title: Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: a mixed methods study.
abstract: BACKGROUND
  With end-of-life (EOL) central to the nursing role in intensive care, few studies have been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing.
  
  
  OBJECTIVE
  To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL care.
  
  
  METHODS
  Sequential mixed methods study using cross sectional survey with follow-on focus groups.
  
  
  METHODS
  NZ intensive care nurses (N=465) across four large tertiary intensive care units (ICUs) were contacted to complete a 43-item web-based survey. A follow-on focus group was conducted in each of the sites to explore specific aspects of the survey findings.
  
  
  RESULTS
  203 fully completed surveys were returned (response rate 44%) from the four ICUs. Over half of nurses surveyed (55%, n=111) disagreed that withholding and withdrawing life support treatment were ethically the same. 78% (n=159) of nurses stated that withholding treatment was ethically more acceptable than withdrawing it. Whilst nurses generally supported reducing inspired oxygen to air for ventilated patients at EOL (71%, n=139) this was also an area that demonstrated one of the highest levels of uncertainty (21%, n=41). Just under a quarter of respondents were also uncertain about the use of continued nutritional support, continued passive limb exercises and use of deep sedation during EOL. The 18 nurses who participated in follow-on focus groups detailed the supportive, culturally sensitive, collaborative environment that EOL was conducted in. However diverse opinions and understandings were held on the use of passive limb and use of fluids at EOL.
  
  
  CONCLUSIONS
  Whilst results from this NZ study broadly align with European studies, uncertainty about specific areas of EOL practices highlight that further guidance for nurses is required.
authors.affiliation: Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand. Electronic address: mo.coombs@vuw.ac.nz.
authors.forename: Maureen
authors.initials: M
authors.lastname: Coombs
authors.affiliation: School of Nursing, Midwifery, and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Fulbrook
authors.affiliation: Victoria University of Wellington, Wellington, New Zealand.
authors.forename: Sarah
authors.initials: S
authors.lastname: Donovan
authors.affiliation: Victoria University of Wellington, Wellington, New Zealand.
authors.forename: Rachel
authors.initials: R
authors.lastname: Tester
authors.affiliation: Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.
authors.forename: Kay
authors.initials: K
authors.lastname: deVries
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D064648:Critical Care Nursing; D003430:Cross-Sectional Studies; D003657:Decision Making; D004993:Ethics, Nursing; D005260:Female; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care; D035501:Uncertainty; D028761:Withholding Treatment
keywords: Death and dying; End of life care; Intensive care; Intensive care nurse; Nursing care; Treatment withdrawal