Near‐Death Experiences in Adult ICU Patients: A Scoping Review

ABSTRACT

Background

Near‐death experiences occur in approximately 15% of intensive care unit survivors. Despite their profound impact on post‐intensive care syndrome and long‐term psychological recovery, near‐death experiences remain under‐addressed in clinical settings.

Aim

To systematically map and synthesize evidence regarding the subjective experiences, influencing factors, assessment tools, and prognostic impacts of near‐death experiences in adult intensive care unit patients, aiming to provide a comprehensive overview and solid reference for clinical identification and future research.

Study Design

Scoping review. Guided by a scoping review framework, a systematic literature search was conducted across PubMed, Embase, Web of Science, CINAHL, the Cochrane Library, PsycINFO, China National Knowledge Infrastructure, Wanfang Database, and VIP Database, from database inception to April 17, 2026. Data from the included literature were subsequently extracted and synthesized.

Results

Seven included studies (five prospective cohorts, one qualitative, one mixed‐methods) revealed that adult intensive care unit patients experience multidimensional near‐death experiences (cognitive, affective, supernatural, and transcendental). The Greyson near‐death experience scale is the primary, albeit limited, assessment tool. Prognostically, near‐death experiences produce vivid, stable long‐term memories and elevate spiritual needs; however, their impacts on psychosocial states and death attitudes remain heterogeneous.

Conclusion

The near‐death experiences of adult intensive care unit survivors constitute a unique and multidimensional subjective experience, the understanding of which requires both optimized assessment tools and a deeper integration of neurobiological and psychological frameworks. While increased religious interest and memory stability are evident, the persistent contradictions in psychosocial outcomes suggest that specific disease trajectories and cultural factors play a critical moderating role.

Relevance to Clinical Practice

Within clinical intensive care unit practice, it is paramount to promptly identify near‐death experiences by evaluating patients' multifaceted subjective experiences and providing proactive, effective support, as this plays a critical role in facilitating psychological recovery and improving long‐term prognosis.

Impact Statements

• What Is Known About This Topic

  • ○
    This review establishes a clinical profile for intensive care unit near‐death experiences, addressing the gap between consciousness research and critical care while advocating for integrated survivorship support.
  • ○
    Near‐death experiences (NDEs) are profound psychological events occurring in intensive care unit (ICU) survivors, exerting deep existential impacts on their prognosis.
  • ○
    Despite the immense influence of NDEs on psychological recovery, patients who report these experiences frequently face misunderstanding in clinical practice or lack timely clinical validation from healthcare professionals.
• What This Paper Adds

  • ○
    This scoping review systematically maps the multidimensional phenomenological features of NDEs within the adult ICU setting.
  • ○
    The study reveals that while NDEs consistently elevate patients' spiritual needs and long‐term memory stability, their prognostic impacts on psychosocial states and attitudes toward death demonstrate high heterogeneity and are deeply moderated by specific disease trajectories and cultural backgrounds.

1. Background

Near‐death experiences (NDEs) refer to a sequence of profound psychological events occurring during clinical death, which is characterized by the cessation of respiration and cardiac function [1, 2]. These experiences typically arise in critical or life‐threatening situations [3], such as cardiac arrest, traumatic brain injury, or major surgery [4]. NDEs are fundamentally distinct from intensive care unit (ICU) delirium or hallucinations induced by sedatives and analgesics. ICU delirium typically manifests as clouded consciousness, attention deficits, and fragmented, terrifying, unstructured hallucinations [5]. In contrast, NDEs can occur even during states of severe brain dysfunction or pharmacological suppression of the central nervous system. They are characterized by paradoxical lucidity, highly coherent logical structures, and the formation of stable, accurate long‐term memories [6, 7]. Consequently, NDEs serve as a unique window for exploring human consciousness and the dying process [8].

