The Role of Nurses in End-of-Life Care Planning Examined

The November-December 2008 issue of Nephrology Nursing Journal included an article examining the role nurses could plan in end-of-life (EOL) care planning for dialysis patients, 65 percent of whom do not have advance care plans in place. The article's authors, Christine M. Ceccarelli, MSN, RN, MBA, CNN; Debra Castner, MSN, RN, APNC-BC, CNN; and Mary S. Haras, MS, MBA, APN, NP-C, CNN, explored nurses' barriers to discussing EOL care.

They cite studies that have examined why nurses are reluctant to start these discussions, including fear of patient and/or family reactions to the topic, lack confidence in starting EOL conversations, feeling uncertain their supervisors will support their efforts, and being unsure how to handle patients' religious and cultural beliefs. There are also concerns about ethical and legal boundaries in EOL discussions. 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.