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Nurse involvement in end-of-life decision making: the ETHICUS Study

Julie Benbenishty| Freda DeKeyser Ganz| Anne Lippert| Hans-Henrik Bulow| Elisabeth Wennberg| Beverly Henderson| Mia Svantesson| Mario Baras| Dermot Phelan| Paulo Maia| Charles L. Sprung
Original
Volume 32, Issue 1 / January , 2006

Pages 129 - 132

Abstract

Objective

The purpose was to investigate physicians’ perceptions of the role of European intensive care nurses in end-of-life decision making.

Design

This study was part of a larger study sponsored by the Ethics Section of the European Society of Intensive Care Medicine, the ETHICUS Study. Physicians described whether they thought nurses were involved in such decisions, whether nurses initiated such a discussion and whether there was agreement between physicians and nurses. The items were analyzed and comparisons were made between different regions within Europe.

Setting

The study took place in 37 intensive care units in 17 European countries.

Patients and participants

Physician investigators reported data related to patients from 37 centers in 17 European countries.

Interventions

None.

Measurements and results

Physicians perceived nurses as involved in 2,412 (78.3%) of the 3,086 end-of-life decisions (EOLD) made. Nurses were thought to initiate the discussion in 66 cases (2.1%), while ICU physicians were cited in 2,438 cases (79.3%), the primary physician in 328 cases (10.7%), the consulting physician in 105 cases (3.4%), the family in 119 cases (3.9%) and the patient in 19 cases (0.6%). In only 20 responses (0.6%) did physicians report disagreement between physicians and nurses related to EOLD. A significant association was found between the region and responses to the items related to nursing. Physicians in more northern regions reported more nurse involvement.

Conclusions

Physicians perceive nurses as involved to a large extent in EOLDs, but not as initiating the discussion. Once a decision is made, there is a sense of agreement. The level of perceived participation is different for different regions.

Keywords

References

  1. Prendergast TJ (2000) Withholding or withdrawal of life-sustaining therapy. Hosp Prac 35:91–92, 95–100, 102
  2. Eidelman LA, Jakobson DJ, Pizov R, Gerber D, Leibovitz L, Sprung CL (1998) Foregoing life sustaining treatment in an Israeli ICU. Intens Care Med 24:162–166
    • View reference on publisher's website
  3. Sprung CL, Cohen SL, Sjokist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T (2003) End of life practices in European intensive care units: the ETHICUS study. JAMA 290:790–797
    • View reference on publisher's website
    • View reference on PubMed
  4. ANA (2002) http://nursingworld.org/gova/hod98/endlife.htm#position
  5. American Association of Critical Care Nurses (1999) Designing an agenda for the nursing profession on end-of-life care. Report of the nursing leadership consortium on end-of-life care
  6. Baggs JG, Schmitt MH (2000) End-of-life decisions in adult intensive care: current research base and directions for the future. Nurs Outlook 48:158–164
    • View reference on publisher's website
    • View reference on PubMed
  7. Oberle K, Hughes D (2001) Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions. J Adv Nurs 33:707–715
    • View reference on publisher's website
    • View reference on PubMed
  8. Masri C, Farrell CA, Lacriox J, Rocker G, Shemie SD (2000) Decision making and end-of-life care in critically ill children. J Palliat Care 16:s45–s51
    • View reference on PubMed
  9. Jezuit DL (2000) Suffering of critical care nurses with end-of-life decisions. Medsurg Nurs 9:145–152
    • View reference on PubMed
  10. Kirmse JM (2000) Aggressive implementation of advance directives. Crit Care Nurs Quart 21:83–89
  11. Johns JL (1996) Advanced directives and opportunities for nurses. J Nurs Scholar 28:149–153
  12. Dimond EP (1992) The oncology nurse’s role in patient advanced directives. Oncol Nurs Forum 19:891–896
    • View reference on PubMed
  13. Deliens L, Mortier F, Bilsen J, Cosyns M, Stichele RV, Vanoverloop J, Ingles K (2000) End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey. Lancet 356:1806–1811
    • View reference on publisher's website
    • View reference on PubMed
  14. Vincent JL (1999) Forgoing life support in western European intensive care units. Crit Care Med 27:1626–1633
    • View reference on publisher's website
    • View reference on PubMed
  15. Oberle K, Hughes D (2001) Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions. J Adv Nurs 33:707–715
    • View reference on publisher's website
    • View reference on PubMed
  16. Johnson N, Cook D, Giacomini M, Willms D (2000) Towards a good death: end-of-life narratives constructed in an intensive care unit. Culture Med Psych 24:275–295
    • View reference on publisher's website
  17. 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 (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
    • View reference on publisher's website
    • View reference on PubMed
  18. Bowman KW (2000) Communication, negotiation, and mediation: dealing with conflict in end-of-life decisions. J Palliat Care 16:s17–s25
    • View reference on PubMed
  19. Gillon R (1999) End-of-life decisions. J Med Ethics 25:435–436
    • View reference on PubMed

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