Nurses have an essential role as team members in establishing the goals of care in the ICU.

The uncertainty that JS feels most likely is due to the experience of caring for an ever-increasing population of chronically, critically ill elderly patients who have little chance of surviving hospitalization. Because of the increase in life-prolonging therapies, people are living much longer with chronic disease. Many of these elderly people die in an intensive care unit (ICU).1,–3 Up to 11% of Medicare beneficiaries spend more than 7 days in an ICU within the final 6 months of their life. In some instances, only 35% to 50% of all elderly patients in the ICU survive to discharge.1,4,5 Among critically ill patients who require prolonged mechanical ventilation (>14 days), have cancer, or have multisystem failure, mortality often exceeds 50%.3,6,–8...

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