"I Just Know if I Keep Going, I'll End Up Hating Nursing." Lived Experiences of Emergency Nurses Three Years Into the Global COVID-19 Pandemic.

INTRODUCTION: As the coronavirus disease 2019 pandemic continues globally, the personal and professional pressure on health care workers continues to accumulate. Literature suggests that as the pandemic evolves, nurses are experiencing increased levels of anxiety, depression, and post-traumatic stress, ultimately leading them to voice intentions to leave the profession, if they have not done so already. METHODS: Informed by an interpretive hermeneutic phenomenological approach, this longitudinal study was designed to capture how the lived experiences of 9 emergency nurses evolved over the coronavirus disease 2019 pandemic, highlighting their feelings, attitudes, and perceptions toward working in the emergency department at this time in history. Interviews were undertaken in June 2022 and were analyzed using a thematic analysis approach. RESULTS: Data analysis resulted in a total of 2 major themes and 8 minor themes. The 2 major themes included "exposed wounds" and "Band-Aid solutions." Levels of burnout increased during the pandemic, with most of the emergency nurse participants dropping their hours, moving roles within the profession, or leaving the profession entirely. Findings elucidate where and how concerns may arise in clinical practice and holistic well-being among emergency nurses, particularly surrounding professional boundaries and protecting work-life balance and professional identity. DISCUSSION: As the world moves to managing coronavirus disease 2019 as a recognized common respiratory illness, providing time and space for emergency nurses to voice their concerns, design their well-being interventions, set professional boundaries, and reconnect with their professional passion may see lower attrition rates and higher levels of professional satisfaction in emergency nurses globally.

Cuidados paliativos e assistência de enfermagem na pandemia por covid-19: revisão de escopo / Palliative care and nursing assistance in the covid-19 pandemic: a scope review / Cuidados paliativos y asistencia de enfermería en la pandemia covid-19: una revisión del alcance

Introdução: O ato e o dever de cuidar é um componente crítico em qualquer plano de classificação da pandemia e o papel das equipes de enfermagem é fornecer o alívio ao sofrimento, fundamental durante o curso da pandemia, em especial, no atendimento integral contínuo dos pacientes em cuidados paliativos. Objetivos: verificar tendências sobre cuidados paliativos e assistência de enfermagem durante a pandemia por COVID-19. Métodos: revisão de escopo. Utilizado o método População, Conceito e Contexto. Critérios de inclusão foram estudos publicados no ano de 2020 e 2021, nos idiomas português e inglês, com disponibilidade eletrônica na íntegra. Critérios de exclusão: publicações em anais de congressos e resumos, e artigos duplicados. Houve a inclusão dos descritores de acordo com os Descritores em Ciências da Saúde: "pandemia por COVID-19", "assistência de enfermagem" e "cuidados paliativos''. Foram identificados 138 artigos com potencial de relevância, sendo excluídos 6 por duplicidade, totalizando em 132 artigos identificados. Após leitura do título e resumo foram selecionados 32 artigos, e excluídos 100. Em seguida, excluídos 16, por não responderem a questão norteadora do estudo, totalizando em 16 artigos para realizar a síntese qualitativa na íntegra. Resultados: 7 (43,75%) dos Estados Unidos da América, 6 (37,5%) no Brasil, 1 (6,25%) no Equador, 1 (6,25%) na China, 1 (6,25%) no Reino Unido, 10 (62,5%) foram publicados no ano de 2021 e6 (37,5%) em 2020. Quanto as bases de dados, 10 (62,5%) encontrados na BVS, 1 (6,25%) no Portal CAPES e 5 (31,25%) na plataforma SciELO. Tipo de estudo: 5 (31,25%) revisão de literatura, 4 (25%) recomendações de especialistas, 3 (18,75%) estudos quantitativos, 2 (12,5%) qualitativos, 1 (6,25%) editorial e 1 (6,25%) relato de experiência. Conclusão: A equipe de enfermagem especializada em cuidados paliativos deve cada vez mais priorizar o alívio do sofrimento durante o curso da pandemia.

