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

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.