Facilitators and Barriers to the Provision of End-of-Life Care Among Critical Care Nurses in Adult Intensive Care Units: An Integrative Review

Despite the high occurrence of end-of-life (EOL) care in adult intensive care units, the role of the critical care nurse is underutilized. Understanding factors that influence critical care nurses’ abilities to provide EOL care is essential to improving patient care at the EOL. This study aimed to synthesize research evidence on facilitators and barriers influencing the provision of EOL care among critical care nurses in adult intensive care units. A structured integrative review, guided by Whittemore and Knafl methodology, was conducted. In July 2025, keywords, synonyms, and Medical Subject Headings were used to search the Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycInfo, and Web of Science databases. Of 786 records screened, 15 studies published between 2016 and 2024 met eligibility criteria. Data were extracted using a standardized template, quality appraisal was performed, and findings were analyzed using the constant comparison method. Four themes emerged: family dynamics, interdisciplinary collaboration, the role of critical care nurses, and systems and environment. Providing EOL care is a meaningful yet complex responsibility that requires clinical expertise, time, and effective communication. Environmental and cultural barriers, along with limited protocols and education, impede critical care nurses’ ability to ensure a comfortable death.