Palliative Care Specialty Nursing in Medical Intensive Care Units

Given the serious illness burden of patients in medical intensive care units, palliative care is a key element of their care. This case discussion highlights the role of the palliative care specialty registered nurse in an embedded palliative care model in medical intensive care units.

A 44-year-old female patient with decompensated cirrhosis was transferred to the study hospital for liver transplant evaluation. Her hospital stay involved multiple complications.

The patient was determined to have palliative care needs. Multiple areas of intervention were identified.

A model including a palliative care specialty registered nurse was initiated in the medical intensive care unit.

The palliative care specialty registered nurse had 2 roles: (1) optimizing patient care by partnering with medical intensive care unit colleagues to develop a plan of care aligned with patient and family values and preferences and (2) supporting and enhancing critical care nursing excellence by helping bedside nurses advocate for the patient's palliative care needs. Nurses were also empowered with communication skills to engage with patients, family members, and primary team colleagues.

The palliative care specialty registered nurse model can be used in various intensive care unit settings. However, the complex care needs of critically ill patients, the unique nature and structural variations across critical care settings, and the resources required to implement this model are potential challenges.