End-of-life issues in intensive care units: a national random survey of nurses' knowledge and beliefs

Am J Crit Care. 2001 Jul;10(4):216-29.

Abstract

Objective: To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units.

Methods: A survey was mailed to 3000 members of the American Association of Critical-Care Nurses. The survey contained various scenarios depicting end-of-life actions for patients: pain management, withholding or withdrawing life support, assisted suicide, and voluntary and nonvoluntary euthanasia.

Results: Most of the respondents (N = 906) correctly identified the distinctions among the end-of-life actions depicted in the scenarios. Almost all (99%-100%) agreed with the actions of pain management and withholding or withdrawing life support. A total of 83% disagreed with assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to 98% disagreed with nonvoluntary euthanasia. Most (78%) thought that dying patients frequently (31%) or sometimes (47%) received inadequate pain medicine, and almost all agreed with the double-effect principle. Communication between nurses and physicians was generally effective, but unit-level conferences that focused on grief counseling and debriefing staff rarely (38%) or never (49%) occurred. Among the respondents, 37% had been asked to assist in hastening a patient's death. Although 59% reported that they seldom acted against their consciences in caring for dying patients, 34% indicated that they sometimes had acted against their conscience, and 6% had done so to a great extent.

Conclusions: Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Attitude to Death*
  • Clinical Competence
  • Decision Making*
  • Ethics, Nursing
  • Euthanasia
  • Female
  • Humans
  • Intensive Care Units / standards*
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Nursing Staff, Hospital / psychology*
  • Nursing Staff, Hospital / statistics & numerical data
  • Palliative Care
  • Suicide, Assisted
  • Surveys and Questionnaires
  • Terminal Care / methods
  • Terminal Care / standards*
  • United States