title: [Decision-making processes in nursing and activities at the end of life in intensive care–An international comparative study].
abstract: 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.
  
  
  OBJECTIVE
  Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described?
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: 1 Philosophisch-Theologische Hochschule Vallendar, Deutschland.
authors.forename: Helen
authors.initials: H
authors.lastname: Kohlen
authors.affiliation: 2 University Cork, Irland.
authors.forename: Joan
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: 3 University of São Paulo, Brasilien.
authors.forename: Regina
authors.initials: R
authors.lastname: Szylit Buosso
authors.affiliation: 4 University of Surrey, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Gallagher
authors.affiliation: 2 University Cork, Irland.
authors.forename: Tom
authors.initials: T
authors.lastname: Andrews
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000941:ethics*; D064648:Critical Care Nursing / Q000941:ethics*; D003431:Cross-Cultural Comparison; D004993:Ethics, Nursing; D005858:Germany; D066296:Grounded Theory; D006801:Humans; D038622:Internationality; D018447:Medical Futility / Q000941:ethics; D017008:Negotiating; D026684:Personal Autonomy; D019555:Physician-Nurse Relations; D011368:Professional-Family Relations / Q000941:ethics; D036301:Qualitative Research; D013727:Terminal Care / Q000941:ethics*
keywords: Entscheidungsfindungsprozesse am Lebensende; Grounded Theory; Intensive care; Intensivstation; Pflege; decision-making processes at the end of life; nursing