Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

Abstract

Aim: To explore the association of organizational structures when integrating palliative care in intensive care units. Background: Palliative care within intensive care settings has been widely recognized as an area requiring improvement when caring for patients and their families. Despite this, intensive care units continue to struggle to integrate palliative care. Methods: A qualitative descriptive methodology was used. Data were collected through research interviews with 15 managers and 36 health care professionals working in intensive care. The data were analysed adopting constant comparative analysis. Results: This study provides insight into a diverse range of perspectives on organizational structure in the context of facilitation and the challenges posed. Three themes were identified: Do not resuscitate policy as a gateway to palliative care, facilitating family members to enable participation and support and barriers for palliative care in intensive care unit as a result of intensive care organization. Conclusions: In fostering a sustainable organizational culture and practice development in intensive care, the findings indicate the need for specific palliative care policies and implementation strategies tailored according to context. Implications for nursing management: Management has a responsibility to facilitate dialogue within any multidisciplinary team regarding palliative care and, in particular, to focus on ‘do not resuscitate’ policies as a gateway into this conversation.