title: South African critical care nurses' views on end-of-life decision-making and practices.
abstract: BACKGROUND
  Care of patients at the end-of-life (EOL) may be influenced by the experiences, attitudes and beliefs of nurses involved in their direct care.
  
  
  OBJECTIVE
  To investigate South African critical care nurses' experiences and perceptions of EOL care.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  South African critical care nurses completed a modified version of the 'VENICE' survey tool. Data were collected concerning: attitudes towards EOL care; involvement in EOL decision-making; and beliefs about EOL practices.
  
  
  RESULTS
  Of 149 surveys distributed, 100 were returned (response rate 67%). Seventy-six percent stated that they had had direct involvement in EOL care of patients, but a minority (29%) had participated in EOL decision-making processes. Whilst most nurses (86%) were committed to family involvement in EOL decisions, less than two thirds (62%) reported this as routine practice. When withdrawing treatment, around half (54%) of the respondents indicated they would decrease the inspired oxygen level to room air, and the majority (84%) recommended giving effective pain relief. Continued nutritional support (84%) and hydration (85%) were advocated, with most nurses (62%) indicating that they were against keeping patients deeply sedated. Most respondents (68%) felt patients should remain in intensive care at the end of life, with the majority (72%) supporting open-visiting, no restriction on number of family members visiting (70%), and the practising of religious or traditional cultural EOL rituals (93%).
  
  
  CONCLUSIONS
  The involvement of Johannesburg critical nurses in EOL care discussions and decisions is infrequent despite their participation in care delivery and definite views about the process.
  
  
  CONCLUSIONS
  Use of formal guidelines and education is recommended to increase the nurses' involvement in and their confidence in participating in EOL decisions. Educators, managers, senior nurses and other members of the multi-disciplinary team should collaborate to enable critical care nurses to become more involved in EOL care.
authors.affiliation: G Langley, RN; MSc (Nursing), MPhil, PhD, Senior Lecturer, Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Gayle
authors.initials: G
authors.lastname: Langley
authors.forename: Shelley
authors.initials: S
authors.lastname: Schmollgruber
authors.forename: Paul
authors.initials: P
authors.lastname: Fulbrook
authors.forename: John W
authors.initials: JW
authors.lastname: Albarran
authors.forename: Jos M
authors.initials: JM
authors.lastname: Latour
mesh_terms: D000328:Adult; D000368:Aged; D002835:Christianity / Q000523:psychology; D002983:Clinical Competence / Q000706:statistics & numerical data; D064648:Critical Care Nursing; D003430:Cross-Sectional Studies; D003657:Decision Making; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000941:ethics / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D012069:Religion and Psychology; D013019:South Africa; D013727:Terminal Care / Q000523:psychology*; D028761:Withholding Treatment / Q000941:ethics
keywords: End-of-life; Intensive care; South Africa