Purpose: This performance improvement study was conducted to assess Critical Care nurses’ perceived competence and their experience in caring for terminal ICU patients on comfort care.
Background/ Significance: Despite the consensus for palliation, there remains the dominant concern that ICU nurses under treat discomfort and do not improve pain levels of patients before death. Methods: A concurrent survey was given primary care RNs caring for patients not expected to survive hospitalization and withdrawn from life-sustaining measures with a focus on palliation. Questions on a Likert scale elicited responses on (a) participation in planning for comfort care, (b) comfort administering medication doses for palliation, and (c) family satisfaction with patient comfort. Results: There were 94 survey responses from the nursing staff of this 19-bed adult medical-surgical ICU of an HMO community hospital. Nurse reported their patients as very comfortable (43%), comfortable (50%) and uncomfortable to very uncomfortable (7%). Nurses’ views of family satisfaction with the level of comfort achieved were very adequate to adequate (94%) and inadequate to very inadequate (4%). When asked about their level of comfort administering medication doses for palliation, only 8% of the nurses reported being very uncomfortable to uncomfortable. When asked about their satisfaction with level of participation in planning for comfort goals for their patients, 85% reported very adequate to adequate satisfaction.
Conclusions: Nurses in our study reported that they were skilled in providing comfort measures and were involved in planning for comfort care. Further study is needed to evaluate effectiveness of symptom management through the patient’s response.
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