title: Nurses' perspectives: hospitalized older patients and end-of-life decision-making.
abstract: OBJECTIVE
  To explore pressing issues identified by nurses caring for older patients in US NICHE (Nurses Improving Care for the Healthsystem Elders) hospitals, regarding palliative care and end-of-life (EOL) decision-making. Objectives are to (1) identify the most pressing palliative care and EOL decision-making issues and strategies to address them and (2) identify the association of nursing demographics (age, gender, race, education and experience), institutional/unit characteristics and these issues.
  
  
  BACKGROUND
  Critical care nurses have an integral role in supporting older patients and families faced with palliative care and EOL decision-making issues. Despite national imperatives to improve the quality of palliative care, patients continue to experience uncontrolled pain, inadequate communication, disregard of their wishes and life prolonging interventions. These contribute to increased hospitalizations and costs. Understanding the prevalent issues is needed to address patient needs at the end-of-life.
  
  
  METHODS
  It is a mixed method study.
  
  
  METHODS
  A secondary analysis of the NICHE Geriatric Institutional Assessment Profile (GIAP) database (collected 1/08-9/13) was conducted using the sample of Critical Care RNs who provided comments regarding palliative care and EOL decision-making. Qualitative data were analyzed using Dedoose software. Data clusters and patterns of co-occurring codes were explored through an iterative analysis process. Themes were examined across nurse demographics, institutional and unit characteristics.
  
  
  RESULTS
  Comments specifically addressing issues regarding EOL decision-making were provided by 393 critical care nurses from 156 hospitals (x‾ age = 42·3 years, 51% BSN degree). Overarching theme was discordance in goals of care (prolonging life versus quality of life), ineffective physician-patient-family communication, lack of time and unrealistic expectations.
  
  
  CONCLUSIONS
  Nurses' descriptions highlight the need for increased communication, staff education and availability of palliative care services.
  
  
  CONCLUSIONS
  Palliative care and EOL decision-making will remain a nursing priority as people age and require increased care.
authors.affiliation: New York University, College of Nursing, New York, NY, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Dillworth
authors.affiliation: New York University, College of Nursing, New York, NY, USA.
authors.forename: Victoria V
authors.initials: VV
authors.lastname: Dickson
authors.affiliation: New York University, College of Nursing, New York, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Mueller
authors.affiliation: New York University, College of Nursing, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shuluk
authors.affiliation: New York University, College of Nursing, New York, NY, USA.
authors.forename: Hye W
authors.initials: HW
authors.lastname: Yoon
authors.affiliation: Hunter College, School of Nursing, New York, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Capezuti
mesh_terms: D000328:Adult; D000375:Aging; D003142:Communication; D064648:Critical Care Nursing; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D024802:Nurse's Role / Q000523:psychology*; D010166:Palliative Care / Q000379:methods; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods*; D014481:United States
keywords: Adult intensive care; Intensive care; Nurses; Older adults; Qualitative research; Quality of life