• Judy Dillworth, Victoria V Dickson, Anna Mueller, Joseph Shuluk, Hye W Yoon, and Elizabeth Capezuti.
• New York University, College of Nursing, New York, NY, USA.
• Nurs Crit Care. 2016 Mar 1; 21 (2): e1-e11.

AimsTo explore pressing issues identified by nurses caring for older patients in US NICHE (Nurses Improving Care for the Healthsystem Elders) hospitals, regarding palliative care and end-of-life (EOL) decision-making. Objectives are to (1) identify the most pressing palliative care and EOL decision-making issues and strategies to address them and (2) identify the association of nursing demographics (age, gender, race, education and experience), institutional/unit characteristics and these issues.BackgroundCritical care nurses have an integral role in supporting older patients and families faced with palliative care and EOL decision-making issues. Despite national imperatives to improve the quality of palliative care, patients continue to experience uncontrolled pain, inadequate communication, disregard of their wishes and life prolonging interventions. These contribute to increased hospitalizations and costs. Understanding the prevalent issues is needed to address patient needs at the end-of-life.DesignIt is a mixed method study.MethodsA secondary analysis of the NICHE Geriatric Institutional Assessment Profile (GIAP) database (collected 1/08-9/13) was conducted using the sample of Critical Care RNs who provided comments regarding palliative care and EOL decision-making. Qualitative data were analyzed using Dedoose software. Data clusters and patterns of co-occurring codes were explored through an iterative analysis process. Themes were examined across nurse demographics, institutional and unit characteristics.ResultsComments specifically addressing issues regarding EOL decision-making were provided by 393 critical care nurses from 156 hospitals (x‾ age = 42·3 years, 51% BSN degree). Overarching theme was discordance in goals of care (prolonging life versus quality of life), ineffective physician-patient-family communication, lack of time and unrealistic expectations.ConclusionsNurses' descriptions highlight the need for increased communication, staff education and availability of palliative care services.Relevance To PracticePalliative care and EOL decision-making will remain a nursing priority as people age and require increased care.© 2015 British Association of Critical Care Nurses.

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