Introduction: The act and duty to care is a critical component in any pandemic classification plan and the role of nursing teams is to provide relief to suffering, fundamental during the course of the pandemic, especially in the continuous comprehensive care of patients in palliative care. Objectives: to verify trends in palliative care and nursing care during the COVID-19 pandemic. Methods: Scope review. Used the method Population, Concept and Context. Inclusion criteria were studies published in 2020 and 2021, in Portuguese and English, with full electronic availability. Exclusion criteria: publications in conference proceedings and abstracts, and duplicate articles. There was the inclusion of descriptors according to the Health Sciences Descriptors: ''COVID-19 pandemic', "nursing care" and 'palliative care'. 138 articles with potential for relevance were identified, 6 were excluded due to duplication, totaling 132 articles identified. After reading the title and abstract, 32 articles were selected and 100 were excluded. Then, 16 were excluded because they did not answer the guiding question of the study, totaling 16 articles to perform the qualitative synthesis in full. Results: 7 (43.75%) from the United States of America, 6 (37.5%) from Brazil, 1 (6.25%) from Ecuador, 1 (6.25%) from China, 1 (6.25%) from the United Kingdom, 10 (62.5%) from 2021 and 6 (37.5%) from 2020. As for the databases, 10 (62.5%) found in the VHL, 1 (6.25%) in the CAPES Portal and 5 (31.25%) in the Scielo platform. Type of study: 5 (31.25%) literature review, 4 (25%) expert recommendations, 3 (18.75%) quantitative studies, 2 (12.5%) qualitative, 1 (6.25%) editorial and 1 (6.25%) experience report. Conclusion: The nursing team specialized in palliative care should increasingly prioritize the relief of suffering during the course of the pandemic.

Introducción: El acto y deber de cuidar es un componente crítico en cualquier plan de clasificación de pandemia y el papel de los equipos de enfermería es brindar alivio del sufrimiento, lo cual es fundamental durante el transcurso de la pandemia, en particular, en el cuidado integral continuo de los pacientes en cuidados paliativos. Objetivos: Verificar las tendencias en cuidados paliativos y cuidados de enfermería durante la pandemia de COVID-19. Métodos: Revisión del alcance. Utilizando el método de Población, Concepto y Contexto. Los criterios de inclusión fueron estudios publicados en 2020 y 2021, en portugués e inglés, con total disponibilidad electrónica. Criterios de exclusión: publicaciones en actas de congresos y resúmenes y artículos duplicados. Se incluyeron descriptores de acuerdo con los descriptores de ciencias de la salud: "pandemia de COVID-19", "cuidados de enfermería" y "cuidados paliativos". Se identificaron 138 artículos con potencial relevancia, siendo excluidos 6 por duplicidad, totalizando 132 artículos identificados. Después de leer el título y el resumen, se seleccionaron 32 artículos y se excluyeron 100. Luego, se excluyeron 16 por no contestar la pregunta orientadora del estudio, totalizando 16 artículos para realizar la síntesis cualitativa completa. Resultados: 7 (43,75%) de los Estados Unidos de América, 6 (37,5%) de Brasil, 1 (6,25%) de Ecuador, 1 (6,25%) de China, 1 (6,25%) del Reino Unido, 10 (62,5%) se publicaron en 2021 y 6 (37,5%) en 2020. En cuanto a las bases de datos, 10 (62,5%) se encontraron en la BVS, 1 (6,25%) en el Portal CAPES y 5 (31,25%) en la plataforma SciELO. Tipo de estudio: 5 (31,25%) revisión de la literatura, 4 (25%) recomendaciones de expertos, 3 (18,75%) estudios cuantitativos, 2 (12,5%) cualitativos, 1 (6,25%) editorial y 1 (6,25%) relato de experiencia. Conclusión: El equipo de enfermería especializado en cuidados paliativos debe priorizar cada vez más el alivio del sufrimiento durante el transcurso de la pandemia.

Forever Changed: RNs Speak of their COVID-19 Experiences through a System-Wide Nursing Web Site.

A COVID19RNStories website allowed RNs in this integrated health system to "tell their stories" during the recent pandemic. From April to August 2020, approximately 100 items were posted with 4 themes emerging. COVID19RNStories had no preconceived hypotheses or specific questions to answer: RNs shared whatever they felt was relevant to their experiences. This approach provided real-time information on issues and concerns of RNs during the 1st wave of COVID-19. This article discusses the identified themes with recommendations for nursing leaders to support staff during the pandemic and future unexpected emergency situations.

The light of Florence Nightingale in the care for COVID-19 patients in primary health care.

