Nurse Involvement in End of Life Decision
Making in the Intensive Care Unit:
A Literature Review
Abstract
This article reviews the evidence related to nurse
involvement in the end of life (EOL) decision making in
the Intensive Care Unit (ICU). This study was conducted
by analyzing 53 scholarly papers which met the inclusion
criteria. Data were searched through CINAHL, Science
Direct, ProQuest, Wiley Online Library, and PubMed.
The keywords used were “ICU Nurse”, combined with
“end of life”, “decision making” and “end of life decision
making”. The databases of PubMed, ProQuest, CINAHL,
Wiley Online, Ovid, and Science Direct were used to
search for the relevant articles. The results of the analysis
present the definition of end of life decision making, type
of end of life decision making, persons involved in end of
life decision making in the ICU, process of end of life
decision making in the ICU, a nurse’s role in end of life
decision making, and factors influencing end of life
decision making in the ICU. The results of this study are
important to develop an understanding regarding nurse
involvement in end of life decision making in the ICU.
Keywords: decision making; end of life; intensive care unit
I. INTRODUCTION
Healthcare providers who work in the Intensive
Care Unit (ICU) focus on delivering care to patients
during their acute threats and restoring their quality of
lives [50]. Approximately 20% of patients die while
receiving care in an ICU [35] which causes the ICU to
have the highest mortality rate compared with other
units in the hospital. The majority of patients died after
end of life (EOL) decision making [33] which makes
EOL decision making become a crucial component of
nursing care in the ICU.
Nurses in the ICU inevitably become a substantial
component during EOL decision making. Nurses are
often concerned with doing their best for the patient
and the patient’s family during EOL decision making
and perceive that they have full responsibility
regarding the patient’s condition which can increase
psychological problems among ICU nurses. Profound
knowledge regarding nurse involvement in EOL
decision making is needed to increase the quality of
EOL decision making in the ICU. For an
understanding in this area, a literature review was
undertaken.
II. METHODS
The data of this literature review were collected
from searches on databases and manual searching. The
databases of PubMed, ProQuest, CINAHL, Wiley
Online, Ovid, and Science Direct were used to search
for relevant articles using the search terms “ICU
Nurse”, combined with “end of life”, “decision
making”, and “end of life decision making”.
The articles used in this study were limited to
articles published in English during the years 2005-
2017. The relevant articles were graded for the level of
evidence using the Joanna Briggs Institute for
Evidence-Based Nursing and Midwifery (JBI) 2014
levels of evidence. Key information and analysis were
extracted into tables which consisted of topics and
authors, year of publication, design of the study,
Arif Imam Hidayat
Master of Nursing Science Student (International
Program), Faculty of Nursing, Prince of Songkla
University, Thailand
hidayat.al.fikri@gmail.com
Waraporn Kongsuwan
Associate Professor, Adult and Elderly Nursing
Department, Faculty of Nursing, Prince of
Songkla University
Hat Yai, Thailand
waraporn_kongsuwan@yahoo.co.uk
Kittikorn Nilmanat
Associate Professor, Adult and Elderly Nursing
Department, Faculty of Nursing, Prince of
Songkla University
Hat Yai, Thailand
kittikorn.n@psu.ac.th
DOI: 10.5176/2345-7198_5.1.5
ISSN 2345-7198
©The Author(s) 2018. This article is published with open access
by the GSTF
GSTF Journal of Nursing and Health Care (JNHC)
Vol.5 No.1, Apr-2018