Jane Morgan1. 1. Critical Care, Essex Rivers Healthcare NHS Trust, Colchester District General Hospital, Colchester, Essex, UK. morganz@intamail.com
Abstract
AIM: To appraise literature concerning end-of-life care (ELC) in adult critical care units in the UK in order to improve clinical practice. OBJECTIVE: To understand the interplay between legal and ethical, political, societal aspects of ELC for sustainable quality care. BACKGROUND: Significant changes in health care policy for the critically ill patient have occurred since 1999. Simultaneously, the government is committed to improving care for the dying by integrating the palliative care ethos across the National Institutes of Health (NHS) to include non-cancer sufferers. Death continues to be a feature of critical illness, particularly following the decision to withhold/withdraw life-prolonging treatments. SEARCH STRATEGY: A search of MEDLINE, BNI, CINAHL and PSYCinfo using key words revealed very few results; consequently, the search was broadened to include ASSIA, King's Fund, TRIP, Healthstar, NHS Economic Evaluation Data, Cochrane, professional journals and government documents. CONCLUSIONS: The literature reveals a paradigm shift from critical to palliative care, in other words, from a reductionist approach to a more humanistic approach in the acute setting. When treatment is deemed futile, quality ELC involving the assessment, ongoing assessment and care after death becomes the new goal for the critical care team. To practice ELC competently, nurses require organizational and educational support at local and national levels. RELEVANCE TO CLINICAL PRACTICE: Although medico-legal decision-making is not part of their professional role, critical care nurses have an extraordinary opportunity to make a difference to the dying patient and their family and their acceptance of death.
AIM: To appraise literature concerning end-of-life care (ELC) in adult critical care units in the UK in order to improve clinical practice. OBJECTIVE: To understand the interplay between legal and ethical, political, societal aspects of ELC for sustainable quality care. BACKGROUND: Significant changes in health care policy for the critically ill patient have occurred since 1999. Simultaneously, the government is committed to improving care for the dying by integrating the palliative care ethos across the National Institutes of Health (NHS) to include non-cancer sufferers. Death continues to be a feature of critical illness, particularly following the decision to withhold/withdraw life-prolonging treatments. SEARCH STRATEGY: A search of MEDLINE, BNI, CINAHL and PSYCinfo using key words revealed very few results; consequently, the search was broadened to include ASSIA, King's Fund, TRIP, Healthstar, NHS Economic Evaluation Data, Cochrane, professional journals and government documents. CONCLUSIONS: The literature reveals a paradigm shift from critical to palliative care, in other words, from a reductionist approach to a more humanistic approach in the acute setting. When treatment is deemed futile, quality ELC involving the assessment, ongoing assessment and care after death becomes the new goal for the critical care team. To practice ELC competently, nurses require organizational and educational support at local and national levels. RELEVANCE TO CLINICAL PRACTICE: Although medico-legal decision-making is not part of their professional role, critical care nurses have an extraordinary opportunity to make a difference to the dying patient and their family and their acceptance of death.