Alleviation of Pain and Symptoms With a Life-Shortening Intention

Abstract

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a ;grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values.

Attitudes of nursing staff towards involvement in medical end-of-life decisions: A national survey study

“…Consequently, nurses can be an important source of information for a physician who has to decide about forgoing or starting a medical treatment. Two studies performed in the Netherlands showed that nurses were involved in end-of-life decision-making by the physician in more than half of all cases [5] and [6]. The study by Van Bruchem-van de Scheur et al indicated that there were consultations between physicians and nursing staff in 56% of the decisions about intensifying drug treatment to alleviate pain or other symptoms [6].…”

Policy statements and practice guidelines for medical end-of-life decisions in Dutch health care institutions: Developments in the past decade

“…Therefore, institutions are not only responsible for introducing practice guidelines in their institutions, but also for educating and stimulating their professionals to use these guidelines. It is important that not only physicians, but also nurses are involved in this, since they are often involved in medical end-of-life decisions [3][4][5][6]. Finally, practice guidelines are just a helpful tool for quality care.…”

“…However, practice guidelines for intensified alleviation of symptoms with possible life-shortening effect can be very useful in institutions, since it is a common medical end-of-life decision [15]. In this practice guideline, attention should be paid to the role of nurses, since they are often involved in this medical end-of-life decision, but their role is often unclear [4,5]. Furthermore, it should include information about the lifeshortening effects of pain medication, since there is still uncertainty about this among physicians [19].…”

“…Guidelines can also be relevant because of the ethical and legal aspects of medical decision-making, and this applies in particular to medical end-of-life decisionmaking. Most important professionals regarding medical end-of-life decision making in institutions are physicians and nurses [3][4][5][6] and practice guidelines therefore should be useful and available for them.…”

Development and dissemination of institutional practice guidelines on medical end-of-life decisions in Dutch health care institutions

“…Compared with physicians, far fewer nurses are involved in the development and revision of the institutional practice guidelines on medical end-of-life decisions. However, it is also important that nurses are involved, since several research projects in The Netherlands and Belgium showed that nurses have an important role in daily end-of-life care and medical endof-life decisions [13][14][15][16].…”