South African critical care nurses' views on end‐of‐life decision‐making and practices

<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Care of patients at the end‐of‐life (<jats:styled-content style="fixed-case">EOL</jats:styled-content>) may be influenced by the experiences, attitudes and beliefs of nurses involved in their direct care.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To investigate South African critical care nurses' experiences and perceptions of <jats:styled-content style="fixed-case">EOL</jats:styled-content> care.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross‐sectional survey.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>South African critical care nurses completed a modified version of the ‘<jats:styled-content style="fixed-case">VENICE</jats:styled-content>’ survey tool. Data were collected concerning: attitudes towards <jats:styled-content style="fixed-case">EOL</jats:styled-content> care; involvement in <jats:styled-content style="fixed-case">EOL</jats:styled-content> decision‐making; and beliefs about <jats:styled-content style="fixed-case">EOL</jats:styled-content> practices.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 149 surveys distributed, 100 were returned (response rate 67%). Seventy‐six percent stated that they had had direct involvement in <jats:styled-content style="fixed-case">EOL</jats:styled-content> care of patients, but a minority (29%) had participated in <jats:styled-content style="fixed-case">EOL</jats:styled-content> decision‐making processes. Whilst most nurses (86%) were committed to family involvement in <jats:styled-content style="fixed-case">EOL</jats:styled-content> decisions, less than two thirds (62%) reported this as routine practice. When withdrawing treatment, around half (54%) of the respondents indicated they would decrease the inspired oxygen level to room air, and the majority (84%) recommended giving effective pain relief. Continued nutritional support (84%) and hydration (85%) were advocated, with most nurses (62%) indicating that they were against keeping patients deeply sedated. Most respondents (68%) felt patients should remain in intensive care at the end of life, with the majority (72%) supporting open‐visiting, no restriction on number of family members visiting (70%), and the practising of religious or traditional cultural <jats:styled-content style="fixed-case">EOL</jats:styled-content> rituals (93%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The involvement of Johannesburg critical nurses in <jats:styled-content style="fixed-case">EOL</jats:styled-content> care discussions and decisions is infrequent despite their participation in care delivery and definite views about the process.</jats:p></jats:sec><jats:sec><jats:title>Relevance to clinical practice</jats:title><jats:p>Use of formal guidelines and education is recommended to increase the nurses' involvement in and their confidence in participating in <jats:styled-content style="fixed-case">EOL</jats:styled-content> decisions. Educators, managers, senior nurses and other members of the multi‐disciplinary team should collaborate to enable critical care nurses to become more involved in <jats:styled-content style="fixed-case">EOL</jats:styled-content> care.</jats:p></jats:sec>