OBJECTIVE: To analyze the contributions of Florence Nightingale`s care model in the COVID- 19 pandemic. METHOD: Reflection that addresses her theoretical model and its validity in this pandemic, using interpretative research methods and limiting nursing care to primary care. RESULTS: Some pandemics that have caused great impact in humanity are reviewed throughout history; the evolution of nursing care in relation to pandemics is studied; the genesis of community nursing is considered, and Nightingale's care model is reviewed in COVID-19. CONCLUSIONS: Florence Nightingale's thinking withstands the passage of time and, today, as the COVID-19 pandemic rages across the planet, her concept of holistic care and her idea of the art of nursing take on special significance by considering the context involving patients, families and communities.

Boundary Spanning Leadership in Response to the COVID-19 Pandemic: Experience of Nurse Leaders in a Large Integrated Long-term Health Care System.

This article provides insight into the impact of boundary spanning for nurse leaders in a large integrated post-acute health care system in the southeastern part of the United States as they responded (not reacted) to the COVID-19 pandemic that threatened the lives of 2 of society's most vulnerable populations, the elderly and the disabled. Through illustrative examples, the authors describe the 6 strategies of boundary spanning leadership-buffering, reflecting, connecting, mobilizing, weaving, and transforming-that enabled these nurse leaders to respond effectively during this crisis. The literature informs on the merit of situational leadership, as no single type of leadership is right for all circumstances. Today's new novel pandemic served as a powerful catalyst for a group of nurse leaders in a large non-acute network of health care organizations, their colleagues, and other key stakeholders to reframe the boundaries that existed between their organizations and associations, thus enabling them to successfully problem solve together to accomplish several high-stakes goals.

The Impact of an Online Mindfulness-Based Stress Reduction Program on Sleep Quality of Nurses Working in COVID-19 Care Units: A Clinical Trial.

The coronavirus disease-2019 (COVID-19) epidemic is associated with impaired sleep quality in nurses for several reasons. The present study aimed to determine the effect of an online mindfulness-based stress reduction (MBSR) program on improving the sleep quality of nurses working in the COVID-19 care units. In this randomized controlled clinical trial study, all nurses in the 2 COVID-19 patient care units were randomly assigned to the control and intervention groups. The MBSR program was implemented online for 7 weeks for the intervention group by a trainer. The Pittsburgh Sleep Quality Index (PSQI) was completed online by the participants in both groups before and after the intervention. The results of the data analysis indicated that the intervention improved the scores of subjective sleep quality, sleep latency, and sleep efficiency in the intervention group. In the control group, there was a significant increase in the scores of subjective sleep quality, daily performance, and the total index score in the posttest. Besides, there was a significant difference between the 2 groups in only 2 components of sleep latency and subjective sleep quality. The MBSR program can be an effective intervention to improve the sleep quality of nurses working in COVID-19 intensive care units who are at risk of sleep quality disorders in stressful situations.

Holistic Supports for Street Nurses and Front-line Workers during the COVID-19 Pandemic.

Street nurses who serve people experiencing homelessness and substance abuse are at risk of vicarious trauma and long-term mental health challenges. These risks have increased during the COVID-19 pandemic due to a concomitant spike in opioid overdoses and deaths in Canada, fewer available support services and worsening social challenges. This article describes innovative interdisciplinary and participatory research currently being undertaken to develop and evaluate a multifaceted support program to promote the holistic well-being of street nurses and their front-line colleagues.

Exhausted and Burned Out: COVID-19 Emerging Impacts Threaten the Health of the Pediatric Advanced Practice Registered Nursing Workforce.

INTRODUCTION: The purpose of this study was to describe the holistic impacts of COVID-19 on pediatric advanced practice registered nurses (APRNs). METHOD: AA convenience sample of APRNs affiliated with the National Association of Pediatric Nurse Practitioners participated in this cross-sectional descriptive study. An investigator-developed survey explored multifocal, holistic impacts of COVID-19. RESULTS: A total of 886 participants were provided the survey, with 796 (90%) completing the entire survey. Respondents indicated adverse impacts across personal, clinical, educational, and research foci. Among the most alarming findings, 34% indicated moderate or extreme concern for feeling professionally burned out, 25% feeling nervous or anxious, and 15% feeling depressed or hopeless. DISCUSSION: The pediatricAPRN workforce pipeline is at significant risk for provider burnout and compromised mental health. Acknowledgment of pandemic-related trauma on families, children and APRNs is essential. Sustained intentional efforts to cultivate holistic wellness are critically emergent.

