Development and Feasibility of the Brief Care Preferences Conversation Framework

Advance care planning (ACP) is inconsistently implemented in emergency departments (EDs), where time constraints limit meaningful patient engagement. Reframing ACP as a holistic, relational nursing practice may enhance its integration into acute care. Guided by Watson's Theory of Human Caring, the Brief Care Preferences Conversation Framework (BCPCF) was developed as a theory-informed nursing intervention to facilitate value-centered, whole-person conversations in time-limited encounters. This study aimed to develop and evaluate the feasibility and clinical utility of the BCPCF in the ED. Development included literature review, expert consultation, and iterative pilot testing. Final evaluation used a practice innovation approach incorporating field observations, workflow assessment, and clinician feedback. The BCPCF supported structured yet flexible conversations integrating physical, psychosocial, and spiritual dimensions of care, with an average duration of 25.3 min and minimal workflow disruption. Beyond feasibility, it facilitated narrative expression, meaning-making, and identification of patient-defined quality-of-life priorities. Documentation met Centers for Medicare and Medicaid Services standards and informed clinical decision making. As a holistic nursing intervention, the BCPCF operationalizes caring science in acute care, supporting relational presence, meaning-centered communication, and whole-person care.