Prolonged Grief in ICU Nurses After Supporting Families Through Pragmatic Decisions Regarding Terminal Extubation
DOI:
https://doi.org/10.61919/1mtps325Keywords:
Compassion Fatigue, Critical Care Nursing, End-of-Life Care, Grief, Intensive Care Units, Secondary Traumatic Stress, Terminal ExtubationAbstract
Background: Intensive care nurses repeatedly participate in terminal withdrawal of mechanical ventilation while simultaneously supporting patients and families through emotionally demanding end-of-life decisions. Persistent grief-related responses associated with this professional exposure remain insufficiently characterized. Objective: To examine grief-related symptoms and compassion-fatigue dimensions and explore the lived experiences of ICU nurses repeatedly involved in terminal weaning and extubation. Methods: A mixed-methods study comprising a cross-sectional quantitative component and a qualitative phenomenological component was conducted in tertiary-care hospitals in Punjab, Pakistan, from August to November 2025. Purposively selected ICU nurses completed the PG-13 and Compassion Fatigue Short Scale followed by semi-structured interviews. Quantitative analysis included descriptive statistics, Pearson correlations, and independent-samples t tests; interview data underwent thematic analysis. Results: Forty-two of 48 screened nurses completed both study components (87.5%); 20 (47.6%) had ≤7 years and 22 (52.4%) had >7 years of ICU experience. Greater terminal-extubation exposure was associated with higher grief-related, secondary traumatic stress, and burnout scores. Nurses with >7 years of experience demonstrated greater grief-related and secondary traumatic stress burden, whereas burnout did not differ significantly by tenure. Three qualitative themes emerged: emotional burden during family decision support, compartmentalization of sorrow during clinical duties, and persistent guilt and unresolved grief-related feelings after patient death. Conclusion: Repeated involvement in terminal extubation is associated with important grief-related and secondary-traumatic psychological burden among ICU nurses. These findings support context-specific organizational support while avoiding diagnostic interpretation of PG-13 scores in the absence of occupational validation
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Copyright (c) 2026 Fouzia Pervaiz, Sumaira Nazir, Summra Nazir, Khawar Saddique, Zarina Naz (Author)
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