Critical Care Outreach Team Nurses' Approaches to End-of-Life Conversations: An Interpretive Descriptive Study

Critical care outreach team (CCOT) nurses are part of hospital emergency response teams, assessing and mobilising resources for decompensating patients. Although a significant proportion of this role involves addressing end-of-life (EOL) issues, this role is ill-defined in the literature and in practice.

To explore the experiences of CCOT nurses with EOL conversations.

A qualitative interpretive descriptive methodology guided the study. A semi-structured interview guide was used to collect audio-recorded individual interview data from CCOT nurses from seven hospitals in Ontario. Interview data were analysed using a thematic analysis approach.

Data from 11 CCOT nurse participants revealed two key themes: 'Acquiring skills to discuss end-of-life issues' and 'Dynamic approaches to end-of-life conversations'. CCOT nurses' role in EOL conversations diverged significantly from their practice as bedside critical care nurses, assuming additional autonomy and responsibility in these conversations. Although CCOT nurses frequently had to navigate EOL discussions, they reported very little training to assist in acquisition of this skill. Despite no uniform education being provided to CCOT nurses, all nurses across multiple unrelated organisations reported using similar approaches.

Findings from this study suggest that navigating EOL issues is an important learning need for CCOT nurses, pointing towards the need for more robust education at organisational, provincial and national levels. Additional research is recommended to quantify the participation of CCOT nurses in EOL discussions, expanding knowledge about the extent of their involvement. Further research is also warranted to delineate and support nursing scope of practice within this role, informing policy and guidelines.

CCOT nurses encounter EOL issues in their daily practice. Additional education and increased role clarity are recommended to support nurses in this practice area.