How nurses' and physicians' emotions, psychosocial factors, and professional roles influence the end-of-life decision making process: An interpretive description study

Abstract

Background: Critical care physicians and nurses have significant roles in the complex process of end-of-life decision making.

Objective: To understand how nurses' and physicians' emotions, psychosocial factors and professional roles influence end-of-life decision making in critical care.

Research design/methodology: An interpretive descriptive qualitative approach was applied to collect and analyse data from semi-structured interviews with five critical care nurses and four critical care physicians from April to June 2018.

Setting: Four Canadian critical care units; three tertiary and one rural setting.

Findings: Three major themes arose: (1) the goal of avoiding futility as a shared mission, (2) ambiguity of the decision making process; and (3) influencing factors of subjective variability. The significant influencers shaping the dynamic and value-laden process were individual philosophy, moral weightiness, and family receptiveness.

Conclusion: There is a need for a shared understanding of professional roles and clear communication of shared mission within health professional teams. Improved understanding of the end-of-life decision making process in critical care is essential to support nurses and physicians.

Keywords: Critical care; Decision making; Health transitions; Medical futility; Qualitative research; Terminal care.