Nurses’ Perception of Futile Care: A Systematic Review

Abstract

Background: Advances in medical technology have improved patient survival; however, the continuation of treatment at the end of life often raises ethical and professional concerns, particularly when such care is perceived as futile. Nurses, due to their continuous bedside presence, are frequently involved in and affected by decisions related to futile care.

Methods: This review aimed to synthesize existing literature on nurses’ perceptions of futile care, including how futility is defined, factors influencing these perceptions, and the professional outcomes associated with providing such care. A systematized systematic review was conducted in accordance with PRISMA guidance. PubMed, Medline, ProQuest, and Google Scholar were searched for relevant English-language studies published between 1980 and 2020. Qualitative, quantitative, and mixed-methods studies focusing on nurses’ perceptions of futile care were included. Due to methodological diversity among studies, findings were synthesized narratively.

Results: Twenty-two studies met the inclusion criteria. Across settings, nurses’ perceptions of futile care ranged from moderate to high. Futile care was commonly described as treatment lacking physiological benefit, prolonging the dying process, or failing to improve quality of life. Factors influencing perception included family insistence on continued treatment, cultural and religious values, interprofessional conflict, and organizational constraints. Perceived futile care was consistently associated with moral distress, emotional exhaustion, burnout, and reduced job satisfaction among nurses.

Conclusion: In conclusion, nurses frequently encounter and perceive futile care in critical care environments, with notable ethical and occupational consequences. Interventions focusing on education, communication, multidisciplinary decision-making, and institutional support may help reduce moral distress and improve the quality of end-of-life care.