end-of-life care, intensive care units, nurses, qualitative research, systematic review



  1. Velarde-Garcia, Juan Francisco PhD
  2. Pulido-Mendoza, Rosa PhD
  3. Moro-Tejedor, Ma Nieves MSc
  4. Cachon-Perez, Jose Miguel PhD
  5. Palacios-Cena, Domingo PhD


A qualitative systematic review was conducted to review and explore published qualitative research describing the challenges faced by nurses providing terminal care in intensive care units. Qualitative evidence was considered regarding nurses and terminal care for critical care patients. A search of qualitative research articles published between January 2003 and April 2015 was undertaken. PubMed, MEDLINE, PsycINFO, EMBASE, Scopus, and CINAHL databases were searched. Methodological quality was assessed using the Consolidated Criteria for Reporting Qualitative Research. Twenty-two articles were included in the review. Three superordinate themes emerged from the data: (a) the nurse on the intensive care unit: understanding how emotional burden, coping with death, and the nurse's role in the decision-making process may influence end-of-life care; (b) end-of-life care for the critically ill patient: influenced by the presence of academic, health care, and environmental barriers and by facilitators such as communication with the family; and (c) the role of the family within the intensive care unit: the second priority in the care process, although a potential source of stress. Nurses providing end-of-life care in intensive care units face a number of ethical, academic, health care-related, and environmental barriers.