title: End of life decisions: nurses perceptions, feelings and experiences.
abstract: Decisions to withdraw treatment are made on a regular basis in intensive care units. While nurses play a central role in patient care, previous studies have found that they are not always involved in withdrawal decisions.
  
  
  OBJECTIVE
  To explore the experiences of ICU nurses caring for patients who have had their treatment withdrawn and to answer two research questions: what role do nurses play and how does this affect them?
  
  
  METHODS
  Constructivist grounded theory was used to explore the experiences and feelings of ICU nurses. A purposive sample of eight ICU nurses participated and semi-structured interviews were used to collect data. Framework analysis was used to facilitate systematic analysis.
  
  
  RESULTS
  The analysis revealed two major themes (1) the nurse's role: experience counts, not really a nurse's decision, planting the seed, supporting the family and being a patient advocate and (2) perceptions of the withdrawal of treatment: getting the timing right and emotional labour.
  
  
  CONCLUSIONS
  Nurses make an important contribution to end of life decisions and care. Guidelines recommend they have input into withdrawal decisions, therefore it is imperative that nurses are supported in this role and their responsibilities to continue to provide care during withdrawal.
authors.affiliation: Faculty of Health, Sport and Science, Glyntaff Campus, University of Glamorgan, Pontypridd, United Kingdom. rmcmille@glam.ac.uk
authors.forename: Rachel E
authors.initials: RE
authors.lastname: McMillen
mesh_terms: D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000523:psychology; D002983:Clinical Competence; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D003659:Decision Making, Organizational; D004644:Emotions; D004645:Empathy; D004739:England; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D024802:Nurse's Role / Q000523:psychology*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D010344:Patient Advocacy; D019555:Physician-Nurse Relations; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D011368:Professional-Family Relations; D036301:Qualitative Research; D012944:Social Support; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D013997:Time Factors; D028761:Withholding Treatment / Q000941:ethics