Abstract
The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research.
Highlights
End-of-life (EOL) decision making in acute care is complex, involving difficult decisions, such as whether to initiate or discontinue life support, place a feeding tube or a tracheostomy, or initiate cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest
The intervention arm did not improve the study outcomes of decreasing the length of time to obtain a DNR order, length of stay in intensive care unit (ICU), and resource utilization [16], subsequent analyses of narrative data from this study demonstrated that nurses played a significant role in supporting the patients and families and guiding them toward a readiness to withhold or withdraw care [11, 13]
There are some differences in acuity of care and the level of technology between intensive care and acute care hospital units, the findings in studies of nurses’ involvement in EOL decision making in these environments were similar enough that we decided to include all studies of inpatient, acute care settings that addressed how nurses are involved in EOL decision making
Summary
End-of-life (EOL) decision making in acute care is complex, involving difficult decisions, such as whether to initiate or discontinue life support, place a feeding tube or a tracheostomy, or initiate cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest. One of the biggest challenges to EOL decision making is prognostic uncertainty and determining when to initiate EOL discussions with family members [5, 6]. Nurses and physicians express fear of removing all hope, making the wrong decision or giving up too soon [7,8,9]. It is difficult emotionally for both family members and health care professionals to give up on curative care [6, 10, 11].
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