Spiritual Health First Aid for Self-Care: Nursing During COVID-19.

ABSTRACT: Nurses who provided care to patients with coronavirus (COVID-19) and supported patients in their transition from life to death in the absence of patients' families have been especially needful of spiritual self-care. A spiritual first aid kit can help nurses cope with these difficult times. Spiritual self-care is vital for all nurses to renew and preserve the psychological, spiritual, and physical self.

World Health Organization Chief Nursing Officer Elizabeth Iro in interview: the COVID-19 pandemic, and nursing and midwifery challenges and qualities.

In an interview, World Health Organization Chief Nursing Officer Elizabeth Iro reflected on nursing during the COVID-19 pandemic and how nurses have risen to the challenges they have faced. Despite the cancellation of virtually all the activities planned to mark 2020 as the International Year of the Nurse and Midwife, she believes that nurses' leadership, courage, compassion, commitment and expertise have been revealed to the world like never before. However, it is critical to nurture and support the next generation of nurses so that they can help to bring about the necessary reforms for health systems around the world.

A Look Back at the Year of the Nurse and the Midwife.

An unprecedented year highlighted the essential care nurses provide.

Exploring Large Community- and Clinically-Generated Datasets to Understand Resilience Before and During the COVID-19 Pandemic.

PURPOSE: To explore resilience in the context of whole-person health and the social determinants of health at the individual and community levels using large, standardized nursing datasets. DESIGN: A retrospective, observational, correlational study of existing deidentified Health Insurance Portability and Accountability Act (HIPAA)-compliant data using the Omaha System and its equivalent, Simplified Omaha System Terms. METHODS: We used three samples to explore for patterns of resilience: pre-COVID-19 community-generated data (N = 383), pre-COVID-19 clinical documentation data (N = 50,509), and during-COVID-19 community-generated data (N = 102). Community participants used the My Strengths + My Health (MSMH) app to generate the two community datasets. The clinical data were obtained from the Omaha System Data Collaborative. We operationalized resilience as Omaha System Status scores of 4 (minimal signs or symptoms) or 5 (no signs or symptoms) as a discrete strengths measure for each of 42 Omaha System problem concepts. We used visualization techniques and standard descriptive and inferential statistics for analysis. FINDINGS: It was feasible to examine resilience, operationalized as strengths by problem concept, within existing Omaha System or Simplified Omaha System Terms (MSMH) data. We identified several patterns indicating strengths and resilience that were consistent with literature related to community connectedness for community participants, and sleep for individuals in the clinical data. CONCLUSIONS: When used consistently, the Omaha System within MSMH enabled robust data collection for a comprehensive, holistic assessment, resulting in better whole-person data including strengths, and enabled us to discover a potentially useful approach for defining resilience in new ways using standardized nursing data. CLINICAL RELEVANCE: The notion that how we assess individuals and communities (i.e., the completeness of our assessments in relation to whole-person health) determines what we can know about resilience is seemingly in opposition to the critical need to decrease documentation burden, despite the potential to shift from a problem deficit-based assessment to one of strengths and resilience. However, a patient-facing comprehensive assessment that includes resilience and the social determinants of health can provide a transformative, whole-person platform for strengths-based care and population management.

Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way.

The corona pandemic challenges countries worldwide in many different ways. Due to its magnitude and impact on global health, this health crisis exposes several shortcomings in their health systems and emphasizes their shortcomings and deficiencies. These deficiencies have quickly affected the most frail citizens, such as older people. The first wave of the COVID19 pandemic in Belgium has quickly shown that nursing homes were not prepared for these kinds of crises. The nature, speed and extent gave rise to an accelerated and more extensive collaboration between various nursing homes and Ghent University Hospital. Before this crisis, the level of integrated care between nursing homes and hospitals was mostly limited. But setting up a strong collaboration model and integrated care between nursing homes and hospitals enables the nursing homes to manage this specific and complex care in their own environment. IMPLICATIONS FOR PRACTICE: This case study shows that integrated care is possible and that both the hospital and the nursing homes benefit from such a system. Investments in people, resources, training and guidance concerning transitional care and knowledge exchange between hospitals and nursing homes, are necessary to guarantee a more efficient and robust approach to (pandemic) crises in nursing homes.

