Table 2 ICU nurses’ perceived barriers to end-of-life care

2.The nurse having to deal with distraught family members while still providing care for the patient.

2.91

1.21

1

3.09

1.31

1

8.99

21.The nurse having to deal with angry family members.

2.86

1.30

2

3.06

1.37

2

8.75

22.The family, for whatever reason, is not with the patient when he or she is dying.

2.82

1.29

3

3.02

1.29

4

8.52

5.Not enough time to provide quality end-of-life care because the nurse is consumed with activities that are trying to save the patient’s life.

2.72

1.43

4

2.94

1.41

5

8.00

1.Families not accepting what the physician is telling them about the patient’s poor prognosis.

2.59

1.10

8

3.03

1.29

3

7.85

19.Family members not understanding what “life-saving measures” really mean, i.e., that multiple needle sticks cause pain and bruising, that an ET tube won’t allow the patient to talk, or that ribs may be broken during chest compressions.

2.68

1.31

6

2.90

1.33

6

7.77

20.The nurse not knowing the patient’s wishes regarding continuing with treatments and tests because of the inability to communicate due to a depressed neurological status or due to pharmacologic sedation.

2.68

1.29

6

2.87

1.30

7

7.69

3.Intra-family fighting about whether to continue or stop life support.

2.54

1.12

10

2.87

1.25

8

7.29

6.Poor design of units which do not allow for privacy of dying patients or grieving family members.

2.55

1.44

9

2.70

1.47

9

6.89

10.No available support person for the family such as a social worker or religious leader.

2.54

1.64

10

2.70

1.66

9

6.86

14.Continuing treatments for a dying patient even though the treatments cause the patient pain or discomfort.

2.53

1.32

12

2.62

1.38

11

6.63

18.Being called away from the patient and family because of the need to help with a new admit or to help another nurse care for his/her patients

2.47

1.31

13

2.61

1.33

13

6.45

7.Unit visiting hours that are too restrictive.

2.47

1.41

13

2.59

1.43

15

6.40

15.Lack of nursing education and training regarding family grieving and quality end-of-life care.

2.40

1.36

15

2.62

1.37

11

6.29

4.The nurse knowing about the patient’s poor prognosis before the family is told the prognosis.

2.69

1.47

5

2.33

1.55

20

6.27

12.Continuing intensive care for a patient with a poor prognosis because of the real or imagined threat of future legal action by the patient’s family.

2.40

1.36

15

2.57

1.40

16

6.17

13.Pressure to limit family grieving after the patient’s death to accommodate a new admit to that room.

2.33

1.33

18

2.6

1.43

14

6.06

17.The unavailability of an ethics board or committee to review difficult patient cases.

2.36

1.45

17

2.52

1.46

17

5.95

9.Dealing with the cultural differences that families employ in grieving for their dying family member.

2.25

1.22

19

2.51

1.31

18

5.65

16.Physicians who won’t allow the patient to die from the disease process.

2.24

1.21

20

2.43

1.27

19

5.44

11.Employing life sustaining measures at the families’ request even though the patient had signed advanced directives requesting no such treatment.

2.11

1.31

21

2.32

1.37

21

4.90

26.When the nurses’ opinion about the direction patient care should go is not requested, not valued, or not considered.

1.97

1.21

22

2.19

1.31

22

4.31

24.Multiple physicians, involved with one patient, who differ in opinion about the direction care should go.

1.68

1.17

23

1.91

1.29

23

3.21

23.Physicians who are evasive and avoid having conversations with family members.

1.59

1.28

25

1.84

1.36

24

2.93

8.The patient having pain that is difficult to control or alleviate.

1.64

1.21

24

1.78

1.25

25

2.92

25.Continuing to provide advanced treatments to dying patients because of financial benefits to the hospital.

1.34

1.31

26

1.57

1.40

26

2.10