A holistic perspective on comfort care as an advance directive

Critical care nurses are frequently involved with patients and families who must choose among the various advance directives. Although "comfort care" is a familiar option, there is a lack of clarity about specific components of comfort as well as the nurse's role as a member of the interdisciplinary team. This lack of clarity can result in disruption of the patient or family decision-making process surrounding impending death. This article defines comfort care as a holistic and positive choice for patients and families among advance directive options. A two-dimensional grid is applied to assist with discussion and decision making regarding the dying process. Methods for applying the framework and developing a care plan are presented in case study format. Practicing these methods will enable critical care nurses and other team members to empower patients and families to work through the dying process with optimal comfort.