Nurse Leaders Employ Contemplative Practices to Promote Healthcare Professional Well-being and Decrease Anxiety.

OBJECTIVE: The purpose of this study was to test the effectiveness of a daylong resilience retreat on healthcare professionals' anxiety levels, intention to engage in mindfulness practices, and self-efficacy around mindfulness. BACKGROUND: Caregiver burnout is a concern that needs to be addressed at the organizational level so that professionals can reduce their risk of psychological injury while providing high-quality care. The COVID-19 (novel coronavirus) pandemic has exacerbated symptoms of burnout among nurses nationally. METHODS: Ten sessions of daylong resilience retreats were delivered to independent groups of nurses, nurse practitioners, and other healthcare professionals. Preretreat and postretreat assessments were completed using a 19-item survey developed by the research team to assess state anxiety, intention to engage in mindfulness practices, and self-efficacy around mindfulness. RESULTS: One hundred six healthcare professionals completed the resilience retreats. There was a statistically significant decrease in state anxiety scores following the retreat. The majority of the participants reported high intentions to engage in mindfulness practices and felt confident about incorporating mindfulness in their lives. CONCLUSIONS: Brief resilience retreats endorsed by nurse leadership can reduce perceived anxiety and facilitate engagement in contemplative practices, which are associated with a decrease in the risk of burnout.

Midwifery and Nursing Strategies to protect against COVID-19 During the Third Trimester of Pregnancy.

OBJECTIVE: The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) presents significant challenges to midwives and nurses. This study aimed to explore midwifery and nursing interventions to limit the transmission of COVID-19 among women in their third trimester of pregnancy, to reduce the incidence of nosocomial infection and promote safety of care for women and their infants. METHOD: We completed a retrospective review of medical records from 35 women in their third trimester of pregnancy with SARS-CoV-2, admitted to one hospital in Wuhan, China in January and February 2020. We investigated the clinical characteristics of the COVID-19 infection in pregnancy, and the individualized midwifery and nursing care offered, including environmental protection, prevention of nosocomial infection, maternal observations, monitoring of signs and symptoms of COVID-19, and psychological care. RESULT: Thirty-one women had a caesarean section, and four had vaginal births. Retrospective analysis of midwifery and nursing strategies implemented to care for these women showed no maternal complications or nosocomial infections. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The care strategies we implemented could prevent complications and nosocomial infection in the third trimester of pregnancy, thus ensuring the safety of women and their infants. Further research needs to determine treatment priorities for women infected with COVID-19 during pregnancy and the postnatal period.

Covid-19: um novo fenômeno de representações sociais para a equipe de enfermagem na terapia intensiva / Covid-19: a new phenomenon of social representations for the nursing team in intensive care / Covid-19: un nuevo fenómeno de representaciones sociales para el equipo de enfermería en cuidados intensivos

Objetivo: refletir sobre a COVID-19 como um fenômeno de representações sociais para a equipe de enfermagem da Unidade de Terapia Intensiva, analisando as implicações dessa compreensão teórica no delineamento das práticas sociais de tais profissionais. Método: estudo teórico-reflexivo, pautado no referencial das representações sociais. Captaram-se artigos científicos, livros e dados oficiais sobre a COVID-19; posteriormente, procedeu-se o aprofundamento reflexivo com base nos preceitos da teoria. Desenvolvimento: a COVID-19 vem apresentando um forte impacto no cuidado de enfermagem na terapia intensiva. O atendimento dos critérios das representações sociais: da relevância, da prática, do consenso e da afiliação; as dimensões dos afetos, imagética e das práticas sociais mobilizadas na construção social desse fenômeno; e as características do cotidiano da pertença social da equipe de enfermagem atuante na terapia intensiva diante dos pacientes com a COVID-19 foram os argumentos teóricos que sustentaram a defesa de que a COVID-19 é um fenômeno de representação social para esse grupo social. Conclusão e implicações para a prática: estudos das representações sociais desses profissionais sobre a COVID-19 podem subsidiar a proposição de tecnologias de cuidado-educação que qualifiquem a sua atuação no atendimento aos pacientes críticos com a COVID-19

