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Monday, November 18, 2019
Home Specialties Geriatrics Nursing Contributions to End-of-Life Decisions

Nursing Contributions to End-of-Life Decisions

Nurses are charged with nearly all palliative care, and yet they are often left out of end-of-life (ELD) discussions. Several studies have directly surveyed nursing attitudes toward ELD and found that most nurses involved in terminal patient care have expressed a high interest in participating in the decision-making process.

Studies have found that critical care, hospice, palliative care, and intensive care nurses wish to have a more active role in ELD. A national survey of staff nurses working in hospitals, home care, or nursing/elder care in Denmark found that:

  • nearly 75% felt they should be consulted throughout the end-of-life process
  • 58% felt they should be consulted on decisions to withdraw care
  • 64% believed patients were more comfortable talking with nurses than physicians, and
  • 72% reported that physicians showed a willingness to listen to their opinions.

In a small sample of nurses and physicians, both reported positive ELD experiences when a balance of multiple factors — including a team approach, shared goals, understanding the perspectives of those involved, and knowledge of self-beliefs — was present. When these features were out of balance, health care practitioners became morally distressed.

Emotional responsiveness, understanding of professional roles and responsibilities, and intentional communication and collaboration were overlapping themes that contributed to successful interactions. Improved communication between clinical care team members leads to improved ELD and a higher quality of patient care and improved experience for patient families.

References:

Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study, National Center for Biotechnology Information.

A Balancing Act: Experiences of Nurses and Physicians When Making End-of-Life Decisions in Intensive Care Units, National Center for Biotechnology Information.

Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward, National Center for Biotechnology Information.

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