Bringing palliative care to the surgical intensive care unit.

CriticalCareNurse Vol 33, No. 1, FEBRUARY 2013 71 Maxwell Mirel is a registered nurse and Tonja Hartjes is a clinical nurse educator in the surgical/cardiothoracic intensive care unit at Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida. For questions related to this article, contact Tonja Hartjes at [email protected]. Surgical critical care typically focuses on curative measures and aggressive therapies. Traditionally, surgical culture is procedure oriented, and death is often seen as a failure. Death within 30 days of a surgical procedure is monitored nationally. This places additional external pressure on the surgical team and reinforces a perception of death as failure. It can also discourage openness to a more collaborative model of palliative care. Critical care nurses often cite a need for improved end-of-life care. In a study by Poncet et al, a relationship between burnout syndrome and the stresses associated with providing end-of-life care was identified. Burnout syndrome can occur when excessive energy and resources are used during management of stressful situations. Repetition of these kinds of awkward circumstances can ultimately lead to feelings of frustration and failure when caring for a patient. Conflicts among patients, families, nurses, and physicians frequently occur when patients are near death. In a recent study by Azoulay et al, up to 70% of ICU nurses reported such conflicts associated with end of life, which had a negative effect on job stress and In August 2010, we began our Beacon journey. During the journey, staff in our 18-bed combined surgical intensive care unit (SICU) and cardiothoracic intensive care unit (CTICU) evaluated many aspects of the care we provided and our unit’s processes. One aspect of care that we identified as underemphasized was extended care and endof-life care. In this article, we describe the process that we followed in developing and initiating a palliative care program in our SICU/CTICU. Typically care provided in a SICU is focused on curative therapies. In our unit, when patient care priorities were more in line with palliative care concerns, we had no structured or interdisciplinary process in place to accommodate those needs. Palliative care neither hastens nor postpones death. It supports the patient and family during an illness or at the end of life and helps them to understand and cope with the changes in their condition. Palliative care is defined by the World Health Organization as follows: Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.