Intensive care nurses' experiences with patient deaths in Germany - A qualitative interview study

Background Intensive care nurses frequently encounter patient deaths, which may manifest in emotional responses, as well as cognitive and physical reactions. Evidence suggests that this can negatively impact psychological well-being, job performance and satisfaction, and may contribute to compassion fatigue or burnout. The aim of this study was to explore intensive care nurses' experiences with patient deaths, their coping mechanisms and perceived unmet needs in Germany. Methods A qualitative study was conducted using semi-structured phone interviews from May 2024 to July 2024. Participants were 25 intensive care nurses from Germany, who were recruited by contacting nursing management staff, via social media and through direct-in-person contact. We applied purposive sampling with a maximum variation approach. The interviews were audio recorded, transcribed verbatim and analyzed using content analysis. Results The sample consisted predominantly of women (72%) and the participants experienced an average of two patient deaths per month. The participants described both emotional and cognitive reactions regarding patient deaths (e.g. grief, relief, long-term memory of the deceased). Patient deaths that occurred suddenly, under tragic circumstances or despite intensive medical efforts were experienced as particularly stressful. Frequent confrontation with death and acting against one's own moral beliefs were described as factors that can influence emotional distress. The effects of patient deaths on ICU nurses' personal life included a greater appreciation of their own life and health, as well as acceptance of death as natural part of life. Peer support was identified as a valuable coping mechanism, whereas attitudes toward formal support services were mixed-ranging from a desire for greater support to skepticism regarding their usefulness. Conclusion This study highlights both negative and positive effects on ICU nurses in Germany related to patient deaths, with moral distress and circumstances of death emerging as key stressors. The results underscore the need for institutional support and a more open culture around death and dying in intensive care settings. Further research should clarify which support measures are perceived as effective and for whom, in order to develop tailored interventions to mitigate professional grief. Trial registration Open Science Framework: https://doi.org/10.17605/OSF.IO/R2YVF Registration date: 11/28/2024 Keywords: Intensive care nurses, patient death, professional grief, qualitative interview study