Attitudes of Dutch nurses towards their involvement in end-of-life decisions with a possible life-shortening effect.

Background: Nurses are often involved in end-of-life decision making as they play an important role in caring for terminally ill patients. Aim: To investigate nurses’ attitudes towards their involvement in end-of-life decisions with a possible lifeshortening effect, and a possible relationship with sociodemographic characteristics and work-related factors. Methods: A representative sample of 903 nurses in the Netherlands received a written structured questionnaire about experiences with medical end-of-life decisions, and the extent to which they agreed with statements about attitudes towards and their role in medical end-of-life decisions on a 5-point scale. Logistic regression models were fitted for each statement to determine the relation between nurses’ attitudes and socio-demographic and work-related characteristics. Results: The response rate was 66 percent. Most nurses, especially highly educated nurses, nurses working in a hospital, and nurses who had experience with or had received training on end-of-life decisions, agreed that patients talk rather to a nurse about end-of-life decisions than to a physician (64%). In particular highly educated and female nurses, believed that they are in a better position to assess patients’ wishes than physicians are (38%). Most nurses, especially those working in a hospital and nursing home agreed that they should be involved in the whole process of end-of-life decisions (74%), and in decisions to withhold or withdraw life sustaining treatment (58%). Though the core value of nursing is the patient’s wellbeing most nurses believed that nursing may also include decisions with a possible life shortening (71%). Conclusion: Overall, nurses agree that decisions with a possible life-shortening effect are part of their job and they want to be involved in these decisions. Work setting seems to be the most important determinant regarding the preferred involvement in decisions which may have a shortening effect. (aut. ref.