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barriers to care, critical care, end of life, nursing



  1. Espinosa, Laura MSN
  2. Young, Anne EdD
  3. Walsh, Teresa PhD


Traditional goals of critical care center on curative interventions for patients with acute illness. However, death is a common occurrence in critical care, which means a shift from curative care to comfort care. For a number of reasons, the transition in care is often not a smooth one. An integrated literature review was completed on 22 studies related to provision of terminal care. These 13 quantitative studies along with 9 qualitative studies identified specific barriers to effective terminal care provision including (a) lack of involvement in the plan of care and comfort, (b) disagreement among physicians and other healthcare team members, (c) inadequacy of pain relief, (d) unrealistic expectations of families, (e) nurses' difficulty coping, (f) lack of experience and education, (g) staffing levels, and (h) environmental circumstances. Recommendations address strategies to improve terminal care and suggest future research needed.