{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:30:28Z","timestamp":1791570628527,"version":"4.3.4"},"reference-count":56,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>End\u2010of\u2010life care in intensive care units presents multifaceted challenges for nurses, whose duties include balancing clinical responsibilities with the emotional and ethical complexities of caring for dying patients and their families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to explore the perceptions and experiences of intensive care nurses regarding the provision of end\u2010of\u2010life care in the adult intensive care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>This qualitative study utilised an exploratory descriptive design, sampling 16 experienced intensive care nurses with at least 5\u2009years of intensive care experience from an 18\u2010bed multidisciplinary tertiary hospital's intensive care unit. Data were collected through face\u2010to\u2010face, semi\u2010structured interviews and analysed using inductive thematic analysis. The research adhered to the Consolidated Criteria for Reporting Qualitative Studies guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Four major themes were developed: \u2018emotional toll on nurses\u2019, \u2018challenges in communicating with families\u2019, \u2018ICU physical environmental challenges\u2019 and \u2018feeling powerless and excluded\u2019. Personal attachments led to burnout and emotional strain, underscoring the emotional toll on nurses. Grief, family denial and tense nurse\u2013family relationships all exacerbated communication issues. Nurses reported that physical environmental factors, including overcrowding and a lack of privacy, exacerbated stress levels. Finally, they expressed a sense of helplessness stemming from their exclusion from decision\u2010making, which in turn led to moral distress and frustration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study highlights the urgent need to enhance intensive care unit end\u2010of\u2010life care by addressing systemic barriers, fostering interprofessional collaboration and strengthening nurse education and emotional support systems. Nurses must be empowered as key contributors to decision\u2010making and supported in their roles as caregivers and communicators during end\u2010of\u2010life care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Improving end\u2010of\u2010life care in intensive care units necessitates a comprehensive approach that encompasses training in communication and palliative care, reconfiguring intensive care environments to facilitate family presence and implementing staff well\u2010being initiatives. These changes are crucial for fostering a dignified end\u2010of\u2010life experience and promoting sustainable nursing practices in intensive care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70278","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T04:44:26Z","timestamp":1764737066000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Caring Amid Complexity: Intensive Care Nurses' Perceptions and Experiences of End\u2010Of\u2010Life Care\u2014A Qualitative Study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5120-0529","authenticated-orcid":false,"given":"Emmanuel Kwame","family":"Korsah","sequence":"first","affiliation":[{"name":"Division of Clinical Associates, Department of Family Medicine and Primary Care, Faculty of Health Science University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2190-1505","authenticated-orcid":false,"given":"Shelley","family":"Schmollgruber","sequence":"additional","affiliation":[{"name":"Department of Nursing Education, Faculty of Health Science University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhassan Sibdow","family":"Abukari","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Nursing &amp; Midwifery University of Ghana  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCC.0000000000000479"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010022\u201001020\u2010"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2021.103057"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2017.09.012"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijans.2023.100636"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0000792022"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/2164956120916176"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ANC.0000000000000677"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004763"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2019.08.004"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.12968\/bjon.2019.28.16"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2024.01.001"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1477750920927174"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/joom.1245"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnss.2024.10.005"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010024\u201001801\u20107"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010024\u201001543\u2010y"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2015.11.002"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAJCC.2021.v37i1.454"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.12026"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAJCC.2020.v36i2.435"},{"issue":"1","key":"e_1_2_12_23_1","first-page":"32","article-title":"Defining Exploratory\u2010Descriptive Qualitative (EDQ) Research and Considering Its Application to Healthcare","volume":"4","author":"Hunter D.","year":"2019","journal-title":"Journal of Nursing & Healthcare"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.45.3.214"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/medhum-2017-011435"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.12562"},{"key":"e_1_2_12_29_1","doi-asserted-by":"crossref","unstructured":"F.Rubic M.Curkovic S.Jankovic et\u00a0al. \u201c327 Difficulties Emerging From The End\u2010Of\u2010Life Care in The Pediatric Intensive Care Units \u201d(2021).","DOI":"10.1136\/archdischild-2021-europaediatrics.327"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.4102\/sajpsychiatry.v28i0.1748"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2017.0472"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.supp.2020.35.2.25288"},{"issue":"4","key":"e_1_2_12_33_1","first-page":"352","article-title":"Gaps in Adult End of Life Education: A Multimodal Approach","volume":"20","author":"Schroeder K.","year":"2017","journal-title":"Journal of Palliative Medicine"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2020.05.001"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/13561820.2019.1636008"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-021-00802-6"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13893"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06712-w"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCC.0000000000000310"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2016.03.003"},{"key":"e_1_2_12_41_1","unstructured":"E. 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