Development and Feasibility of the Brief Care Preferences Conversation Framework

Area of Science:

• Nursing Science
• Healthcare Delivery
• Bioethics

Background:

• Advance care planning (ACP) implementation is inconsistent in emergency departments (EDs) due to time constraints.
• Reframing ACP as a holistic nursing practice may improve integration into acute care.
• Existing ACP methods often fail to engage patients meaningfully in time-limited ED settings.

Purpose of the Study:

• To develop and evaluate the feasibility and clinical utility of the Brief Care Preferences Conversation Framework (BCPCF) in the ED.
• To operationalize Watson's Theory of Human Caring within an acute care nursing intervention.
• To facilitate value-centered, whole-person conversations during time-limited patient encounters.

Main Methods:

• The BCPCF was developed through literature review, expert consultation, and iterative pilot testing.
• A practice innovation approach was used for final evaluation, including field observations and clinician feedback.
• The intervention involved structured yet flexible conversations integrating physical, psychosocial, and spiritual care dimensions.

Main Results:

• The BCPCF demonstrated feasibility in the ED, with an average conversation duration of 25.3 minutes and minimal workflow disruption.
• The framework facilitated patient narrative expression, meaning-making, and identification of quality-of-life priorities.
• Documentation using the BCPCF met regulatory standards and informed clinical decision-making.

Conclusions:

• The BCPCF is a feasible and clinically useful nursing intervention for advance care planning in the ED.
• This theory-informed framework operationalizes caring science, promoting relational presence and whole-person care.
• The BCPCF supports meaningful patient engagement and value-centered communication in acute care settings.