Research indicates that the prevalence of NDEs among ICU patients is approximately 15% [7, 9], notably higher than the 4%–8% incidence reported in the general population [10, 11]. Moreover, as critical care medicine advances, a growing number of critically ill patients survive their ICU admissions and subsequently report experiencing NDEs [9]. Consequently, investigating NDEs within this population holds profound psychological, existential, and clinical significance. Patients who undergo NDEs frequently experience significant and enduring transformations in their psychological states, social behaviours, and core life values [12, 13, 14, 15]. Particularly within the context of post‐intensive care syndrome (PICS), NDEs can exert a complex influence on patients' long‐term psychological outcomes [16]: On one hand, these experiences may alleviate the fear of death and foster a heightened sense of meaning in life [17]. Conversely, if these profound events are inadequately addressed or misunderstood by healthcare professionals, they may precipitate adverse psychological outcomes, including feelings of detachment from reality and social alienation [7, 18]. Furthermore, this existential paradigm shift in patients poses considerable challenges to the coping mechanisms of their families and the daily clinical practice of healthcare providers [19].

However, owing to a general lack of attention to NDE research among healthcare professionals, patients who disclose their profound experiences often fail to receive timely clinical validation and positive reinforcement [18]. Currently, significant knowledge gaps remain regarding the specific subjective experiences most frequently reported by adult ICU patients during NDEs, the associated influencing factors, the assessment tools utilized, and the prognostic impacts of NDEs on this demographic. Therefore, it is imperative to conduct comprehensive research to synthesize this evidence, thereby providing guidance for clinicians to promptly identify NDEs and optimize effective therapeutic responses [20].

Accordingly, this study employs a scoping review methodology to systematically map the current research landscape of NDEs among adult ICU patients. By synthesizing evidence on subjective experiences, influencing factors, and prognostic impacts, this review constructs a comprehensive clinical profile tailored to adult ICU survivorship. This integrated perspective is designed to help clinicians clearly identify the NDE population, anticipate subsequent psychological needs, and establish a solid foundation for targeted clinical support and future research.

2. Methods

This scoping review is grounded in the enhanced methodological framework proposed by Levac et al. [21] and is reported in accordance with the PRISMA‐ScR guidelines [22] (Supporting PRISMA guideline). The protocol for this study has been prospectively registered on the Open Science Framework (OSF) (https://osf.io/xa3pv/?view_only=11bd2adc7ec64661b2db3764994dbe3c).

2.1. Identifying Research Questions

Following a preliminary literature review and consensus‐building discussions among the research team, the core review questions were formulated as follows: (1) What specific types of subjective experiences do adult ICU patients typically report during NDEs? (2) Which factors are most frequently associated with the occurrence of NDEs in this population? (3) What assessment tools are currently utilized to evaluate NDEs in adult ICU patients? (4) What prognostic impacts do NDEs exert on the psychological recovery, behavioural patterns, and life attitudes of adult ICU survivors?

2.2. Literature Search Strategy

A systematic literature search was conducted across the following eight electronic databases: PubMed, Embase, Web of Science, CINAHL, the Cochrane Library, PsycINFO, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. The search timeframe extended from the inception of each database to April 17, 2026. To ensure a comprehensive mapping of the historical evolution and foundational evidence regarding NDEs in the ICU, no lower date limit was applied. The search strategy utilized a combination of subject headings and keywords. Specifically, our search included keywords such as “near‐death”, “near death”, “cardiac death”, “end of life”, “dying” and “sudden death” which were combined with terms related to subjective phenomena like “experience”, “cognition”, “sensation” and “consciousness” as well as setting‐specific terms including “intensive care unit” and “ICU”. In addition to the electronic database search, we performed citation tracking by examining the reference lists of all included articles and relevant existing reviews. Supporting web searches were also conducted via Google Scholar using comparable search terms. To maintain feasibility, the overall search was restricted to articles published in English and Chinese. Detailed search strategies for all databases are provided in (Table S1).

