Dying in the Intensive Care Unit: A Candle Vigil Using Illustrations

Area of Science:

• Medical Ethics
• Palliative Care
• Intensive Care Medicine

Background:

• Intensive care units (ICUs) frequently encounter patient death and dying.
• Families of critically ill patients require sensitive bereavement support.
• Current methods for identifying patients receiving comfort care or who have died may lack neutrality and subtlety.

Purpose of the Study:

• To propose and evaluate a novel, neutral symbol for identifying patients in ICUs who have transitioned to comfort care or have died.
• To assess the impact of this symbol on healthcare staff and patient families.
• To foster an environment of reflection and tranquility during end-of-life care.

Main Methods:

• Implementation of a visual cue: a candle illustration on the door of rooms with patients receiving comfort care or who have died.
• Placement of additional candle illustrations at the nurses' station.
• A 1-year trial period in a neurointensive care unit.
• Qualitative assessment of staff and family experiences.

Main Results:

• The candle symbol was perceived as a neutral and effective way to identify relevant patient rooms.
• Staff reported a positive experience, noting the symbol encouraged modified communication, silence, and reflection.
• Families also reported a positive experience, with the symbol contributing to a sense of tranquility.

Conclusions:

• The candle illustration serves as a sensitive and effective symbol for end-of-life care in ICUs.
• This initiative enhances bereavement support by promoting staff mindfulness and creating a more tranquil atmosphere for families.
• The symbol's success in the neuro-ICU suggests potential for broader implementation in critical care settings.