Nurses have traditionally relied on five vital signs to assess their patients: temperature, pulse, blood pressure, respiratory rate and oxygen saturation. However, as patients hospitalised today are sicker than in the past, these vital signs may not be adequate to identify those who are clinically deteriorating. This paper describes clinical issues to consider when measuring vital signs as well as proposing additional assessments of pain, level of consciousness and urine output, as part of routine patient assessment.

AimTo synthesize qualitative studies of patients’ families’ experiences and perceptions of end‐of‐life care in the intensive care unit when life‐sustaining treatments are withdrawn.DesignQualitative meta‐synthesis.Data sourcesComprehensive search of 18 electronic databases for qualitative studies published between January 2005 ‐ February 2019.Review MethodMeta‐aggregation.ResultsThirteen studies met the inclusion criteria. A conceptual ‘Model of Preparedness’ was developed reflecting the elements of end‐of‐life care most valued by families: ‘End‐of‐life communication’; ‘Valued attributes of patient care’; ‘Preparing the family’; ‘Supporting the family’; and ‘Bereavement care’.ConclusionA family‐centred approach to end‐of‐life care that acknowledges the values and preferences of families in the intensive care unit is important. Families have unmet needs related to communication, support, and bereavement care. Effective communication and support are central to preparedness and if these care components are in place, families can be better equipped to manage the death, their sadness, loss, and grief. The findings suggest that health professionals may benefit from specialist end‐of‐life care education to support families and guide the establishment of preparedness.ImpactUnderstanding the role and characteristics of preparedness during end‐of‐life care will inform future practice in the intensive care unit and may improve family member satisfaction with care and recovery from loss. Nurses are optimally positioned to address the perceived shortfalls in end‐of‐life care. These findings have implications for health education, policies, and standards for end‐of‐life care in the intensive care unit.

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