2.3. Inclusion and Exclusion Criteria

This study systematically defined the research boundaries and established inclusion criteria based on the JBI guidelines for scoping reviews and the “PCC” (Population, Concept, Context) framework [23]: (1) Population (P): adult patients (aged ≥ 18 years). (2) Concept (C): near‐death experiences (NDEs). To enhance the transparency and reproducibility of the screening process, this study explicitly defined the core concept as subjective psychological experiences recalled by patients that occurred during periods of unconsciousness, cardiac arrest, or severe, life‐threatening illness or trauma. (3) Context (C): NDEs occurring within the ICU setting. Specifically, the onset of the NDEs must have occurred within the ICU environment; however, data collection was not restricted to the ICU and could be conducted following ICU discharge, in step‐down units, or during long‐term post‐discharge follow‐up. We primarily relied on rigorous manual screening, such as examining the inclusion and exclusion criteria of the primary studies and the timing of data collection, to ensure this requirement was met.

The exclusion criteria were as follows: (1) literature published in languages other than Chinese or English; (2) articles for which full texts were unavailable; (3) studies with incomplete data; (4) duplicate publications; and (5) reviews, systematic reviews, conference proceedings, policies, guidelines, and study protocols.

2.4. Literature Selection and Data Extraction

All retrieved literature was imported into EndNote 21 reference management software to eliminate duplicates. Two researchers (G.K.L., S.H.Q.) trained in evidence‐based medicine independently conducted an initial screening of titles and abstracts based on the predefined inclusion and exclusion criteria, followed by a rigorous full‐text review for final selection. Any discrepancies or disagreements arising during the screening process were resolved through discussion and consensus with a third researcher (Y.J.) to determine the final inclusion of studies.

A standardized Excel data extraction spreadsheet was developed to systematically extract and organize the data. The extracted variables included the first author, year of publication, country of origin, study setting, target population, sample size, identified influencing factors, assessment tools utilized, common subjective experiences reported, and prognostic outcomes. In this review, the dimensional classification of subjective experiences reported by ICU patients with NDEs was predicated on the Greyson NDE Scale, comprising four distinct dimensions: cognitive, affective, supernatural, and transcendental [24]. Specifically, the cognitive dimension encompasses anomalous alterations in thought processes during the NDE (e.g., time distortion, thought acceleration, and life review). The affective dimension denotes emotional sensations (e.g., feelings of profound peace, intense joy, and being enveloped in light). The supernatural dimension involves perceptions extending beyond conventional sensory capabilities (e.g., enhanced sensory acuity and precognition), whereas the transcendental dimension encapsulates otherworldly experiences (e.g., entering unearthly realms or encountering deceased individuals). Furthermore, to ensure the richness and integrity of the qualitative evidence, subjective experiences detailed in qualitative studies were independently extracted by two researchers. The findings were subsequently compared and synthesized through critical discussion to finalize the extracted themes.

3. Results

3.1. Literature Search Results and Characteristics of Included Studies

The initial database search yielded a total of 16 715 records, comprising 12 797 English‐language articles and 3918 Chinese‐language articles. After the removal of duplicates, 9704 records remained. Following the screening of titles and abstracts based on the predefined inclusion and exclusion criteria, 66 articles were retained. Subsequent full‐text assessment resulted in the exclusion of 59 articles, ultimately leaving seven studies included in this review. The publication dates of the included studies span a significant timeframe. Among the seven articles, only two were published within the last 5 years. To a certain extent, this temporal distribution reflects that the overall number of empirical NDE studies in the ICU context remains limited, and progress has been relatively slow in recent years. Therefore, by including earlier literature, this study aims to present the evolution and current landscape of evidence in this field as comprehensively as possible. The PRISMA flow diagram detailing the selection process is presented in (Figure 1). The baseline characteristics of the included studies are summarized in (Table 1).

FIGURE 1.

The PRISMA flow diagram.

TABLE 1.

Characteristics of the included studies (n = 7).

