{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:26:24Z","timestamp":1792113984321,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The integration of palliative care into intensive care units is increasingly recognised as essential to ensuring quality end\u2010of\u2010life care, yet persistent barriers continue to challenge its implementation. Nurses, as continuous bedside providers, are central to delivering comfort, but their perspectives remain underexplored in the Portuguese context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore the challenges and strategies identified by intensive care nurses in the provision of palliative care, guided by Kolcaba's Comfort Theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A qualitative descriptive design was adopted. Data were collected through a broader questionnaire on palliative care that included two open\u2010ended questions. Written responses were analysed using Bardin's content analysis, with interpretation informed by Kolcaba's Comfort Theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 52 intensive care nurses, five categories emerged: physical comfort (symptom control and proportionality of interventions), psychospiritual comfort (emotional and spiritual support), sociocultural comfort (family involvement and shared decision\u2010making), environmental comfort (privacy and humanisation of care) and organisational factors (training needs, institutional resistance and protocols). Nurses highlighted barriers such as therapeutic obstinacy, insufficient training and organisational constraints, while proposing strategies centred on communication, teamwork and education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Kolcaba's Comfort Theory provided a meaningful lens to interpret the multidimensional nature of comfort in intensive care palliative care. The findings extend understanding of how nurses perceive and address structural and cultural barriers, contributing to theory\u2010informed nursing knowledge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Grounding practice in nurses' perspectives and comfort theory may enhance education, organisational policies and models of care, promoting a more consistent integration of palliative care in intensive care units.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70240","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T10:42:24Z","timestamp":1766140944000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Palliative Care in Intensive Care Units: Nurses' Perspectives on Challenges and Strategies"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6715-3621","authenticated-orcid":false,"given":"Daniela Filipa Almeida","family":"da Cunha","sequence":"first","affiliation":[{"name":"Center for Interdisciplinary Research in Health, Faculty of Health Sciences and Nursing Catholic University of Portugal  Porto Portugal"},{"name":"Porto Nursing School University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5809-3788","authenticated-orcid":false,"given":"Jos\u00e9 Carlos Fernandes","family":"Alves","sequence":"additional","affiliation":[{"name":"Center for Interdisciplinary Research in Health, Faculty of Health Sciences and Nursing Catholic University of Portugal  Porto Portugal"},{"name":"Intensive Care Unit Local Healthcare Unit of Braga  Braga Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3603-2656","authenticated-orcid":false,"given":"Ana Jorge Santos","family":"Marques","sequence":"additional","affiliation":[{"name":"Center for Interdisciplinary Research in Health, Faculty of Health Sciences and Nursing Catholic University of Portugal  Porto Portugal"},{"name":"Intensive Care Unit Local Healthcare Unit of Gaia\/Espinho  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6089-0924","authenticated-orcid":false,"given":"Rui Filipe S\u00e1","family":"Santos","sequence":"additional","affiliation":[{"name":"Neurosurgical Ward Local Healthcare Unit of Santo Ant\u00f3nio  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3357-7984","authenticated-orcid":false,"given":"Liliana Andreia Neves","family":"da Mota","sequence":"additional","affiliation":[{"name":"Northern School of Health Portuguese Red Cross  Oliveira de Azemeis Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"e_1_2_20_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010024\u201007579\u20101"},{"key":"e_1_2_20_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000237044.79166.E1"},{"key":"e_1_2_20_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102702.2008.02712.x"},{"key":"e_1_2_20_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCC.0000000000000252"},{"key":"e_1_2_20_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010024\u201001543\u2010y"},{"key":"e_1_2_20_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13035"},{"key":"e_1_2_20_8_1","volume-title":"Comfort Theory and Practice: A Vision for Holistic Health Care and Research","author":"Kolcaba 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