RESUMO
BACKGROUND: Intensive care units (ICUs) are traditionally settings that offer high technologically advanced treatment for those who are in critical situations due to an illness or accident. Questions regarding the withdrawal and withholding as well as the ending of life sustaining treatment are related to ethical dilemmas. Nurses' decision-making processes and nursing activities in different countries are scarcely studied. QUESTION: Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described? AIM: The objective is the identification of a nursing terrain regarding decision-making and activities in patient end-of-life care on the intensive care unit. METHOD: Semi-structured interviews were conducted with 51 experienced nurses in university or hospital premises: 10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine. The study used grounded theory to inform data collection and analysis. RESULTS: The finding of the study is the identification of a dynamic process in which activities with a focus on cure shift to activities with a focus on end-of-life care. The core category that emerged was 'negotiated reorienting': The shift of activities implies negotiations between nurses and physicians, relatives as well as with oneself. Moreover the process is characterized by a constant re-orientation that is induced by changing patient data and the realisation of the whole situation. Nurses' core practices are 'consensus seeking' and 'emotional holding' (sub-categories). CONCLUSIONS: In all countries a nursing terrain of activities in end-of-life care could be identified and described. However, it is unclear whether nursing activities connected to relatives of the patient are dominant in such a way that relations to dying patients and respect for their autonomy are put into the background. A field study could give answers to this question possible.
