Nurses’ Roles in Supporting Family End-of-Life Decision-Making in Intensive Care Units: A Phenomenological Study

Nurses’ Roles in Supporting Family End-of-Life Decision-Making in Intensive Care Units: A Phenomenological Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nurses’ Roles in Supporting Family End-of-Life Decision-Making in Intensive Care Units: A Phenomenological Study Abdulaziz M. Alodhailah, Albandari Almutairi, Faihan F. Alshaibany, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8996149/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background: End-of-life decision-making in intensive care units represents one of the most challenging aspects of nursing practice. Despite the critical role nurses play in supporting families through these decisions, limited understanding exists regarding the strategies, challenges, and contextual factors that shape this experience. This study seeks to understand how nurses provide emotional and psychological support to families navigating end-of-life decisions in ICU settings. Methods: A phenomenological qualitative study was conducted with 15 nurses from three major healthcare facilities in Riyadh, Saudi Arabia. Semi-structured interviews were conducted between December and February 2025. Thematic analysis was performed using Braun and Clarke's six-phase approach to identify patterns and themes reflecting nurses' lived experiences. Results: Four overarching themes emerged from the analysis: (1) Balancing act, which entails navigating competing demands between patient care and family support; (2) Emotional labor and resilience, involving the managing personal distress while maintaining professionalism; (3) Institutional barriers and facilitators, which are systemic factors affecting support provision; and (4) Strategies for effective engagement, encompassing communication techniques and approaches that foster family understanding and decision-making. Nurses described profound emotional experiences, ranging from deep satisfaction when providing meaningful support to significant moral distress when institutional constraints prevented them from fully meeting family needs. Conclusions: Nurses serve as critical bridge-builders during end-of-life transitions, yet their capacity to provide comprehensive psychosocial support is significantly constrained by institutional resources, organizational policies, and insufficient training. Enhanced institutional support, structured training programs, and policy reforms are essential to strengthen nurses' ability to accompany families through these profound life transitions. end-of-life care intensive care unit nurses family support decision-making phenomenology qualitative research palliative care Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFiles.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Mar, 2026 Reviewers agreed at journal 19 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers invited by journal 16 Mar, 2026 Editor invited by journal 04 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Submission checks completed at journal 03 Mar, 2026 First submitted to journal 28 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Despite the critical role nurses play in supporting families through these decisions, limited understanding exists regarding the strategies, challenges, and contextual factors that shape this experience. This study seeks to understand how nurses provide emotional and psychological support to families navigating end-of-life decisions in ICU settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A phenomenological qualitative study was conducted with 15 nurses from three major healthcare facilities in Riyadh, Saudi Arabia. Semi-structured interviews were conducted between December and February 2025. Thematic analysis was performed using Braun and Clarke's six-phase approach to identify patterns and themes reflecting nurses' lived experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Four overarching themes emerged from the analysis: (1) Balancing act, which entails navigating competing demands between patient care and family support; (2) Emotional labor and resilience, involving the managing personal distress while maintaining professionalism; (3) Institutional barriers and facilitators, which are systemic factors affecting support provision; and (4) Strategies for effective engagement, encompassing communication techniques and approaches that foster family understanding and decision-making. Nurses described profound emotional experiences, ranging from deep satisfaction when providing meaningful support to significant moral distress when institutional constraints prevented them from fully meeting family needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Nurses serve as critical bridge-builders during end-of-life transitions, yet their capacity to provide comprehensive psychosocial support is significantly constrained by institutional resources, organizational policies, and insufficient training. Enhanced institutional support, structured training programs, and policy reforms are essential to strengthen nurses' ability to accompany families through these profound life transitions.\u003c/p\u003e","manuscriptTitle":"Nurses’ Roles in Supporting Family End-of-Life Decision-Making in Intensive Care Units: A Phenomenological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 01:43:26","doi":"10.21203/rs.3.rs-8996149/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-20T06:43:17+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"43737675457130852493465243971542881228","date":"2026-03-19T08:21:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60311550826903268391610160381396775945","date":"2026-03-18T20:28:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T19:40:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T21:30:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109698210580436742196461515336623295351","date":"2026-03-17T19:51:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61106612682413521936373630643632209982","date":"2026-03-17T09:15:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203321841927839376087036750664150770169","date":"2026-03-17T01:07:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227429187085197611933777145525564684511","date":"2026-03-16T21:50:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83137197023595434299391994887972191293","date":"2026-03-16T19:23:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218022822100599600533349589876140123840","date":"2026-03-16T19:19:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T19:18:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-04T06:29:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-04T00:59:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-04T00:58:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-02-28T14:35:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2eba6dd2-058e-410f-a442-d2a4897c65e6","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-28T09:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 01:43:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8996149","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8996149","identity":"rs-8996149","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}