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The involvement of intensive care nurses in end-of-life decisions: a nationwide survey

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Abstract

Objective

To investigate the prevalence and predictors of intensive care nurses’ active involvement in end-of-life (EOL) decisions.

Design and setting

A survey of intensive care nurses from 36 intensive care units (ICUs) in New Zealand.

Measurements and results

A total of 611 ICU nurses from 35 ICUs responded to this survey. The response rate was estimated to be between 43% and 81%. Seventy-eight percent of respondents reported active involvement in EOL decisions, especially the senior nurses (level IV vs. I nurses, OR 7.9; nurse educators vs. level I nurses, OR 4.3). Asian (OR 0.2) and Pacific Islander nurses (OR 0.2) were less often involved than European nurses. Sixty-eight percent of respondents preferred more involvement in EOL decisions, and this preference was associated with the perception that EOL decisions are often made too late (OR 2.2). Sixty-five percent believed their active involvement in EOL decisions would improve nursing job satisfaction.

Conclusions

Most ICU nurses in New Zealand reported that they are often involved in EOL decisions, especially senior and European nurses.

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References

  1. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T; Ethicus Study Group (2003) End-of-life practices in European intensive care units: the Ethicus Study. JAMA 290:790–797

    Google Scholar 

  2. Clarke EB, Curtis JR, Luce JM, Levy M, Danis M, Nelson J, Solomon MZ; Robert Wood Johnson Foundation Critical Care End-Of-Life Peer Workgroup Members (2003) Quality indicators for end-of-life care in the intensive care unit. Crit Care Med 31:2255–2262

    Google Scholar 

  3. Ferrand E, Lemaire F, Regnier B, Kuteifan K, Badet M, Asfar P, Jaber S, Chagnon JL, Renault A, Robert R, Pochard F, Herve C, Brun-Buisson C, Duvaldestin P; French RESSENTI Group (2003) Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. Am J Respir Crit Care Med 167:1310–1315

    Article  PubMed  Google Scholar 

  4. Kirmse JM (1998) Aggressive implementation of advance directives. Crit Care Nurs Q 21:83–89

    Google Scholar 

  5. Deliens L, Mortier F, Bilsen J, Cosyns M, Vander Stichele R, Vanoverloop J, Ingels K (2000) End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey. Lancet 356:1806–1811

    Google Scholar 

  6. Meltzer LS, Huckabay LM (2004) Critical care nurses’ perceptions of futile care and its effect on burnout. Am J Crit Care 13:202–208

    Google Scholar 

  7. Asch DA (1996) The role of critical care nurses in euthanasia and assisted suicide. N Engl J Med 334:1374–1379

    Article  CAS  PubMed  Google Scholar 

  8. Higlett T, Anderson T, Hart GK (2004) Review of intensive care resources & activity 2001/2002. ANZICS, Melbourne, pp 84–138

  9. Ho KM, Liang J (2004) Withholding and withdrawal of therapy in New Zealand intensive care units (ICUs): a survey of clinical directors. Anaesth Intensive Care 32:781–786

    Google Scholar 

  10. Vincent JL (2001) Cultural differences in end-of-life care. Crit Care Med 29: N52–55

    Google Scholar 

  11. Cardoso T, Fonseca T, Pereira S, Lencastre L (2003) Life-sustaining treatment decisions in Portugese intensive care units: a national survey of intensive care physicians. Crit Care 7:R167–175

    Google Scholar 

  12. Cassell J, Buchman TG, Streat S, Stewart RM (2003) Surgeons, intensivists, and the covenant of care: administrative mode and values affecting care at the end of life. Crit Care Med 31:1551–1557

    Google Scholar 

  13. Tanida N, Asai A, Ohnishi M, Nagata SK, Fukui T, Yamazaki Y, Kuhse H (2002) Voluntary active euthanasia and the nurse: a comparison of Japanese and Australian nurses. Nurs Ethics 9:313–322

    Google Scholar 

  14. Mebane EW, Oman RF, Kroonen LT, Goldstein MK (1999) The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making. J Am Geriatr Soc 47:579–591

    Google Scholar 

  15. Frick S, Uehlinger DE, Zuercher Zenklusen RM (2003) Medical futility: predicting outcome of intensive care unit by nurses and doctors-a prospective comparative study. Crit Care Med 31:456–461

    Article  PubMed  Google Scholar 

  16. Morris AH (2003) Perceptions, confessions: a systems response is needed. Am J Respir Crit Care Med 167:1302–1303

    Google Scholar 

  17. Girbes AR (2004) Dying at the end of your life. Intensive Care Med 30:2143–2144

    Article  Google Scholar 

  18. Faber-Langendoen K (1994) The clinical management of dying patients receiving mechanical ventilation. A survey of physician practice. Chest 106:880–888

    Google Scholar 

  19. Melltorp G, Nilstun T (1997) The difference between withholding and withdrawing life-sustaining treatment. Intensive Care Med 23:1264–1267

    Article  CAS  PubMed  Google Scholar 

  20. Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, Mor V (2004) Family perspectives on end-of-life care at the last place of care. JAMA 291:88–93

    Google Scholar 

  21. Mann S, Galler D, Williams P, Frost P (2004) Caring for patients and families at the end of life: withdrawal of intensive care in the patient’s home. N Z Med J 117:U935

    Google Scholar 

  22. Campbell ML, Guzman JA (2003) Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 123:266–271

    Google Scholar 

  23. Campbell ML, Frank RR (1997) Experience with an end-of-life practice at a university hospital. Crit Care Med 25:197–202

    Google Scholar 

  24. Campbell ML, Carlson RW (1992) Terminal weaning from mechanical ventilation: ethical and practical considerations for patient management. Am J Crit Care 1:52–56

    Google Scholar 

  25. Faber-Langendoen K, Lanken PN (2000) Dying patients in the intensive care unit: forgoing treatment, maintaining care. Ann Intern Med 133:886–893

    Google Scholar 

  26. Miller FG, Fins JJ (1996) A proposal to restructure hospital care for dying patients. N Engl J Med 334:1740–1742

    Google Scholar 

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Acknowledgements

This study was performed and funded by the Department of Intensive Care, North Shore Hospital, Auckland, New Zealand. We thank all the intensive care nurses, nurse educators, and nurse managers who have participated in this study. We also thank Dr. Roger Marshall from the School of Population Health at University of Auckland for his valuable statistical comments.

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Authors and Affiliations

  1. Intensive Care Unit, Royal Perth Hospital, 6000, Perth, WA, Australia

    Kwok M. Ho

  2. Intensive Care Unit, North Shore Hospital, 1309, Auckland, New Zealand

    Sonya English & Jeanette Bell

Authors
  1. Kwok M. Ho
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  2. Sonya English
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  3. Jeanette Bell
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Correspondence to Kwok M. Ho.

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Ho, K.M., English, S. & Bell, J. The involvement of intensive care nurses in end-of-life decisions: a nationwide survey. Intensive Care Med 31, 668–673 (2005). https://doi.org/10.1007/s00134-005-2613-5

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  • DOI: https://doi.org/10.1007/s00134-005-2613-5

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