Nurses Need Better End-of-Life Tools to Help in Caring for Terminally Ill Patients

WASHINGTON, DC—A “marked disparity” was found between doctors and nurses regarding knowledge and attitudes about end-of-life treatment decisions, which affected the kind of intervention they would implement in end-of-life case scenarios, according to results of a survey presented at the Oncology Nursing Society (ONS) 38th Annual Congress.

“Specifically, our findings show that nurses felt less equipped than the doctors with communication skills [and offering] emotional support to patients making end-of life-decisions,” stated Ahuva Spitz, RN, MPA, Shaare Zedek Hospital, Jerusalem, Israel. “Additionally, nurses as a group were strongly in favor of the use of feeding tubes at the end-of-life as a sustenance measure.”

She noted that in Israel today, most elderly people die in hospitals. Both increased life expectancy resulting from medical science and technological developments and chronically ill patients living longer “forces medical staff to deal with end of life issues on a daily basis, especially when lacking legal guidelines that address treatment of terminally ill patients.”

Medical, ethical, sociological, legal, financial, and religious concerns surround the elderly, who may have conditions or disorders that affect physical and mental functions. “The conflict lies between patient's autonomy and life sanctity,” she noted. “In the past two decades, patient's autonomy has been valued as an essential element regarding treatment decisions. Therefore, medical teams who care for the elderly in the hospital settings are faced with questionable challenges.”

Doctors and nurses working on the internal medicine wards of three major hospitals in Jerusalem completed 196 questionnaires; 28 closed questions were asked regarding attitudes, behaviors, and knowledge concerning end-of-life issues.

Spitz and colleagues found marked differences among the three hospitals regarding palliative care; two in particular were significantly different on quantitative analysis. The first difference was the administration of morphine; ie, intravenously vs an ET tube. The second was that terminally ill patients are attempted to be fed semi-solids more so than no feeding options.

“The literature describes doctors as tending to favor treatments that prolong lives of terminally ill patients while showing less inclination to relate personally to patients, while nurses tend to be more communicative and prefer not to intervene medically,” Spitz stated. “In contrast, our findings reveal that doctors seem to feel more equipped in handling end of life than nurses, including the ability to discuss imminent death with patients and families.”

These results “indicate a need to provide nurses with better tools to deal with terminally ill patients concerning end-of-life dilemmas,” Spitz noted, who concluded that these findings may “serve as a basis for intervention when providing palliative care.”

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