conceptual model, intensive care nursing, nursing theory, organization, palliative care



  1. Zomorodi, Meg PhD, RN, CNL
  2. Bowen, Gary L. PhD, ACSW


While critical-care nurses wish to improve end-of-life care, personal, environmental, and relational factors affect the delivery of this care. The objective of this study was to examine the relationship between critical-care nurses and patient/family values, behaviors, and contextual factors when undergoing end-of-life care in the ICU. Bowen's Value-Behavior Congruency model was used as a classification tool to review literature on end-of-life care. Published articles were examined for the study design, substantive and methodological characteristics, and study findings. The results from this review were extrapolated to identify personal, environmental, and relational factors ICU nurses face when providing end-of-life care. Factors were identified as either supporting or impeding value-behavior congruency. The Value-Behavior Congruency model suggests that care is improved when the nurse and family work together to ensure that their values and behaviors are congruent, especially in response to the healthcare system. The concepts identified by Bowen in his conceptual model have merit when transitioning to ICU practice and end-of-life care. By exploring the factors that influence care delivery, along with nurses' values, behaviors, and expectations of care, we can identify the ingredients necessary to create and implement interventions to improve end-of-life care in the ICU.