The Journey Towards Withdrawal: Nurses' Experiences of End-of-Life Decisions in Cardiothoracic Intensive Care.

Abstract

Background: End-of-life (EOL) decision-making in intensive care units (ICUs) is ethically demanding. Nurses are often excluded from this process despite their continuous bedside presence. Surgical units, particularly cardiothoracic ICUs, are described as more inclined to pursue aggressive treatment, yet little is known about how nurses in these specialised settings experience EOL decision-making.

Aim: The study aimed to illuminate how nurses in the cardiothoracic ICU experience EOL decision-making and the withdrawal of intensive care.

Methods: A qualitative descriptive design was used. Twelve nurses from six cardiothoracic ICUs in Sweden were recruited through purposive sampling. Data were collected through digital semistructured interviews. An inductive content analysis following Elo and Kyngäs guided the analytic process.

Results: Four categories captured the nurses' experiences. Decision-making as a winding road described the diverse and challenging nature of the decision-making process. Endeavouring to be a part of the team reflected the importance of teamwork and the nurses' inconsistent inclusion in EOL discussions. Facing ethical quandaries: Navigating doing good and doing no harm highlighted the ethical tensions inherent in intensive care. Caring beyond the patient: The crucial role of supporting relatives underscored the difficulties faced by relatives and the nurses' commitment to caring for them.

Conclusion: Cardiothoracic ICU nurses navigate significant ethical challenges during EOL decision-making and emphasise the need for greater inclusion to strengthen advocacy. While several findings align with research from general ICUs, this study provides a context-specific account of how EOL decision-making is navigated in cardiothoracic intensive care. Persistent challenges related to nurses' involvement and interprofessional communication highlight the need for strategies to support nurse inclusion in EOL decision-making, as nurses' contributions may strengthen patient advocacy and care for relatives during EOL transitions.