TITLE:
Experiences of Intensive Care Unit Nurses with the Provision of End of Life Care at Kamuzu Central Hospital, Lilongwe, Malawi
AUTHORS:
Memory Msowoya, Chileshe Mwaba Siwale, Ruth Wahila
KEYWORDS:
Intensive Care Nurse, End-of-Life Care, Experience, Intensive Care Unit
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.8,
August
11,
2026
ABSTRACT: Background: End-of-life care (EOLC) is increasingly recognized as an essential aspect of critical care, particularly in resource-limited settings where patients often present with complex needs and poor prognoses. In the ICU, some patients reach a terminal stage requiring a shift from life-sustaining treatment to EOLC. Nurses’ roles in this process vary across cultural, religious, organizational and legal contexts. In Malawi, limited evidence exists on ICU nurses’ experiences with EOLC. This study explored their emotional, ethical and professional perspectives. Methodology: A descriptive phenomenological design was used to explore ICU nurses’ experiences with EOLC at Kamuzu Central Hospital’s main ICU in Lilongwe. Purposive sampling recruited 12 ICU nurses. Data were collected through in-depth, audio-recorded interviews guided by the core question: “What are your experiences as an ICU nurse providing EOLC?”. Interviews were transcribed verbatim and analysed thematically using Braun and Clarke’s six-step approach, supported by NVivo for data organization. Results: Five themes with sixteen sub-themes emerged: 1) conceptualisation of EOLC, 2) holistic practice, 3) emotional distress, 4) institutional constraints, and 5) need for enhanced support. Nurses’ understanding of EOLC was shaped by culture, beliefs and professional exposure. Holistic practice involved meeting physical, psychological and spiritual needs. However, limited training, resource shortages and lack of dedicated spaces heightened emotional strain. Participants emphasised the need for better training, resources and multidisciplinary collaboration. Conclusion: Nurses strive to provide dignified, holistic EOLC, but institutional barriers hinder practice. Strengthening training, improving resources, supporting palliative care structures and enhancing teamwork are essential to improving EOLC quality and consistency.