Study (Year), country	Design	Setting	Participants (n)	Associated factors	Assessment tool	Prognostic outcomes
Morris (1998) [25], USA	Mixed‐methods	General ICU; CCU	Adult NDE reporters (n = 12)	Not reported	GNDES	Psychosocial: Finding meaning (positive); self‐doubt, confusion, speechlessness (negative). Spiritual: Increased needs; prayer/meditation. Death Attitude: Reduced or absence of fear.
van Lommel et al. (2001) [17], Netherlands	Prospective cohort	CCU	Cardiac arrest survivors (n = 344)	Younger age, Sex, CPR duration	GNDES	Psychosocial: Increased empathy, acceptance, confidence, social/family bonds. Spiritual: Increased interest. Death Attitude: Reduced fear. Memory: Accurate recall of NDE.
Parnia et al. (2001) [26], UK	Prospective cohort	CCU	Cardiac arrest survivors (n = 63)	Higher PaO2 levels	GNDES	Not reported
Greyson (2003) [27], USA	Prospective cohort	CCU	Cardiac patients (n = 1595)	Younger age, Prior paranormal experiences	GNDES	Death Attitude: Death perceived as “entering a pleasurable state.”
De Godoy et al. (2009) [28], Brazil	Qualitative	General ICU	Obstetric patients with severe complications (n = 13)	Not reported	Not reported	Psychosocial: Increased appreciation of health/life; social discomfort/nervousness. Spiritual: Comfort derived from religion.
Rousseau et al. (2023) [9], Belgium	Prospective cohort	General ICU	Long‐stay (> 7 days) patients (n = 126)	Organ dysfunction, MV, sedation, analgesia, dissociation, spiritual inclination	GNDES	Memory: Stability of NDE memories at follow‐up.
Martial et al. (2024) [7], Belgium	Prospective cohort	General ICU	Long‐stay (> 7 days) patients (n = 126)	Not reported	GNDES	Psychosocial: Increased self‐acceptance/meaning; difficulty sharing experience; conflict with reality. Spiritual: Strengthened religious belief. Death Attitude: Limited reduction in fear. Memory: Memories richer and more vivid than ordinary events.

Abbreviations: CCU, coronary care unit; GNDES, Greyson Near‐Death Experience Scale; NDE, near‐death experience.

3.2. Subjective Experiences Reported by Adult ICU Patients During NDEs

The reported subjective experiences were categorized into four distinct dimensions: cognitive, affective, supernatural, and transcendental. Four studies [7, 17, 26, 27] reported subjective experiences within the cognitive dimension, including time distortion, thought acceleration, life review, and the perception of death, with time distortion and thought acceleration being particularly prominent. Five studies [7, 17, 25, 26, 27] detailed experiences in the affective dimension, such as being enveloped in light, profound peace, and intense joy, highlighting a strong concentration of positive emotional states within this category. In the supernatural dimension, four studies [7, 25, 26, 27] documented phenomena such as enhanced sensory acuity, extrasensory perception (ESP), out‐of‐body experiences (OBEs), and precognition. Five studies [7, 17, 25, 26, 27] reported transcendental experiences, including encountering deceased individuals, entering unearthly realms, resisting return, and encountering mystical presences; notably, the encounter with deceased individuals was a frequently reported phenomenon among NDE cohorts across four of these studies [17, 25, 26, 27]. A detailed matrix illustrating the distribution of these subjective experiences across the included studies is presented in (Table 2).

TABLE 2.

Summary of NDE dimensions and specific subjective experiences across the relevant studies (n = 5).

Study	Cognitive dimension	Affective dimension	Supernatural dimension	Transcendental dimension
Morris [25]	Not reported	Feelings of peace; enveloped in light	Out‐of‐body experience	Encountering deceased individuals
van Lommel et al. [17]	Perception of death	Feelings of peace; intense joy	Not reported	Encountering deceased individuals; entering unearthly realms
Parnia et al. [26]	Time distortion; thought acceleration	Feelings of peace; enveloped in light; intense joy	Enhanced sensory acuity; extrasensory perception; out‐of‐body experience	Encountering deceased individuals; resisting return; entering unearthly realms
Greyson [27]	Time distortion; thought acceleration	Feelings of peace; enveloped in light; intense joy	Out‐of‐body experience	Encountering deceased individuals; entering unearthly realms
Martial et al. [7]	Time distortion; thought acceleration; life review	Enveloped in light	Enhanced sensory acuity; extrasensory perception; precognition	Resisting return; entering unearthly realms; encountering mystical presences

