Background Continuing futile life-sustaining treatment prolongs patients’ suffering and family members’ and medical staff’s psychological distress. Additionally, continuing futile treatment is inefficient in healthcare resource distribution. Although the withdrawal of futile life-sustaining treatment is ideal, the prevalence is variable. Objective To synthesise nurses’ and physicians’ experiences with continuing futile life-sustaining treatment in the intensive care unit. Design This meta-synthesis was conducted following the thematic synthesis. The Preferred Reporting Items for Systematic Review and Meta-Analyses and Enhancing transparency in reporting the synthesis of qualitative research statement were used in reporting the synthesis of qualitative research statements. Methods and data sources A systematic search was conducted following the inclusion and exclusion criteria in APA PsycINFO, CINAHL Plus, EMBASE, MEDLINE, PubMed and Web of Science in May 2023. Two reviewers independently screened and extracted the data. The extracted data were analysed using thematic analysis of qualitative research. Findings A total of 16 studies were finally included, and 141 quotes were extracted and analysed. The main findings were categorised into four themes: (1) contextual and cultural diversity, (2) perceptions of futile treatment, (3) professional roles and responsibilities, and (4) emotional distress. Conclusion The study highlights the influence of culture, religion and family members, as well as perceptions of futile treatment among clinicians, on continuing futile life-sustaining treatment. Also, nurses’ awareness of their roles and responsibilities in ensuring patients’ comfort at end of life was revealed. This study informs future research to explore the experiences of futile life-sustaining treatment across various contexts.

Aim: To synthesise nurses' and physicians' experiences with withdrawing life‐sustaining treatment in an intensive care unit.Design: The chosen methodology is thematic synthesis. The Preferred Reporting Items for Systematic Review and Meta‐Analyses and Enhancing Transparency are used in Reporting the Synthesis of Qualitative Research Statement.Methods and Data Sources: A systematic search is conducted in APA PsycINFO, CINAHL Plus, EMBASE, PubMed and Web of Science following the inclusion and exclusion criteria in April 2023. Two reviewers independently screened and extracted the qualitative data. Subsequently, data analysis was conducted using thematic analysis of qualitative research. This study was not registered with any review registry due to the irrelevance of the data to health‐related outcomes.Results: From the 16 articles, 267 quotes were extracted and analysed. The findings of the study revealed five analytical themes: (1) tensions between interdependent collaboration and hierarchical roles; (2) tensions between dignified dying or therapeutic perspectives; (3) family members' reflections of patient's wishes; (4) tensions in family members' positions; and (5) double‐sidedness of distress.Conclusion: This study contributes to nursing knowledge by providing a more nuanced understanding of this complex phenomenon of withdrawing life‐sustaining treatment. The findings of this study have revealed significant variations globally in the practices surrounding the withdrawal of life‐sustaining treatment in intensive care units, emphasising the need for further research to inform clinical practices that cater to diverse contexts.Reporting Method: Enhancing Transparency are used in Reporting the Synthesis of Qualitative Research Statement (ENTREQ statement).Patient or Public Contribution: Since this study reported a potential collision between the patient's dignified dying and the family member's perceptions and interests, the family member's wishes should be carefully distinguished from the patient's quality of end of life in practice.

Aim: Internationalization at Home (IaH) strategies play an important role in nursing curricula to enhance nursing students' cultural awareness in the globalized world. The Community of Inquiry (CoI) is a theoretical framework for the optimal design of online learning environments to support critical inquiry and discourse among students and teachers. To optimise nursing students' online cultural awareness learning experiences, it was timely to develop online IaH strategies based on a sound theoretical model. This study aimed to examine the effectiveness of CoI‐guided online IaH strategies on enhancing the cultural awareness of nursing undergraduates who enrolled in a community nursing course.Design: This was an interventional pre‐test post‐test study.Method: One hundred and six nursing undergraduates who enrolled in the course participated in the study. The online IaH strategies were developed focusing on the interactions of teaching presence, cognitive presence and social presence of CoI framework and they were integrated into the course. A previously validated Cultural Awareness Scale was adopted for pre‐post evaluation. Higher scores indicate greater cultural awareness.Results: The results showed that there was a significantly higher total score of cultural awareness of participating students at post‐online IaH strategies. To be effective, aligning CoI‐guided online IaH strategies with course content, pedagogy and assessment was shown to be significant. The inclusion of technological elements in related strategies was also critical to engage student learning. The positive change on the total score of cultural awareness suggested the effectiveness of the deployed strategies. In this ever‐changing educational landscape, it may provide insights to educators regarding considering online IaH strategies with theoretical underpinning for curriculum planning and design.