Palliative Care in the Intensive Care Unit

2018 ◽  
Author(s):  
Margaret L. Isaac ◽  
J. Randall Curtis
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Information Quality ◽  
Life Support ◽  
Symptom Assessment ◽  
Care Needs ◽  
Prognostic Information ◽  
Screening Criteria ◽  
Palliative Care Needs

Palliative care is increasingly recognized as an important component of care for all critically ill patients and should include both improving the primary palliative care skills of all clinicians working in the intensive care unit (ICU) as well as incorporating palliative care specialists for patients and families with unmet palliative care needs. This chapter highlights the key issues related to palliative care in ICU and evidence-based strategies to manage these issues. Topics covered include screening criteria to help identify patients with a high likelihood of unmet palliative care needs, withdrawal of life support (checklist and communication), providing prognostic information, quality indicators for end-of-life care in the ICU, and symptom assessment and management in the ICU.

scholarly journals Clinical Care Conditions and Needs of Palliative Care Patients from Five Italian Regions: Preliminary Data of the DEMETRA Project

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 221 ◽  
Author(s):  
Gianlorenzo Scaccabarozzi ◽  
Emanuele Amodio ◽  
Luca Riva ◽  
Oscar Corli ◽  
Marco Maltoni ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Care ◽  
Symptom Assessment ◽  
Assessment System ◽  
Care Needs ◽  
Italian Regions ◽  
Palliative Care Units ◽  
The Right ◽  
Noninterventional Study ◽  
Palliative Care Needs

In order to plan the right palliative care for patients and their families, it is essential to have detailed information about patients’ needs. To gain insight into these needs, we analyzed five Italian local palliative care networks and assessed the clinical care conditions of patients facing the complexities of advanced and chronic disease. A longitudinal, observational, noninterventional study was carried out in five Italian regions from May 2017 to November 2018. Patients who accessed the palliative care networks were monitored for 12 months. Sociodemographic, clinical, and symptom information was collected with several tools, including the Necesidades Paliativas CCOMS-ICO (NECPAL) tool, the Edmonton Symptom Assessment System (ESAS), and interRAI Palliative Care (interRAI-PC). There were 1013 patients in the study. The majority (51.7%) were recruited at home palliative care units. Cancer was the most frequent diagnosis (85.4%), and most patients had at least one comorbidity (58.8%). Cancer patients reported emotional stress with severe symptoms (38.7% vs. 24.3% in noncancer patients; p = 0.001) and were less likely to have clinical frailty (13.3% vs. 43.9%; p < 0.001). Our study confirms that many patients face the last few months of life with comorbidities or extreme frailty. This study contributes to increasing the general knowledge on palliative care needs in a high-income country.

I’ve Got the Power: Nurses’ Moral Distress and Perceptions of Empowerment

2021 ◽  
Vol 30 (6) ◽  
pp. 461-465
Author(s):  
Kathleen A. DiGangi Condon ◽  
Jeffrey T. Berger ◽  
Kathleen M. Shurpin
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Screening Tool ◽  
Moral Distress ◽  
Care Needs ◽  
Course Of Action ◽  
Palliative Care Services ◽  
Workplace Empowerment ◽  
Distress Scale

Background Nurses experience moral distress when they feel disempowered or impeded in taking the ethically right course of action. Research suggests an inverse relationship between moral distress and empowerment. In the intensive care unit, providing palliative care services may reduce moral distress because palliative care is often provided in situations that give rise to moral distress. Objective To evaluate the effect of nurses’ use of a palliative care screening tool on their moral distress and perceptions of empowerment. Methods A pretest-posttest pilot study was conducted involving day-shift medical intensive care unit nurses. The nurses administered a palliative care screening tool to their assigned patients daily for 8 weeks and communicated the results to an attending physician or fellow. Demographic information was collected, along with data on nurses’ moral distress and perceptions of structural and workplace empowerment before and after the intervention. Moral distress was evaluated using the Moral Distress Scale–Revised. Perceptions of structural and workplace empowerment were quantified using the Conditions for Work Effectiveness Questionnaire–II and the Global Empowerment Scale, respectively. Results Preintervention and postintervention surveys were completed by 17 nurses. Paired-sample t tests revealed a significant decrease in the frequency of moral distress (t16 = −2.22, P = .04) and a significant increase in workplace empowerment (t16 = −2.75, P = .01). No significant changes in moral distress intensity or structural empowerment were found. Conclusion Nurses’ sense of empowerment and the frequency of moral distress are favorably affected by active participation in assessing and communicating patients’ palliative care needs.

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