3.3. Associated Influencing Factors for NDEs in Adult ICU Patients

Four studies [9, 17, 26, 27] investigated the factors influencing NDEs in adult ICU patients, yielding highly heterogeneous results. Specifically, two studies [17, 27] indicated that younger age was associated with a higher incidence of NDEs, while one study [17] found that female patients reported more profound NDEs. Additionally, one study [9] demonstrated that patients with a higher frequency of dissociative symptoms, spiritual inclinations, and greater personal well‐being were more likely to report NDEs; similarly, another study [27] linked prior supernatural experiences to a higher likelihood of NDEs. Regarding clinical variables, one study [9] revealed that the NDE cohort had significantly higher rates of major organ dysfunction, mechanical ventilation, and the use of sedatives and analgesics. Furthermore, elevated PaO₂ levels were reported in the NDE group in one study [26], whereas prolonged cardiopulmonary resuscitation (CPR) was associated with a lower incidence of NDEs in another [17].

3.4. Assessment Tools for NDEs in Adult ICU Patients

The assessment tools utilized for NDEs in adult ICU patients were relatively consistent, with six studies [7, 9, 17, 25, 26, 27] employing the Greyson NDE Scale. This scale is recognized as an authoritative instrument for screening patients with NDEs; content‐wise, it comprises four dimensions and 16 items, comprehensively capturing various subjective experiences. Furthermore, one study [17] additionally utilized a Weighted Core Experience Index alongside this scale to further evaluate the depth of the patients' NDEs.

3.5. Prognostic Impacts of NDEs in Adult ICU Patients

Regarding psychosocial impacts, four studies [7, 17, 25, 28] reported positive effects, such as enhanced self‐acceptance, a heightened sense of the meaning of love, improved empathy and acceptance of others, greater attention to health, and an elevated sense of meaning in life. Conversely, three studies [7, 25, 28] highlighted negative effects, including an inability to share and articulate their experiences and feelings of detachment from reality. In terms of spirituality and religion, four studies [7, 17, 25, 28] documented reinforced religious convictions, heightened interest, greater spiritual needs among NDE patients, and an increased reliance on spiritual, religious, and positive thinking strategies for self‐help.

Concerning attitudes toward death, two studies [17, 25] reported a reduction or even complete disappearance of the fear of death among NDE patients, while another study [7] indicated that NDEs had a limited impact on patients' fear of death; nevertheless, one study [27] noted that NDE patients were more inclined to view death as “entering a state of joy”. Regarding long‐term memory, three studies [7, 9, 17] demonstrated the stability and accuracy of NDE memories through long‐term follow‐ups spanning 1 month, 1 year, 2 years, or 8 years. Notably, one study [7] revealed that NDE memories were significantly more vivid than those of ordinary events, encompassing rich sensory details; these memories scored exceptionally high across three dimensions: visual detail, spatial orientation, and emotional authenticity.

4. Discussion

4.1. Adult ICU Patients Experiencing NDEs Report Multidimensional Subjective Experiences

The findings of this study demonstrate that the subjective experiences of adult ICU patients undergoing NDEs exhibit multidimensional characteristics, with diverse specific experiences reported within each dimension. In the cognitive dimension, these primarily manifest as various cognitive sensitivities and anomalies, such as time distortion and thought acceleration [7, 17, 25, 26, 27]. Such experiences may cause varying degrees of cognitive distress and impairment for patients, including self‐doubt, executive dysfunction, and communication difficulties [7, 25]. Experiences in this dimension are likely correlated with certain cognitive disturbances; thus, future research should incorporate more controlled interventional designs to verify their association with PICS. Regarding the affective dimension, studies [7, 17, 25, 26, 27] have reported subjective experiences including being enveloped in light, profound peace, and intense joy. The reports in this dimension are highly concentrated on positive emotional experiences, which may serve as a hallmark subjective indicator for clinically identifying patients with NDEs. In the supernatural dimension, studies [7, 26, 27] have documented various forms of subjective experiences, such as enhanced sensory acuity and extrasensory perception. Specifically, this can manifest as patients vividly perceiving the resuscitation process, including conversations among medical staff, despite being in a comatose state. Notably, the focal points of subjective experiences may vary among different typologies of critically ill patients. For instance, compared to general ICU patients admitted for sepsis or trauma, cardiac arrest survivors may more frequently report such extrasensory perceptions or out‐of‐body experiences. Regarding the transcendental dimension, studies [7, 17, 25, 26, 27] reported various forms of subjective experiences, including encountering deceased individuals, entering unearthly realms, and out‐of‐body experiences. Subjective experiences in this dimension may cause significant psychological stimulation to patients; however, existing literature has not yet explored the efficacy of specific clinical interventions for this cohort. Therefore, future research should dedicate efforts to further elucidate the pathophysiological links between these highly subjective transcendental experiences and post‐traumatic stress disorder (PTSD), thereby laying the groundwork for developing scientifically sound interventions.

