Practice and influencing factors of surrogate decision-making support by emergency and intensive care nurses for the terminal care of critically ill patients

Abstract

Purpose: The purpose of this study was to clarify the practice of surrogate decision-making support for the terminal care of critically ill patients, to identify influential factors, and to make suggestions for future practice.

Methods: This study had a hypothesis-testing design, and questionnaire surveys were mailed to nurses involved in emergency care and intensive care at tertiary emergency medical institutions throughout Japan. Data were collected and statistically analyzed regarding systematic factors, nurse’s characteristics, and a nursing practice scale that had previously been developed to measure the support for surrogate decision-makers of terminal care in the intensive and critical care units.

Results: Surveys were returned by 612 nurses (30.2%) and were included in the analysis. The degree of practice regarding unbiased attitude and confirmation of explanations was high, with practice being most greatly affected by knowledge advice and emotional support from supervisors and colleagues.

Discussion: The data suggests that expert nurses were involved with the families of critically ill patients from a holistic perspective and responded flexibly through approval from the supervisor and relationship-based development. To improve the quality of practice, problems regarding surrogate decision-making support, such as a lack of human resources or information sharing, can be solved with the expertise of qualified personnel.

Conclusion: The hypothesis that systemic factors influence the practice of surrogate decision support has been proven. The roles of the certified nurses and nurse specialists should be used to improve the support of surrogate decision-making.