Abstract
The chronically critically ill population is growing rapidly in this country with continued improvement of life-prolonging treatments. This population is characterized by multiple advanced medical problems, which frequently include prolonged mechanical ventilation. Because of the complexity surrounding chronically critically ill patients, the morbidity and mortality rates are high at discharge and after 1 year. Psychological and physical symptom burden also has been more recently examined and found to be significant. Impaired communication has been reported as most distressing during this difficult time of prolonged critical illness. Because communication and symptom management is a focus for the hospice and palliative care provider, it is becoming more vital for this role to be incorporated into the care of the chronically critically ill. Specifically, the role of the advanced practice nurse in palliative care has been found to be increasingly beneficial in such medically complex patients. The opportunities for enhanced palliative care are abundant in the management of this patient population to ensure ongoing clarification of goals and communication surrounding the patient's wishes and needs. A case study is used to present the effects of effective communication and aggressive symptom management by a palliative care advanced practice nurse that allowed comfort and positive outcomes for a patient's goal of returning home in the setting of chronic critical illness.