Culturally appropriate and respectful end-of-life care for patients and their families in the intensive care unit: A mixed-method study

Abstract

Background: Australia is culturally and linguistically diverse. Yet little is known about perceived barriers to the provision of end-of-life care tailored to diverse cultural needs and preferences.

Aims: The aim of this study was to measure critical care nurses' cultural intelligence, comfort, and capabilities in providing end-of-life care and explore the perceived barriers to providing end-of-life care for culturally diverse patients and their families.

Method: An explanatory mixed-method approach was undertaken utilising surveys and interviews. A national survey was distributed in February 2024, collecting data about critical care nurses' capability, comfort, and cultural intelligence when providing end-of-life care. Individual interviews were conducted with nurses between March and April 2024. Quantitative data were analysed using descriptive and inferential statistics, and open-ended survey and interview responses were analysed using inductive content analysis.

Findings: From the sample of 89 survey responses, the median number of years nurses worked in the intensive care unit was 15 (interquartile range = 7.0-21.5). Respondents came from 14 different countries, 20.2% (n = 18) spoke a second language, and 50.6% (n = 45) were affiliated with a religion. One-third had completed end-of-life care training (34.8%, n = 31), whilst 31.5% (n = 28) had completed training in cultural diversity. Respondents who completed end-of-life care training had significantly higher comfort and capability scores regarding end-of-life care provision (Mdn = 91.0) than those with no training (Mdn = 80.5, U = 1301.0, p < 0.001). Interview participants acknowledged some discomfort with diversity, and the importance of prioritising comfort and dignity, and understanding and interpreting cultural preferences. Communication challenges associated with professional interpreter access were also identified.

Conclusion: Critical care nurses' comfort and capabilities with end-of-life care and perceptions of the barriers are critical to understand because end-of-life care is about more than clinical care. Supporting nurses to build their understanding and comfort with providing care that aligns with cultural and religious needs and preferences, and optimising access to professional interpreters, is imperative.

Keywords: Communication; Critical care; Critical care nursing; Cultural diversity; Culture; End-of-life care; Ethnic and racial minorities; Terminal care; Transcultural nursing.