Aim: To reflect on COVID-19 as a phenomenon of social representations for the nursing staff of the Intensive Care Unit, analyzing the implications of this theoretical understanding in the design of the social practices of such professionals. Method: Theoretical-reflective study, based on the framework of social representations. Scientific articles, books, and official data on COVID-19 were captured; subsequently, a deep reflection was conducted based on the principles of the theory. Development: COVID-19 has had a strong impact on nursing care in intensive care. Meeting the criteria of social representations: relevance, practice, consensus, and affiliation; the dimensions of affects, imagery, and social practices mobilized in the social construction of this phenomenon; and the daily characteristics of the social belonging of the nursing team working in intensive care before patients with COVID-19 were the theoretical arguments that supported the defense that COVID-19 is a phenomenon of social representation for this social group. Conclusion and implications for the practice: Studies on the social representations of these professionals about COVID-19 can support the proposition of care-education technologies that qualify their performance in the care of critically ill COVID-19 patients

Objetivo: Reflexionar sobre la COVID-19 como fenómeno de representaciones sociales para el equipo de enfermería de la Unidad de Cuidados Intensivos, con el análisis de las implicaciones de esta comprensión teórica en las prácticas sociales de dichos profesionales. Método: Estudio teórico-reflexivo, basado en el marco de las representaciones sociales. Se capturaron artículos científicos, libros y datos oficiales sobre la COVID-19; posteriormente, se procedió a una profundización reflexiva basada en los preceptos de la teoría. Desarrollo: la COVID-19 ha tenido un fuerte impacto en la atención de enfermería en cuidados intensivos. Cumplir con los criterios de las representaciones sociales: relevancia, práctica, consenso y afiliación; las dimensiones de los afectos, de las imágenes y de las prácticas sociales movilizadas en la construcción social de este fenómeno; y las características cotidianas de la pertenencia social del equipo de enfermería que trabaja en cuidados intensivos ante pacientes con COVID-19 fueron los argumentos teóricos que sustentaron la defensa de que la COVID-19 es un fenómeno de representación social para este grupo social. Conclusión e implicaciones para la práctica: Los estudios de las representaciones sociales de estos profesionales sobre la COVID-19 pueden apoyar la propuesta de tecnologías de cuidado-educación que califiquen su desempeño en el cuidado de pacientes críticos con COVID-19

Academic caring pedagogy, presence, and Communitas in nursing education during the COVID-19 pandemic.

BACKGROUND: Strong faculty academic human caring presence is paramount during the exponential use of asynchronous, remote learning during the COVID-19 pandemic. PURPOSE: The purpose of this article is to provide a holistic, theoretical foundation for evidence informed-caring pedagogical practices. METHODS: Watson's (2008; 2018) Unitary Caring Science theoretical approach offers one pedagogical caring framework for advancing teaching-learning in the digital age. DISCUSSION: Examples to humanize the virtual classroom and remote or online teaching include narrative, theory-guided pedagogical approaches, such as creation of caring spaces and other modalities to transcend physical distancing and nurture Communitas (caring community) among of faculty and students. CONCLUSION: A theory-guided, holistic caring pedagogical approach supports the needs of both faculty and nursing students.

Increasing Critical Care Nurse Engagement of Palliative Care During the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic has led to escalating infection rates and associated deaths worldwide. Amid this public health emergency, the urgent need for palliative care integration throughout critical care settings has never been more crucial. OBJECTIVE: To promote palliative care engagement in critical care; share palliative care resources to support critical care nurses in alleviating suffering during the coronavirus disease 2019 pandemic; and make recommendations to strengthen nursing capacity to deliver high-quality, person-centered critical care. METHODS: Palliative and critical care literature and practice guidelines were reviewed, synthesized, and translated into recommendations for critical care nursing practice. RESULTS: Nurses are ideally positioned to drive full integration of palliative care into the critical care delivery for all patients, including those with coronavirus disease 2019, given their relationship-based approach to care, as well as their leadership and advocacy roles. Recommendations include the promotion of healthy work environments and prioritizing nurse self-care in alignment with critical care nursing standards. CONCLUSIONS: Nurses should focus on a strategic integration of palliative care, critical care, and ethically based care during times of normalcy and of crisis. Primary palliative care should be provided for each patient and family, and specialist services sought, as appropriate. Nurse educators are encouraged to use these recommendations and resources in their curricula and training. Palliative care is critical care. Critical care nurses are the frontline responders capable of translating this holistic, person-centered approach into pragmatic services and relationships throughout the critical care continuum.