Māori end-of-life care in the intensive care unit: A qualitative exploration of nursing perspectives

BACKGROUND: Although goals of care for intensive care patients are typically focussed on restoration of health, 8-15% of patients will die in the intensive care unit (ICU), or soon after transfer to a ward. Early recognition of the need for end-of-life care is vital to identify and support the wishes of the patient and needs of their family. In Aotearoa, New Zealand, Māori are over-represented in admissions to ICUs. Enabling nursing staff to provide culturally safe care to Māori patients and whānau (family, including extended family, kin) at the end of life is critical to upholding Te Tiriti o Waitangi requirements and providing equitable care. This qualitative study explores the experiences of both Māori and non-Māori intensive care nurses, in providing end-of-life care for Māori patients and their whānau. OBJECTIVES: The objective of this study was to characterise nursing experiences of end-of-life care for Māori in the ICU, identify barriers to and facilitators of confident, competent culturally responsive care, and highlight opportunities to improve preparation and support. METHODS: Qualitative semistructured interviews were undertaken with nine intensive care nurses (four Māori and five non-Māori) with experience ranging from novice to expert. Data collection and analysis was underpinned by reflexive thematic analysis strengthened by Kaupapa Māori Research values and tikanga best practice. FINDINGS: Participants described positive and negative experiences in caring for Māori at the end of life. Culturally responsive end-of-life care for Māori in intensive care appears dependent on the acknowledgement and inclusion of whānau as members of the multidisciplinary team. Participants identified a need for high-quality education, supportive unit end-of-life care guidelines and hospital policies, and cultural resources to confidently provide quality end-of-life care. CONCLUSION: Improved understanding of Māori culture, critical awareness of systems of power and privilege, and the availability of cultural liaisons may increase the confidence and competence of ICU nurses providing care to Māori whānau.