Critical Care Nurses’ Perceptions of End of Life Communication

Research Article

Austin Crit Care Case Rep. 2017; 1(1): 1002.

Critical Care Nurses’ Perceptions of End of Life Communication

Sharon Siaw CC, Azlina Y and Soon LK*

School of Health Sciences, Universiti Sains Malaysia, Malaysia

*Corresponding author: Soon Lean Keng, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Malaysia

Received: March 24, 2017; Accepted: July 19, 2017; Published: July 26, 2017


Background: Communication during the End of Life (EOL) is essential for successful navigation through the end of life continuum. However, critical care nurses’ communication during EOL is a phenomenon with limited research.

Objective: This study’s objective was to describe critical care nurses’ perceptions concerning their EOL communication in a tertiary teaching hospital.

Methods: A cross-sectional study was used. Fifty-four critical care nurses were recruited using simple random sampling between December 2014 and February 2015. A 20-item caring for Terminally Ill Patients Nurse Survey (CTIPNS) questionnaire was employed to collect the data. Data was analyzed using SPSS 22.0 for descriptive and inferential analysis.

Results: The mean perception of EOL communication score was 3.28 (SD 0.20). A significant association was found between the critical care nurses’ perceptions of EOL communication and working experience (p = 0.04).

Conclusion: Working experience influences critical care nurses’ perceptions of EOL communication. It can be concluded that specific nursing education programs such as those offered by the EOL Nursing Education Consortium should continue to improve the capacity of critical care nurses to deliver quality EOL communication to dying patients and their families.

Keywords: Critical care nurses; Perception; End of life; Communication; Dying


Communication is a central element of nursing to provide Endof- Life (EOL) care. All nurses will at some point be required to care for patients who are dying and communication is the key to doing this efficiently. Good communication enables nurses to establish the patient’s priorities and wishes, and to support them to make informed decisions about healthcare. It also provides an opportunity to explore any anxieties or gaps in understanding of the situation, reassure patients and their families, and alleviate anxiety and distress. Good communication allows patients and their families to prepare for the future, and to express and meet their preference for EOL care [1]. Ironically, all too often good EOL communication is not achieved [2]. Dying is the final portion of the life cycle for a human. Barriers to EOL communication among nurses include uncertainty about prognosis, which can make nurses reluctant to discuss EOL care with their patients in a clinical environment [3]. This is particularly the case for patients with non-cancer conditions, which are often characterized by relapses and remissions, and have a less predictable dying phase. In some instances, if a patient is faced with a serious illness and little time to live, they may choose to prioritize quality of life over extending the amount of time left, while acknowledging the uncertainty of their situation [4]. A descriptive correlational survey study on 31 oncology nurses in a Magnet-designated hospital in Southern California has shown that despite nurses having fairly positive attitudes toward hospice and engaging in discussions about prognosis with terminally ill patients, they reported missed opportunities for discussions and patient referrals to hospice [5]. There is scant literature regarding critical care nurses’ perceptions of EOL communication in acute care settings. Several early studies focused on nurses caring for patients who were nearing the EOL [6- 9]. Critical care nurses were found to experience various emotions, feelings, and thoughts as they faced EOL issues in the critical care unit. While providing important information, these studies were limited to patients with terminal diagnoses.

Relatively little is known about how critical care nurses perceive EOL communication in Malaysia. It is thus important to investigate this issue. This paper reports a study that sought to fill this gap in knowledge at the local level and share it at the international level to contribute to the evidence base for informing future critical care nursing practice when dealing with EOL communication.


Design, settings, and participants

A cross-sectional research design was employed for the purpose of determining critical care nurses’ perceptions of EOL communication in a tertiary teaching hospital in Malaysia between December 2014 and February 2015. The sample size was determined through Power and Sample (PS) Size calculation software and based on the 95% confidence interval and 80% power in Boyd, Merkh, Rutledge and Randall’s 2011 study [5]. This was done to ensure the accuracy of the sample by avoiding sampling errors, and to determine the sample’s representativeness and parameters. Using the PS calculation, the sample size was 54 participants. Simple random sampling was undertaken using the Microsoft Excel software to recruit eligible study participants. Participants were eligible if they had at least one year of critical care nursing experience and were willing to participate. Participants were excluded if they were unavailable during the data collection period for reasons such as maternity leave or study leave.

Data collection

Data was collected using the 20-item Caring for Terminally Ill Patients Nurse Survey (CTIPNS)developed by Boyd et al. [5], which has been tested for validity and reliability (Cronbach a = 0.7). The dependent variables were critical care nurses’ perceptions of EOL communication, while the independent variables were demographic information including age, gender, years of working experience, and level of nursing education. The CTIPNS questions require Likert-type responses ranging from 1 (strongly agree) to 5 (strongly disagree). On the Likert-type items, higher scores indicate more agreement regarding EOL communication. The main researcher, who knew the system of this critical care service, collected data after shift work.

Ethical considerations

The participating hospital and the researchers’ institution approved the study in accordance with their ethical guidelines. Permission to use the Caring for Terminally Ill Patients Nurse Survey (CTIPNS) questionnaire was sought and granted from its original author. Participants who met the research inclusion criteria were given information about the research, and participation was voluntary.

Data analysis

Statistical analyses were conducted using the Statistical Package Social Sciences (SPSS) software version 22. Descriptive statistics were used to describe frequencies and measures of central tendencies. Associations among selected demographic data (age, gender, years of working experience, and level of nursing education) and nurses’ perceptions were calculated using Pearson’s correlation coefficients, independent t-test, and one-way ANOVA. The significance level was set at 0.05.


Participant characteristics

Table 1 describes the demographic characteristics of the 54 critical care nurses who participated in the study. The majority (66.7%) were females, while 33.3% were males. Most of the nurses’ ages fell between 25-30 years old (40.7%). More than half of the nurses had one to five years’ working experience in critical care nursing. Only two nurses had a Bachelor’s Degree, four had a Post Basic Diploma, while the rest had a Diploma as their highest level of nursing education.

Critical care nurses’ perceptions of EOL communication

Critical care nurses’ perceptions of EOL communication were measured using the 5-point Likert scale. The six domains of perception tested are presented in Table 2. The mean score for self-rated perception was 3.36, while comfort with initializing had the lowest mean score of 2.65. The mean score for benefit of communication to patients was 3.46, while perceived doctors’ comfort and responsibility was 3.23. The mean score for perceived patients’ perception was 3.28, and the highest mean score (3.72) was recorded for palliative care team.

Figure 1 shows that the overall, the nurses’ perception of EOL communication was “good”. The mean perception score for all 54 respondents was 3.28, with a standard deviation of 0.20. The distribution of data was positively skewed. The median (3.25) is slightly lower than the mean.

Citation:Sharon Siaw CC, Azlina Y and Soon LK. Critical Care Nurses’ Perceptions of End of Life Communication. Austin Crit Care Case Rep. 2017; 1(1): 1002.