Ceiling of Care in Acute Care Settings: A Concept Analysis.

AIM(S): To conduct a systematic concept analysis of Ceiling of Care to clarify its definition and distinguish its core features within acute care settings.

METHOD: The Walker and Avant's concept analysis method was applied.

DATA SOURCES: A systematic search of six databases (APA PsycINFO, CINAHL, the Cochrane Library, MEDLINE, ProQuest Central and Scopus) was conducted from inception to July 2026, supplemented by manual reference list searches and AI-assistance tools.

RESULT: Nineteen records met the inclusion criteria. Five defining attributes were identified: (1) patient-centred collaborative decision-making; (2) comprehensive and structured prognostic evaluation; (3) establishment of explicit therapeutic boundaries; (4) proactive and continuous care strategy and (5) standardised documentation and communication. Antecedents included predisposing, precipitating and contextual factors, while key consequences included reduced nonbeneficial treatment and enhanced decision-making clarity. The analysis distinguishes Ceiling of Care as a broad, anticipatory framework rather than a reactive, single-intervention directive such as a do-not-resuscitate order.

CONCLUSIONS

Ceiling of Care is defined as an anticipatory, documented clinical decision-making approach that establishes the maximum appropriate level of treatment escalation for an individual patient, based on clinical assessment, anticipated benefit and patient values.

IMPLICATION FOR NURSING MANAGEMENT: This conceptual clarity provides a foundation for standardised implementation in acute care settings. Nurse managers need to lead the integration of Ceiling of Care frameworks within acute care settings; this could support nursing management in standardising clinical decision-making, reducing nonbeneficial treatment escalation, strengthening communication across multidisciplinary teams and ultimately enhancing the quality and dignity of patient care.