Critical care nurses' experiences of withdrawal of treatment: A systematic review of qualitative evidence

Background: Death and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit. Objective: To synthesize qualitative evidence on the experiences of critical care nurses who have cared for patients and families throughout the process of withdrawal of life-sustaining treatment. Methods: This was a systematic review and qualitative evidence synthesis modeled on the Joanna Briggs Methodology. Pre-defined keywords were searched for in Medline, CINAHL, Psyclnfo, and Web of Science to locate studies published in the English, French, and Greek languages in any year. Two reviewers independently screened articles for congruence with eligibility criteria, engaged in data extraction, and assessed quality of the included studies. Meta-aggregation was performed to synthesize the findings. A protocol was developed by two members of the review team prior to initiation of the study. Results: Thirteen studies were included in the review, 12 qualitative and one mixed-methods. Four key themes were identified from the original research: Navigating Complexity and Conflict; Focusing on the Patient; Working with Families; and Dealing with Emotions Related to Treatment Withdrawal. Critical care nurses provide care to patients and families during the process of withdrawal of life-sustaining treatment which is described as complex and challenging. Despite the inherent challenges, nurses strive towards doing their utmost for patients and families.