Today in the chart

Nursing Contributions to End-of-Life Decisions

Nurses are charged with nearly all palliative care, so how involved are they with end-of-life discussions?

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

Studies have found that critical care, hospice, palliative care, and intensive care nurses wish to be more active 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% thought they should be consulted on decisions to withdraw care.
  • 64% believed patients were more comfortable talking with nurses than physicians.
  • 72% reported that physicians showed a willingness to listen to their opinions.

A small sample of nurses and physicians 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. However, healthcare practitioners became morally distressed when these features were out of balance.

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, a higher quality of patient care, and enhanced experience for patient families.

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