What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU? An integrative review.

Background: Cultural diversity is increasing worldwide. The provision of end-of-life care for people who have culturally diverse rituals, customs and beliefs can present barriers for critical care nurses in delivering high quality end-of-life care.

Aim: To synthesise research evidence about the perceived barriers for critical care nurses providing end-of-life care for patients and their families from diverse cultural backgrounds in ICU.

Research question: What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU?

Design: Following protocol registration, a structured integrative review was undertaken across Medline, Embase, APA PsycINFO, CINAHL Complete, Cochrane library, Google Scholar and ProQuest Dissertation and Theses Global databases. A total of 823 records were independently assessed against inclusion and exclusion criteria. All included studies were assessed for quality. Narrative synthesis was used to report findings.

Results: Fifteen studies published between 2010 and 2022 were included. Findings are presented according to four themes: (i) Language and communication, (ii) (Dis) Comfort with religion, (iii) Consensus challenges and (iv) Caring at the end of life.

Conclusion: Recognising cultural diversity provides opportunity for critical care nurses to build awareness and understanding of cultural diversity as a way of optimising end-of-life care, through routine cultural assessment, advocating for professional interpreters to enhance communication and demonstrating openness to diverse cultural needs, preferences and practices.

Implications for clinical practice: The obvious first step in countering perceived challenges to end-of-life care is to increase awareness by acknowledging and respecting difference and diversity. Cultural assessments for all patients admitted to critical care would be an ideal first step in addressing challenges associated with cultural diversity. Greater access to professional interpreters to overcome language barriers is also essential to optimising communication and consensus in decision-making at the end of life.