Critical care - End-of-life decision making: Nursing

Providing support for decision making. During end of life care is an important role for the critical care nurse.

While guiding patients and their families. Through this unique time, you'll consider several factors that affect end of life care decisions including communication, the patient, the patient's family, culture and spirituality.

Now, when discussing end of life decisions, communication between the patient, the health care team and the patient's family can take place at the bedside in an informal manner and more formally during family meetings or conferences, then goals of care are identified using a shared decision making approach, using the best available evidence about treatment options while respecting the values and preferences of the patient and family.

As the nurse providing care. During this process, you'll use skills to facilitate effective communication like reflection, empathy and silence.

For instance, you can ask the family to consider how they think their family member would proceed with decisions about their care if they were able to communicate their wishes and then pause to give them time to consider their response throughout this process.

Be sure to use simple language to explain life sustaining treatments such as cardiopulmonary resuscitation or CPR and tube feedings also explain terms like do not resuscitate or DNR and explore what it means to transition to comfort care.

And remember to allow time for questions and provide comfort. When talking about death, decisions about end of life care should be made by the patient whenever they're able to communicate for themselves.

However many critically ill patients facing end of life care decisions have limited capacity for decision making due to the cognitive effects of their illness or treatment.

So if the patient is unable to make their own decisions, advance directives like a living will or health care power of attorney should be obtained.

When available, these documents provide clarification on the patient's wishes for treatment. If they become unable to make decisions, a living will specifies whether they wish to receive specific life sustaining treatments such as CPR or mechanical ventilation when facing a terminal illness.

Likewise, the health care power of attorney designates a person to make decisions on behalf of the patient based on the patients preferences.

Ideally, these documents are created prior to the patient becoming critically ill when the patient is not under high levels of physical or emotional stress.

If the patient doesn't have these legal documents work with the health care team to consult with individuals close to the patient, to understand their wishes.

Families need frequent comprehensive communication from the health care team about their patient's prognosis and treatment plan when guiding the family in the decision making process be sure to assess their readiness before initiating discussions about end of life care.

Whenever possible include all family members who want to participate in these discussions using either phone or video calls as needed.

Also remember to avoid negative and misleading terminology when describing options to family members, for example, you can say withdraw treatment instead of withdraw care.

Now there are certain cultural and spiritual factors to consider with end of life decision making as they impact how the health care team and treatment options are viewed by the patient and family.

Because end of life can involve specific death rituals and grieving practices. Becoming familiar with the predominant cultures and religions in the areas surrounding your practice setting will help you to better understand the guiding principles and beliefs held by your patients.

However, keep in mind that every individual won't necessarily follow all the beliefs of their cultural or religious affiliations.

You can also gain more insight by accessing your facility's spiritual care resources or liaisons from the community. If available, another strategy is to assess cultural and religious beliefs using validated tools to quantify the importance of a patients beliefs.

For end of life care if indicated, offer chaplain services or assistance from other spiritual leaders or spiritual support also provides support for specific cultural and religious beliefs.

For instance, you may need to ensure a patient has last rights if they adhere to certain Christian denominations or that a patient who follows Buddhism is allowed quiet time to meditate.

Also be mindful of how your own cultural and spiritual beliefs, influence how you view cultures and beliefs that differ from your own and maintain an attitude of respect and humility.

All right. As a quick recap, providing decision making support during end of life care is an important role of the critical care, nurse factors that affect end of life care decisions include communication, the patient, the patient's family, culture and spirituality.