Nursing Caring for Terminal Patients in the ICU: A Systematic Literature Review on Humanistic Roles Beyond Artificial Intelligence

Background: End of life care (EOLC) in intensive care units (ICUs) involves complex ethical, emotional, and systemic challenges that are increasingly influenced by the integration of artificial intelligence (AI) in healthcare. Nurses often experience moral distress when balancing life sustaining interventions and patient dignity while adapting to technological systems that affect empathy, accountability, and clinical judgment. Objective: This study aims to synthesize empirical evidence on nurses’ experiences, ethical dilemmas, and evolving roles in providing EOLC within the digital era, emphasizing the humanistic aspects that extend beyond AI applications. Methods: A systematic literature review was conducted following the PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, and CINAHL databases for peer reviewed articles published between 2019 and 2025. Nine eligible studies were analyzed thematically, covering ethical, emotional, cultural, systemic, and technological dimensions of EOLC nursing. Results: Nurses reported moral distress, limited palliative care competence, emotional fatigue, and inadequate institutional support. While AI enhanced efficiency and decision accuracy, concerns persisted about algorithmic bias, data transparency, and dehumanization of care. The findings highlight the irreplaceable human role of nurses in providing empathy, moral reasoning, and spiritual presence within AI supported environments. Conclusion: Effective EOLC in the AI era requires synergy between technological precision and compassionate nursing. Sustaining human centered values remains essential to ensure ethical integrity, emotional resilience, and dignified patient care.