Barriers and Facilitators in the Provision of Quality Palliative Critical Care: Critical Care Nurse's Perspectives

Abstract

Intensive care units (ICU) are providing increasing amounts of palliative care. However, a lack of consistency in palliative methods within critical care is reported to create negative end-of-life experiences for patients and their families. Subsequently, there is increasing interest to develop initiatives that improve the quality of palliative care in the critical care setting. The purpose of this qualitative descriptive study was to explore what critical care nurses perceive as facilitators of and barriers to providing quality palliative care in critical care. Eleven critical care nurses working within a general systems intensive care unit (ICU) in a large western Canadian hospital participated in this study. Semi-structured individual interviews were conducted with each participant and data was interpreted using thematic analysis. Key barriers that were identified include ineffective communication, difficulties with end-of-life decision making, not respecting a person’s wishes, the lifesaving mentality of critical care, a lack of palliative care education, and barriers related to the critical care environment. Identified facilitators of quality palliative care include advance care planning, effective communication, palliative care education, contributions of the interdisciplinary team, palliative order sets, and promoting an environment that is conducive to quality palliative care. Additionally, key messages that arose include the reality of mortality, moral distress, the components of a “good death,” connectedness and the nurse’s relational narrative, and the great potential for improvement. These findings point to the importance of promoting advance care planning, early integration of the palliative approach, palliative education, effective communication, palliative care orders sets, critical care environments that are conducive to quality palliative experiences, fostering the nurse-patient relationship, and combatting moral distress. It is anticipated that the results of this study will provide insight into the initiatives and resources that are required to enhance the quality of palliative critical care within the local context.