Losing a close person to death in ICU: A thematic analysis of bereaved family members’ experiences of end-of-life care

OBJECTIVES: This study aims to describe bereaved family members experiences of end-of-life care following the death of a close person in ICU. METHODS: A qualitative descriptive design was used. Semi-structured interviews were conducted with 22 bereaved family members (18 women and 4 men, aged 26 to 81 years). The inclusion criteria were being a bereaved family member of an adult patient who had died in one of the seven participating ICUs, being at least 18 years old, and proficient in Swedish. Data was analyzed using reflexive thematic analysis. RESULTS: The findings are described in five themes: Time filled with fear and uncertainty, Challenges in understanding critical information, Struggling to grasp the imminence of death, Fear of patient had suffered at the very end of life, and The importance of farewell in the ICU. Family members described the transition from therapeutic treatment to end-of-life care as being unclear, with the realization of death was approaching occurring gradually and sometimes suddenly, leading to confusion and distress. The opportunity to take farewell, whether through physical presence, shared silence, or collective rituals, was described as essential to finding peace and fostering emotional closure. CONCLUSIONS: In ICUs, family members are in great need of compassionate support, characterized by the presence of ICU nurses and their emotionally attuned communication. This support helps family members navigate the complexity in care, fostering trust, meaning-making, and a sense of dignity. IMPLICATIONS FOR CLINICAL PRACTICE: It is important that ICU nurses have the possibility to prioritize sensitive, individualized communication, emotional support, and opportunities for meaningful farewells. Flexibly accommodating family members' needs and preferences at the end of life is central to delivering respectful family-centered care.