Maori 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, Maori are over-represented in admissions to ICUs. Enabling nursing staff to provide culturally safe care to Maori patients and whanau (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 Maori and non-Maori intensive care nurses, in providing end-of-life care for Maori patients and their whanau. Objectives: The objective of this study was to characterise nursing experiences of end-of-life care for Maori 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 Maori and five non-Maori) with experience ranging from novice to expert. Data collection and analysis was underpinned by reflexive thematic analysis strengthened by Kaupapa Maori Research values and tikanga best practice. Findings: Participants described positive and negative experiences in caring for Maori at the end of life. Culturally responsive end-of-life care for Maori in intensive care appears dependent on the acknowledgement and inclusion of whanau 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 Maori 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 Maori whanau. (c) 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).