Critical care nurses’ knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care

Abstract

Background End-of-life care can be a difficult and challenging process for critical care nurses in intensive care units (ICUs) due to the care plan shifts from providing life-sustaining measures to end-of-life care. The aims of this study were to assess critical care nurses' perceived knowledge and attitudes toward end-of-life care, as well as their perspectives on promoting advance directives and the associated factors. Methods A cross-sectional study was undertaken in an acute major metropolitan medical center in northern Taiwan between February and March 2020, and 250 critical care nurses were invited to participate in the study. Data on demographics, self-perceived knowledge of end-of-life care, attitudes toward end-of-life care, and perspectives of promoting advance directives were collected. A multiple linear regression model with stepwise selection was used to identify factors associated with their perspectives of promoting advance directives. Results The law related to end-of-life care was rated as the least familiar part of the self-perceived end-of-life care knowledge, while ‘I have sufficient knowledge to care for patients who have accepted end-of-life care’ was the lowest level of agreement in attitude scores among critical care nurses. Increased levels of perceived knowledge (β = 0.134; p = 0.045) and attitudes (β = 0.423; p < 0.001) toward end-of-life care were associated with the perspectives of promoting advance directives. Nurses who worked in cardiac (β = -0.234; p < 0.001) and respiratory ICUs (β = -0.135; p = 0.024) had less motivation to promote advance directives (F = 16.943; p < 0.001). Conclusion Given their important contributions to ICU care services, appropriate and meaningful support is required to optimize critical care nurses' involvement in end-of-life care. This study demonstrated a significant impact on perspectives of promoting advance directives of critical care nurse participants. Findings from this study can inform the design of effective nurse support programs to enhance the promotion of advance directives in intensive care settings.

Level of Knowledge in Palliative Care, Preparation and Capacity to Provide Care at the End of Life by Health Professionals

“…The assessment of health professionals' attitudes toward EOL care revealed a higher score (3.51 ± 1.14) translating into a positive attitude. In the current literature, the values found are variables: 4.26 ± 0.63 (Ho et al, 2022); 3.63 ± 0.34 (Park & Jeong, 2021); 2.91 ± 0.18 (Chu & Jang, 2021); 3.46 ± 0.26 (Park & Oh, 2019). Recent literature indicates that doctors recognize that patients have the right to make decisions about their health and the treatments offered, and geriatric patients should be included in the discussion of EOL care, highlighting the ethical principle of autonomy (Salabarría-Peña et al, 2022).…”

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

“…The landscape of discourse about death and dying in South Korea and other countries has changed dramatically in the past decade, and this has affected how end-of-life care is perceived and delivered [ 1 , 2 ]. For intensive care unit (ICU) nurses, end-of-life care can be challenging because their role often suddenly shifts from providing life-sustaining care to end-of-life care, specifically through withholding or withdrawal of life-sustaining treatments (WLT) [ 3 , 4 ]. In the absence of specific training and systemic protocols in place at their hospital for carrying out WLT orders and end-of-life care, ICU nurses face stress-producing uncertainty, ambiguity, and even moral distress about their identity and role as healthcare professionals [ 5 , 6 ].…”

“…Nurses’ confusion over their roles in end-of-life care is amplified by the ambiguity of the one legal means to which they can refer, the Life-sustaining Medical Determination Act, which does not clearly delineate their role in end-of-life care [ 2 ]. Indeed, many WLT decision-making in ICUs focuses only on whether LST is available and whether legal requirements are met [ 1 , 4 ]. Thus, ICU nurses face a dilemma: They need to care for patients who do not receive active LST, but they also need to care for patients who need active treatment as mandated by law.…”

“…However, numerous Korean ICU nurses participate little, or not at all, in advanced care planning [ 2 , 18 ]. Their roles in end-of-life care are also limited, including WLT decisions [ 4 , 19 ]. While striving to provide dignified end-of-life care for patients who have decided on WLT, Korean nurses have reported that they experience ethical challenges due to various external factors like poor communication among stakeholders, lack of structural or organisational support, and even their own lack of competency in end-of-life care [ 2 , 4 ].…”

How Should Intensive Care Unit Nurses Organize End-of-life Care? A Mixed-methods Study

“…Previous research has elucidated that ICU nurses treat patients with dignity, effectively manage physical symptoms, and engage in fruitful communication with patients' families during end-of-life care, which can yield positive outcomes [6][7][8]. Frequently, the role of an ICU nurse shifts abruptly from providing life-sustaining treatments to the delicate realm of end-of-life care, often involving the withholding or withdrawal of life-sustaining measures [9,10]. Consequently, ICU nurses grapple with the challenging task of determining the most suitable and feasible approach to end-of-life care within the ICU, leading to substantial stress, uncertainty, ambiguity, and moral distress regarding their identity and role in the care of dying patients [11].…”