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What are the challenges for nurses when providing end-of-life care in intensive care units?

12 September 2019
Volume 28 · Issue 16



this literature review aimed to explore qualitative studies in which nurses discussed the challenges they face when delivering end-of-life care in intensive care units (ICUs). Analysis and discussion of the studies' findings aimed to contribute to the current evidence base surrounding the subject.


a systematic search of academic databases was conducted to source relevant studies. An inductive process using grounded theory was undertaken to elicit suitable themes to address the review question.


six relevant studies were identified with four main themes emerging from analysis. The themes were a lack of nurse involvement in end-of-life care decision-making, a lack of nursing knowledge in providing end-of-life care, the dilemma of prioritising care between the patient and family, and the nature of providing end-of-life care within an ICU environment.


the provision of end-of-life care in ICUs requires nurses to be involved in interdisciplinary communication. ICU-specific end-of-life care education, training and guidelines need to be implemented to ensure patients receive high-quality, patient-centred care.

The National Palliative and End of Life Care Partnership (NPELCP) stated that end-of-life care is required by the vast majority of people, therefore the care provided to both dying patients and those closest to them must be a priority and of the highest quality possible (NPELCP, 2015). To achieve this necessitates continuous improvements to the way health professionals plan, approach and prepare people for death (NPELCP, 2015). The Public Health England (PHE) End of Life Care Profiles' data for 2016 stated that the largest proportion (46.9%) of all deaths involving the provision of end-of-life care in England occurred in acute hospital settings (PHE, 2018). Such a figure suggests that caring for dying patients is both a prominent and essential component of hospital-based nursing (Abu-Ghori et al, 2016; Andersson et al, 2016). However, although nurses are required to advocate for patients and support end-of-life care decisions as part of their professional role (Thacker, 2008; Department of Health (DH), 2016), the majority of nurses do not work in specialist hospice settings or possess specialist skills in end-of-life care (Hayes et al, 2014).

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