The Effects of Nurses’ Attitudes and Behaviors Toward End-of-life Care on Clinical Decision-making

Ethical dilemmas in end-of-life care, such as the request for assisted suicide, must be understood in the context of the relationship that exists between patients and the clinicians treating them. This context includes the way health professionals respond to the tasks in caring for a dying patient. This article reviews the literature exploring the factors the influence clinical decision making at the end of life. The interplay of ethics, countertransference and transference are explained in detail.

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Instrument Development Measuring Critical Care Nurses' Attitudes and Behaviors with End-of-life Care

Nursing Research ◽

10.1097/nnr.0b013e3181dd25ef ◽

2010 ◽

Vol 59 (4) ◽

pp. 234-240 ◽

Cited By ~ 16

Author(s):

Meg Zomorodi ◽

Mary R. Lynn

Keyword(s):

Critical Care ◽

End Of Life ◽

Instrument Development ◽

End Of Life Care ◽

Critical Care Nurses ◽

Life Care ◽

Attitudes And Behaviors ◽

And Behaviors

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The attιtudes and behavιors of intensιve care unιt nurses towards end-of-lιfe care

Health & Research Journal ◽

10.12681/healthresj.25302 ◽

2020 ◽

Vol 6 (3) ◽

pp. 93

Author(s):

Sadık Hançerlioğlu ◽

Gülbin Konakçı

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

University Hospitals ◽

Attitudes And Behaviors ◽

And Behaviors ◽

Positive Correlations ◽

Intensive Care Unit Nurses

Introduction: The end-of-life period is a process in which anxiety of death is experienced intensely and there are positive and negative experiences for the nurse and the patient. Nurses' attitudes and behaviors about death affect the quality of care in the end-of-life process.Aim: The aim of the present study was to determine the attitudes and behaviors of intensive care unit nurses towards end-of-life care.Material and Method: The studied sample consisted from 216 nurses working in the intensive care units of three university hospitals. In the present study, the Nurse Identification Form and The Attitude and Behaviors of The Intensive Care Unit Nurses Towards The End-of-Life Care Scale were used as the data collection forms.Results: Statistically significant differences were found between attitudes subscale, behavior subscale, scale total mean scores and some variables such as the education level, the intensive care unit classification, knowledge for end-of-life care, the frequency of death in their unit. As a result of the correlation analysis, there were statistically significant positive correlations between attitudes subscale, behavior subscale, scale total mean scores, and some variables such as total working years as a nurse, total working years in the intensive care unit, age.Conclusions: The level of education, the intensive care unit classification, knowledgeabout end-of-life care, the frequency of death in their unit, age, total working years as a nurse, and total working year in the intensive care unit have relationship with the attitudes and behaviors of intensive care unit nurses towards end-of-life care.

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Acute Care Decision-Making for Patients with Advanced Dementia: An Exploratory Study Using Cognitive Task Analysis

10.21926/obm.geriatr.2101159 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Meira Erel ◽

◽

Esther-Lee Marcus ◽

Freda DeKeyser Ganz

Keyword(s):

Decision Making ◽

End Of Life ◽

End Of Life Care ◽

Task Analysis ◽

Clinical Decision Making ◽

Cognitive Task ◽

Clinical Decision ◽

Cognitive Task Analysis ◽

Thought Processes ◽

Advanced Dementia

Decision-making by medical and health care staff forms the core of professional practice. Thought processes, including non-clinical considerations, significantly impact how clinical decisions are made. Such considerations become more relevant when addressing end-of-life care decisions for patients with advanced dementia (PAD). Though palliative care is recommended for this population, its implementation tends to vary. Given the medical staff’s significant influence in guiding clinical decisions, we examined thought processes that accompany staff decisions. We used Cognitive Task Analysis (CTA) to analyze interviews conducted with 15 physicians and 11 nurses working in acute care wards in Central Israel. Participants were interviewed regarding their clinical decision-making in a hypothetical scenario of a PAD who presents with an acute, potentially life-threatening medical problem. Moral judgment orientation was the primary factor affecting clinical decision-making for advanced dementia, with a pronounced dichotomous split between deontological and utilitarian approaches. This polarization was highly associated with the medical specialty. Practitioners in surgical wards tended to focus on the patient’s current medical condition, as an isolated or disease-centered illness perspective, supported by deontological moral lines of thinking. This perspective was contrary to that of staff in medical wards who mostly treated the patient from a holistic perspective with a patient-focus approach, supported by utilitarian moral lines of thinking. Although all respondents presented the patient or family as primary decision partners, the practitioners were motivated to make decisions based on unit hierarchies or positions of authority figures. Therefore, clinical end-of-life decisions are influenced by different thinking processes of the health staff and several non-clinical factors. The moral thinking paradigm was found to be associated with a professional orientation. Understanding the subjective, non-clinical aspects of decision-making for PAD might improve end-of-life care in this population.

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