Final Decisions: Nurses’ Key Role In End-of-Life Planning

January 27, 2009 at 11:00 am Leave a comment

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 health care 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 coauthors examine why 65% of dialysis patients do not have advance care plans in place and explore 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 health care team.

“Nurses cannot initiate advance care planning with patients in a vacuum,” Ceccarelli writes. “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.

To help support and educate nurses, the American Nephrology Nurses’ Association (ANNA) participates in EOL workgroups with other nephrology organizations across the country. ANNA has also developed two educational modules on “End-of-Life Decision-Making and the Role of the Nephrology Nurse,” which are available in the “Resources” section on ANNA’s Web site.

(Advance Care Planning for Patients with Chronic Kidney Disease – Why Aren’t Nurses More Involved?; Christine M. Ceccarelli, MSN, RN, MBA, CNN; Debra Castner, MSN, RN, APNC-BC, CNN; Mary S. Haras, MS, MBA, APN, NP-C, CNN; Nephrology Nursing Journal; November-December 2008;

Nephrology Nursing Journal is a refereed clinical and scientific resource that provides current information on a wide variety of subjects to facilitate the practice of professional nephrology nursing. Its purpose is to disseminate information on the latest advances in research, practice, and education to nephrology nurses to positively influence the quality of care they provide.

Nephrology Nursing Journal


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