Intensive care unit nurses’ perceptions of obstacles to the provision of end-of-life care in the Kingdom of Saudi Arabia: A mixed methods study

Background Many patients die in intensive care units within an intense medical treatment environment, and this situation can affect the quality of end-of-life care. Studies have reported that nurses may feel a sense of failure when their patient is dying, and can find the provision of end-of-life care emotionally difficult. Very little is known about this phenomenon in the Kingdom of Saudi Arabia, where multiple cultural influences may further influence end-of-life care provision. Aim The aim of this study was to explore nurses’ perceptions of obstacles to the provision of end-of-life care in intensive care units in Saudi Arabia. Method A sequential explanatory mixed method design was used. This method included two phases: questionnaires and interviews. For Phase One a questionnaire developed by Beckstrand and Kirchhoff (2005) was modified and only data about obstacles were collected. For Phase One 87 questionnaires were returned from 140 potential respondents, representing a 62% response rate. In Phase Two, face-to-face interviews were conducted with four ICU charge nurses. The two phases were conducted in a major specialist hospital in Saudi Arabia. Results The Phase One findings highlighted concerns with patient’s family, physicians who differed in opinions, cultural differences, and how language barriers affect communication. The nurses also suggested avoiding unnecessary care, the need for end-of-life care awareness, education and preparation were also issues. The Phase Two findings indicated concerns when family members did not understand the patients’ situations, lack of family support, cultural differences and language barriers. The nurses suggested the need for both end-of-life care awareness for nurses and increased involvement of nurses in decision-making. Education and preparation for dying patients and their family were also recommended by nurses. Conclusion The findings of this study show a number of obstacles to the provision of end-of-life care in intensive care units, which may affect nurses’ ability to maintain quality end- of-life care. Therefore, the further development of both end-of-life care guidelines and nursing education about end-of-life care in intensive care units is recommended.