The Canary in the Coal Mine – Nursing’s Role in Integration of Palliative Care in ICU
Diane L. Capretta, BSN, RN, MBA
Director, Intensive Care Unit
Affinity Medical Center
875 8th Street NE
Massillon, Ohio 44646
Palliative care integration faces many obstacles in ICU settings, leading to unnecessary patient suffering, moral and ethical conflicts, high costs of futile care, and nurse burnout and turnover. Critical care in end-stage serious illness results in high moral distress, especially for ICU bedside RNs who believe care to be futile or in conflict with the patient’s values. Long regarded as trusted care providers, nurses can serve as the “canary in the coalmine” that identifies unmet palliative opportunities in ICU and thus can serve as catalysts in palliative integration.
The Nursing Moral Distress Scoring tool, developed by this author, allows nurses to identify and score sources of moral distress in caring for individual patients and their families. This provides a basis for discussion among the team and with families, allowing palliative care integration where appropriate.
We believe that through use of this tool, we are realizing reduced ethical conflicts and related suffering at end of life, reduced time to hospice consultation where appropriate, and cost reductions through elimination of futile care. Nurses report a sense of reduced moral distress, and satisfaction in meeting patient care needs. Improved job satisfaction reduces nursing turnover and related costs and promotes higher skill levels and patient outcomes.