Synthesis of your own assessed literature showed that nurses’ part during the EOL decision making has evolved since Assistance research . Result of degree from 1996 so you’re able to 2000 indicate that nurses have been significantly more secondary inside their strategy. A much-quoted analysis because of the Viney indicated that nurses thought of which they performed n’t have a valid part inside the EOL elizabeth to play and you will secondary processes with physicians so you’re able to determine decisions . Within and other education, nurses advocated to have customers otherwise loved ones because of the informing doctors regarding patients’ conveyed desires and you may speaking-to the doctor on behalf of the household [23, twenty six, 32]. Although there try proof one certain nurses continue to use secondary actions, more recent training demonstrate that of several nurses now play with alot more direct ways, including speaking with physicians and you can family about analysis and effects of behavior. Out of this paper, we unearthed that nurses enact around three spots in the EOL decision-making: recommendations representative, advocate, and advocate. For every part is exhibited below having a discussion of your own measures nurses used to enact this type of roles (summarized when you look at the Dining table 2). Fundamentally, we discuss the evidence of the outcome you to nurses’ procedures possess for the patient and family members outcomes.
4.1. Guidance Representative
Nurses play a crucial role inside the assisting telecommunications anywhere between and you can certainly members of the family and you will between household members and the health care team (team). The brand new strategies nurses used to enact so it part is actually exhibited inside the around three groups: offer recommendations so you’re able to doctors, promote pointers so you can relatives, and you will mediate.
cuatro.step 1.step one. Provide Advice so you’re able to Physicians
From inside the a books papers towards the part of your interdisciplinary cluster for the handling dying patients inside the an enthusiastic ICU, Baggs et al. learned that nurses was basically named “suggestions brokers” (page 532), a classic role described from the Viney where it exchange guidance about the people and families to help you doctors. Other degree explain nurses enacting so it character by giving the group with information regarding person’s systematic standing [18, 23], about the patient’s and you will family members’ mental and you can psychological state , and you may on the patients’ and you may families’ indicated wants [nine, 18, 34]. Liaschenko mais aussi al. expanded which character then by the describing nurses given that “nodal circumstances to own replace of data” (page 227) that have nurses getting suggestions regarding of several source, synthesizing that information, and ultizing it growing an alternative testing. This alternative otherwise “huge photo” (web page 224) evaluation allows nurses to enhance the role regarding guidance broker so you can advocate and you can endorse. This research reveal that nurses was an important supply of guidance to help physicians when you look at the EOL decision-making.
cuatro.step one.dos. Bring Pointers so you’re able to Members of the family
These types of methods cover anything from describing products , new patient’s position, and you will diagnosis to the family [thirteen, twenty-four, 27, thirty five, 36]; translating medical advice into place words [8, 37, 38]; and you may outlining, teaching, and you will making clear significance away from conditions, like DNR [thirty two, 39, 40]. In one analysis, members of the family reported that whenever nurses gave simply technology information without synthesizing and you can interpreting the definition of that advice, they might possess ingrained not the case pledge . Such, in a nerve ICU, a member of family common that if a Bauern Dating Seite Login nursing assistant told her you to the person’s intracranial pressure (ICP) got get smaller, she was elated, believing that this was an indication the patient try providing finest. In fact, this patient’s standing is actually gradually declining, and also the ICP reading is insignificant to your analysis . Nurses whom feel improperly willing to render recommendations to help you nearest and dearest can provide them meaningless guidance, such “he/she’s had a great evening,” [41, page 140]. Relatives, within the an examination of its expertise in a keen ICU, reported that the fresh new nurses was basically tend to unclear, revealing relaxed details although not factual statements about prognosis .