Synthesis of your own assessed literary works indicated that nurses’ character in the EOL decision-making has evolved as the Help studies . Results of knowledge from 1996 so you can 2000 indicate that nurses had been even more secondary inside their method. A significantly-quoted data by Viney revealed that nurses imagined which they performed n’t have a valid part inside the EOL e to relax and play and you may secondary techniques with doctors so you can dictate behavior . In this or any other education, nurses recommended to possess customers otherwise household members by the telling medical professionals out of patients’ shown desires and speaking-to a doctor with respect to the household [23, twenty six, 32]. Although there was research you to definitely particular nurses continue to use indirect actions, more recent studies reveal that of many nurses now use far more head steps, for example speaking with physicians and you can members of the family in the prognosis and you may implications out-of decisions. From this papers, we found that nurses enact three roles from inside the EOL decision-making: information broker, recommend, and recommend. Per character is actually presented less than with a dialogue of one’s strategies nurses use to enact these opportunities (summarized when you look at the Dining table 2). Eventually, we discuss the evidence of the end result you to definitely nurses’ strategies has on the diligent and you will family members outcomes.
4.1. Pointers Representative
Nurses enjoy a crucial role from inside the assisting telecommunications ranging from and you may certainly household once dating website members and you will ranging from friends and healthcare group (team). The new strategies nurses use to enact that it role try displayed inside the three categories: offer advice so you can physicians, offer pointers so you can friends, and you can mediate.
cuatro.step one.1. Provide Information in order to Doctors
In a books paper toward character of interdisciplinary cluster during the handling dying people when you look at the an enthusiastic ICU, Baggs ainsi que al. unearthed that nurses was referred to as “recommendations brokers” (webpage 532), a timeless character described because of the Viney in which they relay suggestions concerning patients and you can group to medical professionals. Almost every other knowledge define nurses enacting this character giving the team with advice concerning the patient’s clinical position [18, 23], towards patient’s and you can family’s mental and mental health , and about patients’ and you can families’ indicated wishes [9, 18, 34]. Liaschenko mais aussi al. longer so it part further by the describing nurses as “nodal circumstances to have exchange of data” (page 227) that have nurses obtaining pointers out-of of several sources, synthesizing you to suggestions, and using they to grow an alternative research. It alternative or “larger photo” (page 224) assessment allows nurses to expand the character regarding guidance agent in order to recommend and you can advocate. These studies demonstrate that nurses are an essential source of pointers to help doctors inside the EOL decision making.
4.step one.2. Offer Guidance in order to Nearest and dearest
Such procedures vary from detailing devices , new patient’s status, and analysis to the family [thirteen, 24, twenty-seven, thirty five, 36]; converting scientific information towards place conditions [8, 37, 38]; and you will describing, educating, and making clear meanings of words, such as DNR [32, 39, 40]. In one investigation, friends reported that whenever nurses provided merely tech suggestions versus synthesizing and you will interpreting the meaning of these suggestions, they may features ingrained incorrect pledge . Such as, in a nerve ICU, a relative common that in case a nurse told her you to definitely brand new patient’s intracranial stress (ICP) got come down, she try elated, believing that it was indicative your patient was providing finest. In fact, this patient’s updates was continuously declining, and ICP understanding is unimportant towards the medical diagnosis . Nurses just who feel improperly ready to provide recommendations so you can members of the family may give him or her worthless advice, including “he/this lady has got a nights,” [41, web page 140]. Nearest and dearest, within the an examination of its experience with an enthusiastic ICU, stated that the latest nurses had been will obscure, revealing everyday details yet not factual statements about diagnosis .