Nursing care for patients at end of life in the adult intensive care unit

Abstract

The care patients receive at the end of life in the intensive care unit (ICU) is highly dependent on the ICU nurse’s knowledge, skill, and comfort level in caring for the dying patient and the patient’s family. However, formal nursing education supports the acute care culture with little or no curriculum offered on end-of-life care. A search for national standards and best practices and participating in the July 2010 End-of-Life Nursing Education Consortium (ELNEC) Train the Trainer conference led to a needs assessment on how best to educate nurses on quality end of life care in the ICU setting. By identifying the nursing education and skills needed for quality end-of-life care in the ICU on the basis of best practices and national standards, ICU nurses can be empowered to provide optimal end-of-life care. Staff education and development is a key strategy for implementing evidenced-based end-of-life care in the ICU setting. Investing in ELNEC training, using available tools such as the IPAL-ICU screening tool to identify unmet palliative needs, training end-of-life resource nurses for specific hospital units, and offering education for hospital staff can begin to raise awareness regarding end-of-life care and change the existing culture. Developing an evidenced-based order set to treat symptoms of the dying patient can help to ensure that such patients’ symptoms are well managed. A willingness to take information about the end of life to the community, such as a partnership with a local nursing school, is a key strategy for filling the gaps in knowledge in end of life care.