Supporting Families During End-of-Life Care in Intensive Care Units: A Qualitative Descriptive Study of Nurses' Experiences in Saudi Arabia.

Background/Objectives: Supporting families during end-of-life care in intensive care units is clinically, emotionally, and ethically demanding, and nurses' experiences of this work in Saudi Arabian intensive care settings remain underexplored. This study explored nurses' experiences of providing psychosocial and emotional support to families during end-of-life care, including their role in treatment-limitation and goals-of-care discussions. Methods: A qualitative descriptive study, analyzed using reflexive thematic analysis from a contextualist position, was conducted with 15 intensive care nurses across three healthcare facilities in Riyadh. Ten were Saudi nationals and five internationally recruited; eleven had Arabic as a first language. Semi-structured interviews were conducted in Arabic (n = 11) or English (n = 4) between December 2025 and February 2026 and coded in the language of collection. Results: Three themes were developed: doing relational work inside a system organized for clinical throughput; carrying what the work leaves behind; and standing between, brokering understanding for families. Nurses described having no formal decision-making authority while shaping what families understood and what the clinical team heard. Conclusions: Nurses positioned themselves as intermediaries between families and clinical teams. This relational work was shaped by staffing, formal preparation, access to palliative care, and physician recognition of the nursing role. Strengthening these organizational conditions may support more consistent family care.