End-of-Life Decisioning from Nurse Point of View

Author: Mgr. Michaela Březovská, Hana Harazim, MD

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: palliative care | acute care | end-of-life decision-making | nursing | pain

Educational evel: Undergraduate level | Graduate

Palliative care in nursing reflects the view of a dying patient as a entire whole person. The provision of palliative care depends primarily on the non-medical health care staff, which provides, for the majority of the time, the dying patients comprehensive care during hospitalisation in an acute bed. Primarily the nurse is a direct participant in all of the events and comes in to contact with dying and death more often than any other medical staff. Therefore, it is essential that non-medical healthcare professionals have considerable interpersonal skills but, above all, clinical knowledge in relation to observation, response and initiation of symptom therapy. The aim of nursing in palliative care is to provide integrated comprehensive care that prevents and alleviates all aspects that are associated with any form of suffering of the dying patient. The aim is therefore to provide care that guarantees the highest quality of life until the last days of a dying patient in the department of acute and intensive care.

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Therapeutic range of intensive care medicine is enormous. Nevertheless, in a certain number of cases, the illness and the overall condition of the patient have progressed so much that, despite all heroic therapeutic measures, the evolution of the patient's health condition leads to leaving the world, and in such patients it is necessary to find the right time to decide, whether it is ethically necessary to continue intensive medicine and hence to treat the medical condition inappropriately or to switch to a palliative treatment and to focus on letting die.
The presented algorithm offers a solution to a typical situation involving a terminally ill oncological patient, from the nurse´s point of view because of his/her irreplaceable role in deciding at the end of patient´s life. They are in long-term and close contact with patients and can sense when all highly sophisticated diagnostics and treatment are in vain, and therefore have the ability to design a whole patient-care team to move from intense to palliative care. In palliative care, nurses play a key role.
Authors have managed to build a didactically convenient algorithm of steps to proceed in such an ethically sensitive situation. It was a good idea to create such an algorithm and I'm glad it will be published at

publikováno: 1. 7. 2018 | last modified on: 13. 9. 2019