Caring Amid Complexity: Intensive Care Nurses' Perceptions and Experiences of End-Of-Life Care-A Qualitative Study

End-of-life care in intensive care units presents multifaceted challenges for nurses, whose duties include balancing clinical responsibilities with the emotional and ethical complexities of caring for dying patients and their families.

This study aimed to explore the perceptions and experiences of intensive care nurses regarding the provision of end-of-life care in the adult intensive care unit.

This qualitative study utilised an exploratory descriptive design, sampling 16 experienced intensive care nurses with at least 5 years of intensive care experience from an 18-bed multidisciplinary tertiary hospital's intensive care unit. Data were collected through face-to-face, semi-structured interviews and analysed using inductive thematic analysis. The research adhered to the Consolidated Criteria for Reporting Qualitative Studies guidelines.

Four major themes were developed: 'emotional toll on nurses', 'challenges in communicating with families', 'ICU physical environmental challenges' and 'feeling powerless and excluded'. Personal attachments led to burnout and emotional strain, underscoring the emotional toll on nurses. Grief, family denial and tense nurse-family relationships all exacerbated communication issues. Nurses reported that physical environmental factors, including overcrowding and a lack of privacy, exacerbated stress levels. Finally, they expressed a sense of helplessness stemming from their exclusion from decision-making, which in turn led to moral distress and frustration.

The study highlights the urgent need to enhance intensive care unit end-of-life care by addressing systemic barriers, fostering interprofessional collaboration and strengthening nurse education and emotional support systems. Nurses must be empowered as key contributors to decision-making and supported in their roles as caregivers and communicators during end-of-life care.

Improving end-of-life care in intensive care units necessitates a comprehensive approach that encompasses training in communication and palliative care, reconfiguring intensive care environments to facilitate family presence and implementing staff well-being initiatives. These changes are crucial for fostering a dignified end-of-life experience and promoting sustainable nursing practices in intensive care settings.