1. + End-of-Life Care in the ICU: The Impact of Nursing Care on the Spiritual and Religious Needs of Patients and Families

2. + What I’ll cover... Background Spirituality and Religion at the End of Life Unique Role of Intensive Care Unit Nurses Discussion and Conclusions

3. + Background ICU care can be stressful, emotionally draining, and often traumatic for patients and families. Patients are often unable to communicate independently, so the family must provide surrogate decision making. Many families are in need of spiritual and religious support during these times. Religion plays a large role in decision-making at the end of life. Research has shown religious and spiritual beliefs by the patient and family, as well as the clinician can impact the decisions made for care of the patient. Nurses play a unique role in the care of the ICU patient and may be providing around-the-clock care. Nurse-patient relationships often shift to nurse-family relationships in the ICU.

4. + Spirituality and Religion at the End of Life Religion: totality of a belief system, an inner piety or disposition, an abstract system of ideas, or ritual practices. Spirituality can be a component of religion, but can stand alone. Spirituality can be defined as “constructs of meaning or a sense of life’s purpose.”

5. + Spirituality and Religion at the End of Life In general, religious individuals choose more aggressive ICU care. Clinicians are not obligated to provide spiritual care, but are obligated to provide an assessment and referral for spiritual or religious care. Families who were more satisfied with their spiritual care rated their overall satisfaction with the ICU care at a higher level.

6. + Unique Role of ICU Nurses Nurses encounter several obstacles in treating patients Family members who are calling the ICU phone line for updates on loved ones, Families misunderstanding the term “life-saving measures,” And physician disagreement about the treatment plan for the patient. Nurses were found to build family relationships by: Demonstrating commitment to the patient and family, Getting to know the family and patient, Being involved with the care of the patient, And “breaking rules”

7. + Unique Role of ICU Nurses Most highly scored supportive behaviors in ICU care were actions the nursing team was able to directly impact. Allowing families adequate time with the patient after death, Providing a dignified scene around the time of death, And teaching patients’ families how to behave around a dying patient. Critical care nurses were surveyed on end-of-life care and the idea of providing a “good death” surfaced repeatedly.

8. + Discussion and Conclusions Families expressed interest and need for more focus on religious and spiritual needs. Much of the research points to the potential role nurses could play in this critical element of end-of-life care. There is also a place for critical health literacy, confrontation of disparities, and culture-centered approach to improve the end-of- life experience.

9. + Discussion and Conclusions It is not clear that there is any kind of wide spread protocol or method of providing EOL care within an ICU setting. Research in the area of meeting the needs of dying patients in a hospital or hospice setting are available, But the literature is lacking in the area of ICU spiritual and religious care, potentially due to the varied and quickly deteriorating path of individual patients.

10. + Discussion and Conclusions Nurses may play a key role in ensuring patients and families receive the care they need. Barriers exist in time, resources, and expertise to ensure good care. Proper spiritual and religious care should be a major focus of healthcare systems. Simply raising awareness of desired behaviors and actions of the healthcare team, and providing a forum for discussion and analysis, might be a good place to begin.

11. + Questions? I’ve posted my entire paper and bibliography at kristibruno.com if you are interested in learning more.