Background: The intensive care unit environment focuses on interventions and support therapies that
prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in
the multidisciplinary team and on their function in the intensive care unit context. There is much
international research relating to nurses’ involvement in end-of-life situations; however, there is a paucity
of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain
reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the
Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident.
Objective: To understand the process by which nurses exercise autonomy in making end-of-life decisions
in intensive care units.
Research design: Symbolic Interactionism and Corbin and Strauss theory methodology were used for this
study.
Participants and research context: Data were collected through single audio-recorded qualitative
interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding
of the meaning of nurse’s experience in exercising autonomy relating to end-of-life decision-making.
Ethical considerations: Institutional ethics approval was obtained for data collection. Participants gave
informed consent. All data were anonymized.
Findings: The results revealed that nurses experience the need to exercise autonomy in intensive care
units on a daily basis. Their experience expressed by the process of increase opportunities to exercise
autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can
grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions
made by other professionals.
Conclusion: Nurses exercise their autonomy through care. They work to create new spaces at the same
time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life
situation, nurses must adopt a proactive attitude that inserts them into the decision-making process.