The experiences of critical care nurses providing end-of-life care in the ICU

Abstract

Background: Within the intensive care unit (ICU), where technology and cure prevail, nurses frequently accompany patients through dying and death. Providing end-of-life care (EOLC) in this curative environment requires reconciling technical proficiency with compassion and ethical sensitivity. Yet, compared with palliative settings, limited evidence explores how ICU nurses themselves make sense of this experience. Aim: To explore and interpret the lived experiences of ICU nurses providing EOLC to critically ill patients in a Maltese tertiary care hospital. Design and Methods: A qualitative study grounded in Interpretative Phenomenological Analysis (IPA) and informed by the Relational Ethics Framework (Bergum & Dossetor, 2005) was undertaken. Four experienced ICU nurses were purposively sampled. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed through iterative interpretative cycles consistent with IPA principles. Results: Four Group Experiential Themes (GETs) were identified: (1) Shaping the dying process, advocacy and facilitation of a “good death”; (2) Carrying the weight of end-of-life care, emotional and psychological burdens moderated by diverse coping strategies; (3) Care beyond the patient, supporting families through communication and presence; and (4) End-of-life care in a curative space, ethical practice constrained by the ICU’s technological and institutional culture. Collectively, these themes reveal how nurses strive to humanise dying and uphold dignity and personhood despite systemic and emotional challenges. Conclusion and Implications: The interpretative findings of this study reveal how ICU nurses strive to honour the human experience of dying in a setting designed for cure, upholding dignity and personhood through advocacy, emotional presence and relational engagement while navigating hierarchical and systemic constraints. Caring for dying patients and families was experienced as both deeply meaningful and emotionally demanding, highlighting the need for structured education, clear EOLC guidelines, and accessible psychological support. Embedding relational ethics principles into training, interprofessional collaboration, and institutional policy can strengthen compassionate communication, moral resilience, and workforce wellbeing, thereby sustaining high-quality, person-centred EOLC within technologically intensive settings.