gms | German Medical Science

Background and Purpose: Intensive care units (ICUs) focus on treatment for critically ill people. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment. The issue of how to organize a shift to palliative care is particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. The aim is to understand end-of-life decision-making practices from the perspective of nurses in different countries.

Model and Methods: A grounded theory approach was used to inform data collection and analysis. Interviews were conducted with experienced ICU nurses in five countries: Brazil (10), England (9), Germany (10), Ireland (10) and Palestine (11). Ethical approval was granted in each of the participating countries, voluntary informed consent obtained from each participant.

Research Focus: All nurses interviewed were invited to narrate their experiences of participation in end-of-life decision. The focus was to shed light on their lived-experiences and understand of end-of-life care practices.

Results: Data revealed that decision-making cannot be understand as a definable moment, but as a process that involves taking turns between action and reaction. The core category that emerged was Negotiated Reorienting. Nurses engage in two core practices: Consensus Seeking and Emotional Holding.

Conclusions: There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However, the data also pointed to some differences regarding power dynamics. The German data showed that palliative care competencies are decisive to shape the process in a professional way.