4.2. Research on Associated Influencing Factors for NDEs Remains Inconclusive

Regarding the factors influencing NDEs in adult ICU patients, only two studies [17, 27] concurrently reported that younger age corresponds to a higher incidence of NDEs. The findings of the remaining studies were relatively isolated, identifying disparate variables such as sex, cardiopulmonary resuscitation (CPR) duration, PaO₂ levels, prior “supernatural” experiences, major organ dysfunction, mechanical ventilation, sedation and analgesia [9, 17, 26, 27], yielding no significant commonalities thus far. This heterogeneity in results may be attributed to variations among patient cohorts, such as the pathophysiological differences between isolated cardiac arrest cohorts and general ICU cohorts with multiple organ failure. Furthermore, existing literature [29] indicates that the mechanisms by which physiological and psychosocial changes influence NDEs remain unclear. Therefore, it is recommended that future research dedicate greater attention to this domain. Study designs could build upon these existing reports to uncover more substantial common characteristics. Additionally, further exploration of other potential influencing factors is warranted. For instance, from a neurobiological perspective, in‐depth investigations into whether specific or common features exist in electroencephalogram (EEG) activity and neurotransmitter storms among adult ICU patients with NDEs could provide a reference for more accurate clinical identification and the timely implementation of effective interventions [30, 31, 32].

To bridge the gap between these inconsistent clinical findings and the underlying aetiology of NDEs, several prominent theoretical frameworks must be conceptually integrated. Physiologically, the roles of hypoxia and hypercapnia are highly relevant in the ICU context; acute cerebral hypoxia can induce tunnel vision and bright lights, while hypercapnia has been strongly associated with triggering out‐of‐body sensations [4, 33]. Neurobiologically, the theory of “cortical disinhibition” suggests that a dying or severely stressed brain experiences a loss of normal inhibitory control, leading to a hyper‐arousal of the visual and memory cortices, which may explain the hyper‐lucidity and panoramic life reviews frequently reported by survivors [34]. Furthermore, the theory of rapid eye movement (REM) intrusion posits that the extreme stress of a life‐threatening crisis may trigger REM sleep features to abnormally intrude into waking consciousness, producing vividly structured, dream‐like elements accompanied by muscle atonia [35]. Psychologically, the dissociative hypothesis argues that an NDE serves as an ultimate adaptive defence mechanism; when faced with the terrifying inevitability of bodily death, the patient's consciousness detaches from the catastrophic reality, thereby inducing profound peace and a sense of separation from physical pain [36, 37]. Therefore, incorporating these neurobiological and psychological theories into future empirical ICU studies will be crucial for deciphering the complex aetiology and diverse phenomenological features of NDEs.

4.3. Limitations of Assessment Tools and the Necessity of Expanding Qualitative Research

Regarding assessment tools, all included quantitative studies utilized the Greyson NDE Scale [7, 9, 17, 25, 26, 27]. As an authoritative instrument for identifying NDEs, it can serve as the primary tool for determining whether a patient has experienced an NDE in future clinical practice. However, this scale is inherently limited by its lack of content regarding distressing or negative NDEs. Future research is advised to overcome this limitation by employing novel NDE scales, such as the Near‐Death Experience Content (NDE‐C) Scale [38]. Additionally, one study [17] concurrently utilized a Weighted Core Experience Index to further evaluate the depth of patients' NDEs. However, this index is not based on statistical analysis, nor has it ever been tested for internal consistency or reliability [24]. Therefore, future studies must exercise caution when interpreting NDE depth and should strive to develop novel mixed‐methods assessment frameworks that balance psychometric validity and reliability with broad phenomenological features.

