Palliative care in intensive care units: nurses' perspectives on challenges and strategies

Background: The integration of palliative care into intensive care units is increasingly recognised as essential to ensuring quality end-of-life 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. Aim: To explore the challenges and strategies identified by intensive care nurses in the provision of palliative care, guided by Kolcaba's Comfort Theory. Study Design: A qualitative descriptive design was adopted. Data were collected through a broader questionnaire on palliative care that included two open-ended questions. Written responses were analysed using Bardin's content analysis, with interpretation informed by Kolcaba's Comfort Theory. Results: 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-making), 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. Conclusions: 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-informed nursing knowledge. Relevance to Clinical Practice: 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.