Critical care nurses' grief, anxiety, and their preparedness to care for dying patients: a multisite, cross-sectional study in Ireland

Critical care nurses are regularly exposed to emotionally challenging situations, particularly when providing end-of-life care. Within the intensive care units (ICU), nurses must balance complex clinical tasks with the psychological burden of providing end-of-life care. These experiences can elicit grief and anxiety, emotional responses that may affect their sense of preparedness and ability to care for dying patients. Emotional resilience and preparedness to care are essential for delivering compassionate, patient-centred, end-of-life care.

This study examined the levels of grief and anxiety experienced by critical care nurses in the Republic of Ireland and explored the relationship to their perceived preparedness and ability to care for dying patients.

A quantitative, cross-sectional design was employed. Data were collected from registered general nurses working in critical care units across six general hospitals in the Republic of Ireland using a purposive convenience sampling method. Three standardised instruments, the Grief State Scale for Nurses (GSSN), Conte's Death Anxiety Questionnaire, and the Perception of Preparedness and Ability to Care for the Dying (PPACD) tools, were used. Statistical analyses included descriptive and inferential statistics.

Majority of participants were female, with a median age of 34 and median ICU experience of eight years with most of ICU nurses having formal education in end-of-life care. Nurses reported elevated grief and variable anxiety, while feeling moderately prepared to care for dying patients. Higher age and ICU experience were associated with lower grief and anxiety, but higher perceived preparedness. Interestingly, nurses who had more recent experiences caring for dying patients felt slightly less prepared. No significant differences were found based on gender or formal training. Regression analysis indicated that higher grief scores significantly predicted lower perceived preparedness.

The findings collectively underscore the importance of developing comprehensive interventions that address not only clinical competence but also emotional and psychological needs of critical care nurses. Regular debriefings following patient deaths and routine reflective practice may help ICU nurses process grief. ICU-specific end-of-life care training should explicitly incorporate emotional coping strategies and grief awareness, rather than solely on clinical skills. Accessibility to psychological supports such as employee assistance and peer-support systems particularly for less experienced staff who may be more vulnerable to emotional burden.