More importantly, existing standardized tools may fail to comprehensively capture the broad spectrum and highly individualized nuances of NDEs. Given that these experiences are inherently and profoundly subjective, future research designs should significantly increase the proportion of qualitative methodologies to fully comprehend and enrich the characterization of NDEs.

4.4. Prognostic Impacts of NDEs on Psychosocial Outcomes, Spirituality, Attitudes Toward Death, and Long‐Term Memory in Adult ICU Patients

4.4.1. Uncertainties in the Reported Psychosocial Attitudes of Adult ICU Patients Experiencing NDEs

Regarding psychosocial impacts, van Lommel et al. [17] reported positive psychosocial effects, such as enhanced empathy, an increased capacity to accept others, and a heightened sense of meaning in life. However, patients in several other studies [7, 25, 28] reported simultaneously holding both positive and negative psychosocial attitudes; this aligns with previous research [39] indicating that NDEs can concurrently exert both beneficial and adverse effects on patients. Evidently, the psychosocial changes induced by NDEs in ICU patients are characterized by uncertainty, which may be associated with the specific nature of the NDE experienced by the individual, the absolute length of their ICU stay, and their baseline psychological resilience. Consequently, future studies must incorporate larger patient cohorts and more diverse study populations to determine precisely which specific contexts or experiential features precipitate negative psychosocial outcomes, thereby providing an evidence base for the clinical identification of high‐risk patients. In addition, future clinical nursing practice should prioritize the monitoring and identification of psychosocial changes in these patients, guiding positive impacts and transforming negative ones to ensure that their psychosocial well‐being progresses in a favourable direction.

4.4.2. Adult ICU Patients Experiencing NDEs Report Significantly Positive Spiritual Attitudes and Behaviours

Regarding spirituality and religion, adult ICU patients who survived with NDEs consistently demonstrated significantly positive shifts in their attitudes. Multiple studies [7, 17, 25, 28] have robustly documented that these patients exhibit reinforced religious convictions, a heightened interest in spiritual matters, and an increased demand for spiritual engagement following their critical illness. Evidently, experiencing an NDE serves as a critical transformational event that either initiates a newfound interest in the spiritual domain or deeply consolidates patients' reliance on familiar faiths. This may be related to their heightened need for spiritual sustenance and a more profound conviction in spiritual and religious tenets following a near‐death event. Therefore, in future clinical nursing practice, it is essential to comprehensively assess the changes in spiritual and religious attitudes and behaviours of adult ICU patients with NDEs; healthcare professionals must afford full understanding and respect to patients expressing these needs. Furthermore, when formulating post‐discharge rehabilitation plans, incorporating interdisciplinary spiritual care (such as hospital chaplains or cultural support workers) alongside physiological and psychological interventions may hold significant potential for integrative value.

4.4.3. Controversies in the Reported Impacts of NDEs on Attitudes Toward Death Among Adult ICU Patients

In this review, the reported impacts of NDEs on adult ICU patients' attitudes toward death exhibited certain nuances. Among cohorts experiencing classic NDEs, the general trend points toward a positive shift in perspective. Specifically, three studies [17, 25, 27] reported a significant reduction in the fear of death or a tendency to view death as “entering a pleasurable state”. However, one recent study [7] indicated that NDEs had a limited impact on patients' fear of death. This localized finding opposes the general consensus that most individuals who experience NDEs report a decreased fear of death [40, 41]. The underlying reasons for these discrepancies may involve differences in patients' disease trajectories and trauma burdens, the moderating effects of cultural environments and religious beliefs, as well as methodological discrepancies in assessment timing and follow‐up durations across studies. Therefore, it is recommended to further strengthen research on prognostic attitudes toward death in this population. From a study design perspective, researchers should develop more scientifically rigorous qualitative interview outlines or select more tailored assessment scales; additionally, expanding the study population or conducting multicentre studies is warranted to thoroughly explore these underlying associations.

