Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal

Aim. The purpose of this study was to explore the experiences of intensive care nurses who provided end of life care to adult patients and their families after a decision had been taken to withdraw treatment. Background. End of life care following treatment withdrawal is a common phenomenon in intensive care. Less is known about nurses’ experiences of providing care for the dying patient and their family in this context, when compared to specialist palliative care. Design. Descriptive exploratory qualitative study. Methods. A purposive sample of 13 intensive care nurses participated in a semi-structured face to face interview. Transcribed data was analysed using the principles of Interpretative Phenomenological Analysis. Results. The essence of nurses’ experiences of providing end of life care after the withdrawal of treatment was interpreted as “doing the best to facilitate a comfortable and dignified death’’. Four master themes included: caring for the dying patient and their family; providing and encouraging presence; reconnecting the patient and family; and dealing with emotions and ambiguity. Uncertainties were evident on processes and actions involved in treatment withdrawal, how to reconnect patients and their family effectively and how to reduce the technological environment. Conclusions. Providing end of life care after a decision has been taken to withdraw treatment was a common aspect of intensive care. It was evident that nurses were doing their utmost to support patients and families at the end of life, despite the multiple challenges they faced. Relevance to clinical practice. The interpretive findings from this study should assist ICU nurses to better understand and develop their role in providing high quality end of life care after treatment withdrawal. Practice guidelines should be developed to reduce ambiguity and support the delivery of high quality care for adults as they approach the final stages of life in ICU.