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End-of-Life Decision Making in the Intensive Care Unit: Physician and Nurse Perspectives
Dan M. Westphal, MD, MBA, CHQ1*
and
Stefanie Andrea McKee, PhD2
1 Florida Medical Center, Fort Lauderdale, FL
2 Hospice by the Sea, Boca Raton, FL
* To whom correspondence should be addressed. E-mail: dan.westphal{at}tenethealth.com.
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Abstract |
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End-of-life decision making, including consideration of advance directives and code status, is taking place more frequently in critical care units. There is a need to identify how nurses and physicians perceive end-of-life care so that nurse-physician understanding and communication can be improved. A total of 96 physicians and nurses completed a survey about their general beliefs and practices related to end-of-life care in the intensive care unit. Nurses were more likely to ask if there was a living will and to read it. Only 53% of physicians read living wills; however 90% of physicians consider the wishes in the living will when making recommendations to the family. Physicians were more likely to discuss do-not-resuscitate (DNR) orders only when a prognosis was poor. Family dynamics and medical/legal concerns most often affect decisions to obtain/write a DNR order for a critically ill patient. Suggested approaches for improving physician and nurse collaboration about end-of-life decision making are discussed. (Am J Med Qual XXXX;XX:xx-xx)
First published on April 16, 2009, doi:10.1177/1062860608330825
American Journal of Medical Quality 2009;24:222.
A more recent version of this article appeared on May 1, 2009
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