When Heroics are Hurtful: A Systematic Review on Palliative Care Provided by Nurses in Critical Care Settings

Abstract

There is a growing need for end-of-life services in critical care settings. According to the Australian Journal of Advanced Nursing, "ICU patients have the highest incidence of mortality in the acute care setting with one in four patients dying in an ICU, accounting for 15% of all hospital deaths annually" (Hynes et. al., 2022, p. 7). While many nurses serve palliative patients excellently, intensive care units (ICUs), critical care units (CCUs), and emergency departments (EDs) present unique challenges. The focus of these units is the rescue of patients, saving lives. However, there are times when end-of-life, rather than rescue care, is indicated. The purpose of this qualitative systematic review was to examine how a culture of rescue affects palliative care offered by registered nurses in the ICU, CCU, and ED. Eighteen articles were systematically collected and reviewed from three different databases. Qualitative data was then collected and analyzed. From the data, themes emerged. It was found that a rescue culture can negatively affect palliative care. This culture of rescue can be a barrier to providing best practice palliative services. It can cause confusion and moral distress for care providers, patients, and families. A rescue culture may also elicit a disregard for patient preferences, increase patient suffering, increase institutional spending, delay end-of-life conversations, and lead to palliative patients becoming a lower priority.