intervention. While clinical outcomes were not measured, the program shows strong promise for system-wide culture change and quality improvement in EOL care delivery .
Life In The Slower Lane 
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