Learning Objective #1: Describe three ways geographical factors can influence end of life care in critical care.

Learning Objective #2: Discuss the implications of geographical influences on health care practices in critical care.

---

This paper will report the results of a qualitative research study investigating factors influencing critical care nurses' provision of end of life care and their inclusion of families in that care. This paper reports a major theme centered on geographical factors that influence health care providers physical movement across space – during the provision of end of life care. The study design used focus groups with critical care nurses. The study participants were 30 licensed critical care registered nurses with more than nine months of experience working at least 50% time in adult critical care units who were recruited from two Mid-western teaching medical centers. The 5 focus groups lasting approximately 2 hours used an interview guide to focus on the following questions: 1) what makes for a good death or a bad death; 2) expectations of people who are admitted to critical care, i.e., basis for making judgments; 3) In what ways are family helpful or not helpful and included in care; 4) what are the sources of conflict with families and how is conflict resolved. Focus group sessions were audio-taped and transcribed verbatim into typed transcripts. Data analysis was completed by a research team who: 1. read focus group transcripts to get a sense of the whole; 2. identified codes, words or phrases to organize the data; 3. Developed a unified system of coding and collapsed codes into categories; 4. abstracted categories into themes, and wrote detailed descriptions for the multiple dimensions of each theme. The findings describe dimensions of the geographical factors influencing end of life care including: the transformation of critical care space to sacred space; the body as a geographical site mapped by medical specialties and procedurally/spatially driven resuscitation status and goals. Significant implications of how geographical factors shape practice will be discussed.