Palliative care on the intensive care unit

Exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit: a mixed methods study

“…EOL care in the ICU is substantially different from that in other settings, particularly in view of the fact that 90% of patients who die in ICU do so after a decision to limit treatment (Prendergast and Luce, 1997). Significant quality concerns related to EOL care in the critical care setting emerging from the literature have included: inadequate terminal symptom management (Connors et al , 1995; Puntillo et al , 2001), prolongation of the dying process through the use of overly aggressive treatment (Simmonds, 1996; Asch et al , 1997; Cosgrove et al , 2006) and the need for improved communication in relation to treatment decision‐making between patients, families and critical care providers (Lilly et al , 2000; Norton and Talerico, 2000; Norton and Bowers, 2001; Studdert et al , 2003; Carlet et al , 2004; Curtis, 2004; Boyle et al , 2005). EOL care in the ICU represents an appropriate and underdeveloped area for quality assessment and improvement (Mularski, 2006).…”

The critical care nurse's role in End‐of‐Life care: issues and challenges

“…According to Puntillo et al (2004), pain is one of the most prevalent symptoms in critical care as it is usually associated with procedures such as suctioning, turning, wound care and the presence of endotracheal tubes – procedures that patients dying in critical care are subjected to as nurses aim to keep them comfortable. The management of pain in dying critically ill patients may pose difficulties as the common pain assessment tools may be of little value in assessing the semi‐conscious patient's pain (Cosgrove et al , 2006). However, the use of behavioural pain assessment tools based on physiologic variables and behavioural observations, such as the Behavioral Pain Scale (Payeh et al , 2001) or the Critical‐Care Pain Observation Tool (Gelinas et al , 2006), may assist critical care nurses in objectively assessing dying patients' pain.…”

“…Other common symptoms for dying patients in critical care apart from pain include respiratory distress, nausea and increased respiratory tract secretions (Nelson et al , 2001; Cosgrove et al , 2006; Solano et al , 2006). Extensive literature exists with regards the pharmacological management of distressing symptoms and comfort care to guide health care professionals (Toscani et al , 2003; Cosgrove et al , 2006; Hugel et al , 2006; Truog et al , 2008). Despite the existence of a wide pharmacological range for the relief of symptoms at the end of life, critical care nurses are faced with limitations, such as prescribing and consequently delivering medication timely.…”

“…Strategies to support critical care nurses as they provide terminal care have to be considered by all critical care units. Cosgrove et al (2006) suggest formal or informal briefings as a strategy to cope with EoL situations. The briefings could take the format of clinical supervision which is regarded as an effective way to provide peer support and stress relief for nurses (Brunero and Stein‐Parbury, 2008).…”

Managing a good death in critical care: can health policy help?

“…There is substantial empirical and practice development literature originating from North America (Randall Curtis et al , 2001; Puntillo and McAdam, 2006); Australasia (Cassell, 2005); Europe (Valentin et al , 2007) and Asia (Singh, 2008). Interest in this area extends across medical specialities including emergency care (American College of Emergency Physicians, 2006), elderly care (Henderson, 2004) and palliative care (Cosgrove et al , 2006a). Additionally, EoLC has been reviewed using ethical (Cosgrove et al , 2006b) cultural (Carey and Cosgrove, 2006) and legal (Speker, 2006) frameworks.…”