Intensive care nurses' perceptions on barriers impeding the provision of end of life care in the intensive care setting: a quantitative analysis

Background: Intensive care nurses look after the most critically ill patient population with the highest mortality rate on a daily basis. Whilst research to date has highlighted and provided some insights into the current provision of end of life care, further research is much needed to improve the efficacy of nurses existing practice. Objective: To investigate the specific barriers and contextual characteristics that nurses experience within the Intensive Care Unit environment. Study Methods: The National Questionnaire of Critical Care Nurses Regarding End of Life Care was used to collect quantitative and qualitative data to answer the research questions. This study was conducted in a major intensive care unit located in a tertiary public hospital in metropolitan Western Australia. Results: The respondent rate was 67.31%. Obstacles with the highest perceived intensity score (PIS) reported by participants involved issues around the communication and practice of end of life care including family interaction. The ranges of mean scores for supportive behaviours were much higher than the ranges for obstacles. These supportive behaviours included allowing family members to have adequate time alone with the patient after death, and families being taught how to engage with the dying patient. Conclusion: The findings reflect that the most intense and frequently occurring obstacles are consistent with past research. A perceived negative end of life care experience by the nurse was found to negatively impact the nurse's psychological and physiological health. The research demonstrates the need for a stronger multidisciplinary patient centred approach. It is envisaged that the findings will support the review and development of appropriate guidelines to support nurses caring for intensive care patients in the initial and progressive phases of end of life care. What is already known about this topic? ICU patients have the highest incidence of mortality in the acute care setting with one in four patients dying in an ICU, accounting for 15% of all hospital deaths annually. This patient population presents nurses with a set of unique, yet significant challenges related to increased rate of mortality. There is a significant amount of existing literature that has explored moral distress amongst nurses, particularly in relation to end of life care. What this paper adds: This research suggests that there continues to be obstacles that impede critical care nurse's ability to facilitate EOLC in the ICU setting. The participants of this study highlighted the need for stronger emphasis being placed on decision making processes, communication, and standardised practice. The most supportive behaviours reported were associated with practice that could be initiated by the nurse such as, allowing family members adequate time with their loved one pre and post death, and teaching family members how to act and engage with their loved ones during this time.