End-of-life decision making in the intensive care unit: physician and nurse perspectives.
End-of-life decision making, including consideration of advance directives and code status, is taking place more frequently in critical care units. There is a need to identify how nurses and physicians perceive end-of-life care so that nurse-physician understanding and communication can be improved. A total of 96 physicians and nurses completed a survey about their general beliefs and practices related to end-of-life care in the intensive care unit. Nurses were more likely to ask if there was a living will and to read it. Only 53% of physicians read living wills; however 90% of physicians consider the wishes in the living will when making recommendations to the family. Physicians were more likely to discuss do-not-resuscitate (DNR) orders only when a prognosis was poor. Family dynamics and medical/legal concerns most often affect decisions to obtain/write a DNR order for a critically ill patient. Suggested approaches for improving physician and nurse collaboration about end-of-life decision making are discussed.
Westphal
Dan M
DM
Florida Medical Center in Fort Lauderdale, FL, USA. dan.westphal@tenethealth.com
McKee
Stefanie Andrea
SA
D024362:Advance Directive Adherence / Q000523:psychology / Q000706:statistics & numerical data; D016223:Advance Directives; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003657:Decision Making; D005195:Family Relations; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D044469:Racial Groups; D012067:Religion; D016414:Resuscitation Orders; D013727:Terminal Care / Q000523:psychology*