Abstract
Improving care at the end of life is a health priority. At least one-third of deaths in the United States occur in the hospital; nearly half of the Americans who die in the hospital will have spent time in the intensive care unit during the last 3 days of life. Critically ill patients and their families identify significant unmet spiritual, environmental, and communication needs. Although the Society of Critical Care Medicine recommends that the spiritual needs of critically ill patients be addressed by the health care team and be incorporated in patients' plans of care, spiritual concerns are infrequently addressed during goals-of-care discussions. The American Association of Critical-Care Nurses' Synergy Model recognizes the central importance of spirituality to the provision of patient-centered care. Furthermore, the model highlights the value of the relationship between the patient and the nurse to a healing environment. The privileged connection between patients and nurses, foundational to the creation of a healing environment, may be understood as a sacred space. Critical care nurses are uniquely positioned to improve end-of-life care by focusing on the spiritual, environmental, and communication needs of their patients through the creation of a third space in the intensive care unit, a sacred space.