The intensive care unit is a unique setting where death and dying is routine to many who work there.
The intensive care unit (ICU) is a unique setting where death and dying is routine to many who work there. It’s an area where maintaining life in the face of death or illness is entrusted to the health care team.
ICUs usually employ multidisciplinary teams consisting of a physician, pharmacist, nurse, nutritionist, social worker, pastor or spiritual figure, and specialist from cardiology, neurology, or oncology, if needed, as well as the patient’s family. Including family members on the care team prevents them from feeling isolated from the process, which often includes speaking of dying and death.
When working with family members, it’s important to remember 4 things:
1. Be respectful
2. Be empathetic
3. Be compassionate
4. Tell them what you’re doing and why you’re doing it, using words that aren’t harsh, but still honest
Be aware the family may push back and not want to deal with matters of advance directives like do not resuscitate, do not reintubate, or other wishes of the patient. Give them a bit of space, but continue to include them in the patient’s care. Broach the subject later while always discussing what would the patient want.
Once all measures to maintain a patient’s life are attempted, the goal is to relieve suffering. In the ICU, pain and discomfort have to be assessed in the critically ill patient before medications are used to manage symptoms as appropriate.
Comfort care is further provided by withholding or withdrawing treatments of fluids, antibiotics, artificial nutrition, blood products, vasopressors, and ventilator support. This helps prevent administering medications with negligible benefit to the patient. It’s also recommended to not oversedate a patient with opioids or administer paralytics before discontinuing life support, as this can mask symptoms, hasten death, and bring into question whether death was intentional, which can have legal ramifications.
Ultimately, a balance must be maintained when assessing and caring for dying patients. The ICU multidisciplinary team helps maintain that balance, but it’s not uncommon for its members to feel a sense of insufficiency and failure to save a life.
When you’re feeling this way, make sure to repeat this mantra: I did my best trying to save a life, and now I will do my best trying to comfort a family.