Background While a palliative approach is generally perceived to be an integral part of the intensive care unit (ICU), the provision of palliative care in this setting is challenging. This review aims to identify factors (barriers and facilitators) influencing a palliative approach in intensive care settings, as perceived by health care professionals. Method A systematic mixed-methods review was conducted. Multiple electronic databases were used, and the following search terms were utilized: implementation, palliative care, and intensive care unit. In total, 1843 articles were screened, of which 24 met the research inclusion/exclusion criteria. A thematic synthesis method was used for both qualitative and quantitative studies. Results Four key prerequisite factors were identified: (a) organizational structure in facilitating policies, unappropriated resources, multi-disciplinary team involvement, and knowledge and skills; (b) work environment, including physical and psychosocial factors; (c) interpersonal factors/barriers, including family and patients’ involvement in communication and participation; and (d) decision-making, e.g., decision and transition, goal conflict, multidisciplinary team communication, and prognostication. Conclusion Factors hindering the integration of a palliative approach in an intensive care context constitute a complex interplay among organizational structure, the care environment and clinicians’ perceptions and attitudes. While patient and family involvement was identified as an important facilitator of palliative care, it was also recognized as a barrier for clinicians due to challenges in shared goal setting and communication.

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.

Communication is crucial regardless of a patient's condition in Critical Care Units (CCU). However; communication barriers are common in CCU. In recent years there has been a rapid growth within hospital settings in the provision of palliative care according to patient needs. The purpose of the research study was to investigate nurses' experiences of communication with palliative patients in CCU. A cross sectional design was conducted using questionnaire. The study sample included nurses who were working in CCU. The total number of completed and submitted questionnaires were 61. The majority of respondents were females. The results show that 49% of respondents have experienced difficulties in palliative care tasks while 41% respondents have complications with communication in palliative care. Also, nurses who took part in this study reported difficultly in discussing decisions such as advanced directives, do not resuscitate orders, and feeding tubes. In conclusion, nurses experience difficulty with communication whilst carrying out palliative care tasks in critical care units. The common causes of communication difficulty are because of the complexity of palliative care tasks, language barriers, shortage of staff and feeling un-empowered. Moreover, there is a lack of education programs centered around enhancing communication difficulties between nurses and palliative patients.