Abstract
Nurses are in a pivotal position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. However, nurses report a lack of preparation in dealing with end-of-life (EOL) care in the intensive care environment. The aims of the study were to explore nurses' definitions of quality EOL care and to identify the personal, environmental, and relational factors that facilitate or inhibit the nurses' ability to provide EOL care to patients and their families. Nine critical care nurses were interviewed about their values and beliefs related to providing quality EOL care. Interviews were audiotaped, transcribed, and analyzed for themes and patterns. Using Bowen's model of value-behavior congruency, several themes were identified and were examples of personal, environmental, and relational factors that facilitate or hinder critical care nurses' ability to provide quality end of life. Nurses used strategies such as "balancing," "trial and error," "coaching the physicians," and "taking a step back" to improve the quality of EOL care provided. The values and behaviors as well as the personal, environmental, and relational factors identified in this study may be useful in determining factors related to providing quality nursing care at the end of life.