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 healthcare 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 are 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.