Being rooted in ethical values, the nursing profession remains a highly stressful one. The challenges the nurses face require quick decision-making ability and extensive knowledge in the field. End-of-life decision-making is a steep predicament. To deliver the best patient care in such cases, the nurse engages in demanding ethical conversations both with the patient and their relatives and often constitutes to be the one to deliver the bad news. Before making the crucial decision, the nurse must make sure the patient is competent and knows the inevitable consequences. The decision to be made causes frustration and stress to the medical workers. Here, the decision-making activities are at their highest value.
The decision-making in the nursing field is exceptionally complex due to its nature. It demands intuition, knowing the patient and the specific context of the situation, experience, reflection, and interpretation. For end-of-life decision-making, there are several basic principles to consider beforehand (Nibbelink & Brewer, 2018). First, it should reflect respect for both patient’s right to choose and life itself (Nibbelink & Brewer, 2018). Second, it must meet the high standards of medical practice. Third, one must make all efforts possible to reach the appropriate consent through collaborative work. Last but not least, the decision-making process must be transparent and accountable.
Decision-making in this complex area does not rely on any straightforward guidelines. First of all, it happens because the life-sustaining decision-making and treatment withdrawal one is rather different at its core. The decision to stop medical treatment is being accepted when no further improvement in the patient’s condition is possible. The mutual consent of the patient and their family considered properly and discussed carefully, needed to be given for further medical treatment withdrawal.
I resorted to specific decision-making activities to guide others through the decision. First of all, the group should consider whether the decision is urgent or not (End-of-life care, 2020). When the urgency is clear, the patient’s capacity should be assessed – if they have it or not. The capacity implies the patient’s understanding of the matter and its consequences; voluntarily making decisions about treatment withdrawal, and communicating them to the family and personnel (End-of-life care, 2020). Then, if the patient requests the withdrawal, the life-sustaining treatment may be withdrawn solely if the consent was given. Hence, the group checked if the decisions the patient made were had been set out in an AND, and whether it was valid.
The effectiveness of the activities mentioned above was rather simple to notice. The stress and anxiety following the end-of-life decision-making were reduced noticeably. Here, the medical ethic principal – beneficence, “the obligation of health care providers to help people in need” (Bodenheimer & Grumbach, 2016, p. 156) – confronts the necessity to cease the treatment. This causes negative emotional statement which affects the medical workers, nurses, in particular, certain stress which, in turn, might affect their attitudes and behaviors in the workplace. Then, when the competence and capacity of the patient were confirmed, the stress while having a conversation with a patient was reduced significantly. Patient-nurse communication was also smoothed since the medical workers happened to have less stress while at work. Hence, the overall patient care delivery while preparing them for the treatment withdrawal, dealing with their families and further withdrawing itself were implemented more efficiently and smoothly.
Bodenheimer, T. S., & Grumbach, K. (2016). Understanding health policy: A clinical approach. McGraw-Hill Education.
Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5), 917-928. Web.
Queensland Health. (n.d.). Web.