title: Integrating Palliative Care in the ICU: The Nurse in a Leading Role.
abstract: Palliative care is increasingly recognized as an integral component of comprehensive intensive care for all critically ill patients, regardless of prognosis, and for their families. Here we discuss the key role that nurses can and must continue to play in making this evidence-based paradigm a clinical reality across a broad range of ICUs. We review the contributions of nurses to implementation of ICU safety initiatives as a model that can be applied to ICU palliative care integration. We focus on the importance of nursing involvement in design and application of work processes that facilitate this integration in a systematic way, including processes that ensure the participation of nurses in discussions and decision making with families about care goals. We suggest ways that nurses can help to operationalize an integrated approach to palliative care in the ICU and to define their own essential role in a successful, sustainable ICU palliative care improvement effort. Finally, we identify resources including The IPAL-ICU Project™, a new initiative by the Center to Advance Palliative Care that can assist nurses and other healthcare professionals to move such efforts forward in diverse critical care settings.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine and Hertzberg Palliative Care Institute, Project Director, The IPAL-ICU Project™, Center to Advance Palliative Care, Mount Sinai School of Medicine, New York, NY.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Nelson
authors.forename: Therese B
authors.initials: TB
authors.lastname: Cortez
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Dana R
authors.initials: DR
authors.lastname: Lustbader
authors.forename: Anne C
authors.initials: AC
authors.lastname: Mosenthal
authors.forename: Colleen
authors.initials: C
authors.lastname: Mulkerin
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ray
authors.forename: Rick
authors.initials: R
authors.lastname: Bassett
authors.forename: Renee D
authors.initials: RD
authors.lastname: Boss
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Campbell
authors.forename: David E
authors.initials: DE
authors.lastname: Weissman
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Puntillo