This qualitative study examined the experiences of 18 RNs providing terminal care on four ICUs. Through interviews and focus groups, Espinosa and colleagues identified three themes surrounding the nurses' experiences: barriers to optimal care, internal conflict, and coping.

Barriers to optimal care were categorized into six areas: nurses' lack of involvement in the choice and timing of patient care; clashes between physicians who focus on a specific symptom or organ and nurses who use a holistic approach; patients treated by several physician specialists, each of whom focuses on a separate symptom or organ, which can result in different prognoses; the delivery of care that provides no apparent benefit; family members' unrealistic expectations; and the need for more education for nurses who care for terminally ill patients.

Nurses also identified five major areas of internal conflict: feeling relief when the care they provide is switched from curative to palliative; wanting dying patients to be comfortable and families to have good final memories of their loved ones; feeling abandoned while carrying out physicians' orders to stop care and powerless because they're unable to save the patient; conflicted about administering medication to keep patients comfortable that may also cause them harm; and disturbed by younger terminal patients who remind them of their own mortality.

Five coping strategies were highlighted: building trust with family members, crying, humor, talking to others about terminal care, and avoiding caring for terminally ill patients. Some nurses also talked about having a "crusty" attitude as a coping mechanism.

Nurses also suggested that improved education, increased staff support, and better communication would be helpful.