Factors related to the involvement of nurses in medical end-of-life decisions in Belgium: A death certificate study
Section snippets
What is already known about the topic?
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Nurses play a key role in good end-of-life care and are frequently confronted with the question of euthanasia and other end-of-life decisions with a possible or certain life-shortening effect (ELDs).
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Physicians do not systematically involve nurses in ELDs.
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Studies about factors related to the involvement of nurses are limited to healthcare professionals’ characteristics and are only studied in a particular care unit or nursing specialization.
What this paper adds
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Physicians consult nurses in ELDs more often when they intend to hasten the patient's death than without such intention, more often in care homes for the elderly than in hospitals and in institutions, more often with lower than higher educated patients.
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As reported by physicians, nurses administer life-ending drugs more often in institutions than at home, and in institutions more often in case of lower than higher educated patients.
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Physician's perceptions of the role of nurses, as well as their
Aim
The aim of this study is to explore which patient- and decision-characteristics are related to the consultation of nurses and the administering of life-ending drugs by nurses in actual ELDs in institutions as well as at home, as reported by physicians.
Design
A cross-sectional retrospective death certificate study was conducted in 2001 in Flanders, the northern Dutch-speaking region of Belgium where approximately 60% of the Belgian population lives and where about 56 000 deaths occur each year (54% in
Results
The response rate was 59% (n=2950). In 38.5% of all deaths (n=1354), death was preceded by at least one ELD: withholding or withdrawing a probably life-prolonging medical treatment were reported in 14.6%, alleviation of pain and/or symptoms with a possible life-shortening effect in 22.1%, the use of drugs with the explicit intention of hastening the patient's death at the patient's explicit request (euthanasia) occurred in 0.3%, and without the patient's explicit request in 1.5% of all deaths
Discussion
As in previous studies (Muller et al., 1997; Bilsen et al., 2004b), in this study nurses are consulted more frequently in an institution than they are at home. Additionally, we find that within institutions, nurses are consulted more frequently in care homes for the elderly than in hospitals. In care homes for the elderly, nurses provide supervision of and assistance in the daily activities of the residents and have great responsibility in the administering of treatments. They work autonomously
Acknowledgment
The authors thank J. Vanoverloop for his statistical advice, J. Mayes for her useful comments on the article, the Federal and Flemish Ministry of Public Health for their cooperation in the data collection, all participating physicians, and all members of the EURELD consortium.
References (39)
- et al.
Dying at home or in an institution: using death certificates to explore the factors associated with place of death
Health Policy
(2006) - et al.
Involvement of nurses in caring for patients requesting euthanasia in Flanders (Belgium): a qualitative study
International Journal of Nursing Studies
(2006) - et al.
A study of core interventions in home nursing
International Journal of Nursing Studies
(2005) - et al.
End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey
Lancet
(2000) - et al.
Withholding and withdrawal of life support in intensive-care units in France: a prospective survey
French LATAREA Group. Lancet
(2001) - et al.
Voluntary euthanasia and the nurse: an Australian survey
International Journal of Nursing Studies
(1993) - et al.
Canadian nurses’ and respiratory therapists’ perspectives on withdrawal of life support in the intensive care unit
Journal of Critical Care
(2005) - et al.
End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?
Intensive & Critical Care Nursing
(2003) - et al.
End-of-life decision-making in six European countries: descriptive study
Lancet
(2003) - et al.
Socio-economic status of the patient and doctor–patient communication: does it make a difference? Patient Education and Counselling
(2005)
The role of critical care nurses in euthanasia and assisted suicide
New England Journal of Medicine
Euthanasia among US critical care nurses: practices, attitudes, and social and professional correlates
Medical Care
Nurse involvement in end-of-life decision making: the ETHICUS Study
Intensive Care Medicine
The incidence and characteristics of end-of-life decisions by GPs in Belgium
Family Practice
Involvement of nurses in physician-assisted dying
Journal of Advanced Nursing
Belgium: towards a legal recognition of euthanasia
European Journal of Health Law
Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians
Critical Care
Communication of end-of-life decisions in European intensive care units
Intensive Care Medicine
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