Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature

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.

Negotiated reorienting: A grounded theory of nurses’ end-of-life decision-making in the intensive care unit

“…The focus of a 'peaceful' death and nurses' attempts to overcome the dehumanizing aspects of ICU are well documented. Nurses' roles in brokering and mediating information and providing support to doctors and family members have been described in other studies (Adams et al 2011). Previous research also draws attention to the emotional labour involved in EoL care and decision-making (Coombs et al 2010) and in the potential for moral distress (Oberle andHughes 2001, Daly et al 2004).…”

“…The roles identified by Adams (et al 2011), for example, of nurse as information broker, supporter and advocate appear to be components of the practices of consensus seeking and emotional holding. Similarly, the importance of taking cultural and religious values into account is as relevant to our study as to earlier studies (Thelen 2005, Morgan 2008, Latour et al 2009.…”

“…A systematic review of 'nursing roles and strategies in end-of-life decision making (Adams et al 2011), albeit in acute care, identifies three nursing roles as: information broker (giving information to physicians, giving information to family members and mediating); supporter (building trust and using empathy; and as advocate (to physicians and to families). The literature highlights the importance of taking into account cultural and religious values and beliefs (Latour et al, 2009;Morgan, 2008;Thelen, 2005).…”

Editorial

“…Research in countries with legislation on assisted dying shows that nurses play a variety of decisive roles in the context of assisted dying. [12][13][14][15] But the debate is suffering from a division in ''pro'' and ''contra'' camps with the result that a consensus on values and best practices is far from being reached. 16 Leaving aside the issue whether such a consensus is necessary for responding effectively to the needs of patients, the question remains if healthcare professions have a specific voice in this regard.…”

Near Death Experiences in End of Life Conditions: Need for Nursing Perspectives

“…Nursing the patients facing such situations is challenging at several levels. These challenges include taking care of physical decisions like whether to perform tracheostomy, when to feed by endogastric tube, when to start discussing about end of life condition etc (Adams et al, 2011). Challenges also include the psychological ones like providing emotional comfort, understanding and managing grief, preparing for death etc.…”