4.4.4. Adult ICU Patients Experiencing NDEs Report Significant Stability and Accuracy in Long‐Term Memory

Regarding long‐term memory, studies utilizing longitudinal follow‐ups have demonstrated that patients universally report the stability and accuracy of their NDE memories [7, 9, 17]. Furthermore, Martial et al. [7] reported that NDE memories were significantly more vivid than those of ordinary events, encompassing exceptionally rich sensory details. These findings align with previous research [42], corroborating the stability, richness, and clarity of NDE memories. Evidently, an NDE is not a fleeting stimulus but rather a persistent and profound impression. Compared to the fragmented and easily forgotten hallucinations induced by ICU delirium, the highly structured nature and sensory richness of NDE memories suggest that routine psychological screening tools may be insufficient to distinguish their true essence in future clinical practice. Consequently, it is imperative to develop more targeted interview strategies to evaluate the authentic impact of these stable long‐term memories on survivors' mental health. If patients are found to be developing negative psychological states due to the enduring influence of NDE memories, timely psychological nursing and other interventions must be implemented to safeguard their psychological well‐being.

5. Strengths and Limitations

The strength of this review lies in its strict adherence to the PRISMA‐ScR guidelines and the JBI scoping review methodological framework, providing a systematic and transparent comprehensive mapping of this emerging and highly clinically challenging interdisciplinary field. However, this study also presents certain limitations: First, the majority of the included studies were conducted in Western countries or specific regional contexts, which highlights a potential geographical and cultural bias. Given that NDEs are deeply intertwined with cultural and religious backgrounds, the current evidence may not fully represent the phenomenological diversity of NDEs across different global populations. Second, the inclusion of earlier studies may limit the relevance of these findings to modern clinical environments. Future studies are essential to bring the evidence base up to date. Third, in accordance with the core nature of scoping reviews, this study focused on the breadth rather than the depth of evidence; consequently, the risk of bias and methodological quality of the included literature were not assessed. Finally, the overall volume of literature in this field remains limited, with a severe paucity of high‐quality qualitative and mixed‐methods research. This largely restricts our deep understanding of the immensely rich, complex phenomenological details and individualized nuances of NDEs.

6. Implications for Practice and/or Further Research

It is hoped that future research will conduct rigorous, large‐sample, multicenter cohort studies and in‐depth qualitative explorations to further elucidate the potential associations between this extraordinary experience and PICS, thereby providing a scientific basis for developing individualized psychological support and rehabilitation strategies for ICU survivors.

7. Conclusion

This study utilized a scoping review methodology to systematically map the current research landscape of NDEs in adult ICU patients. The results indicate that patients report profound multidimensional subjective experiences, encompassing cognitive, affective, supernatural, and transcendental domains. These experiences not only form highly stable, sensorily rich long‐term memories but also significantly increase patients' spiritual and religious needs. The integration of neurobiological and psychological frameworks provides a necessary conceptual lens to understand these phenomena, yet the identification of uniform physiological or clinical predictors remains a challenge. Furthermore, existing evidence concerning psychosocial outcomes and impacts on attitudes toward death exhibits high heterogeneity and inherent contradictions, which may be moderated by patients' specific disease trajectories, cultural environments, and religious beliefs. Additionally, a noticeable gap in high‐quality empirical research over the past decade has led to a disconnect between existing evidence and contemporary ICU treatment paradigms. This lack of up‐to‐date data, together with an overreliance on standardized quantitative assessment scales, limits the comprehensive capture of patients’ subjective experiences.

Funding

This work was supported by the Medical and Health Science and Technology Program of Zhejiang Province under Grant No. 2025KY081.

Ethics Statement

The authors have nothing to report.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Preferred reporting items for systematic reviews and meta‐analyses extension for scoping reviews (PRISMA‐ScR) checklist.

Table S1: Search strategy.

Data Availability Statement

The authors have nothing to report.