Development of the Palliative Care of Dying Critically Ill Patients Algorithm: Implications for Critical Care Nurses

Critical care nurses need more practice in caring for dying critically ill patients because most have had little experience. Fifty senior nursing students during their critical care nursing course participated in simulations and case study analyses regarding dying critically ill patients/families. Findings indicate that mean posttest scores from the End-of-Life Nursing Education Consortium-Knowledge Assessment Test were statistically significantly higher than the pretest scores (t = 11.31; P < .0001). Ten (20%) of the students had dying critically ill patients whom they cared for in their concurrent rotations, and 25 (50%) additional students gave palliative care to chronically ill terminal patients on other units. The average perceived level of comfort working with patients likely to die doubled by the end of the course. The Palliative Care of Dying Critically Ill Patients Algorithm, consisting of 10 steps (from identifying an advanced directive to communicating a patient plan), was developed to assist nurses in providing comprehensive palliative care. In addition, 3 complex case studies are presented for use in critical care educational programs. Simulation, case study analyses with expert feedback, and role play can facilitate both student nurses' and critical care nurses' improved comfort in caring for critically ill patients who will likely die.