PITMAN, NJ—When it comes to advance care planning and end-of-life (EOL) issues, difficult emotions can easily overwhelm patients and families. This makes it crucial for nurses and healthcare workers to provide guidance and prevent important decisions from falling through the cracks.
In the November-December 2008 issue of Nephrology Nursing Journal, Christine Ceccarelli and co-authors examined why 65 percent of dialysis patients do not have advance care plans in place and explored nurses' role in ensuring optimum EOL planning.
Ceccarelli goes to the heart of the matter by exploring nurses' barriers to broaching this important topic. She cites several studies that reveal nurses fear patient/family reactions to the topic, lack confidence in starting EOL conversations, feel uncertain their supervisors will support their efforts, and are unsure how to handle patients' religious and cultural beliefs. Many nurses also voiced concerns about ethical and legal boundaries in EOL discussions.
To overcome these hurdles, the authors recommend careful collaboration by the healthcare team. "Nurses cannot initiate advance care planning with patients in a vacuum," Ceccarelli wrote. "Support for these discussions requires commitment, planning, and leadership by all caregivers."
Proper planning and appropriate referrals will be achieved after all parties (including patients and families) have been educated and effective communication has occurred, according to the authors.
Click HERE to read the study.
