Purpose/Objectives:

The purpose of this qualitative research study was to describe end-of-life decision-making experiences as they are understood by critical-care nurses and physicians.

Significance:

End-of-life nurse-physician conflict can be a source of moral distress, and unresolved moral distress has been identified as a reason for leaving the critical care specialty, or even the nursing profession (Pendry, 2007; Rushton, 2006).

Design/Methods:

A purposive sample of 7 nurses and 4 physicians working in intensive care units at a large teaching hospital were interviewed. Data analysis involved open, axial, and selective coding processes implementing the technique of comparative analysis (Strauss & Corbin, 1998).

Findings:

The core category, "End-of-life Decision Making Is a Balancing Act," was identified from participants' descriptions of multiple factors that influence the decision-making process. The majority of participants talked about balancing their emotional responsiveness in an end-of-life decision-making situation with their professional role and responsibilities. Additionally, nurses and physicians intentionally communicated and collaborated to balance and connect the elements of complex decision making. When nurses and some physicians were unable to establish a sense of balance in their end-of-life decision-making experiences, they endured emotional or moral distress.

Conclusions:

End-of-life decision making is a complex process that nurses and physicians engage in on a regular basis in the intensive care unit. How nurses and physicians support families differs; however, these professionals have a shared goal, which is to support patients and families throughout end-of-life decisions and experiences.

Implications for Practice:

It is recommended that nurses and physicians receive educational and practice-based support to share their burdens in end-of-life decision making and develop a more collaborative practice environment.

Section Description

The journal is proud to share the student abstracts accepted for poster presentation at the 2010 National Association of Clinical Nurse Specialists Conference. These abstracts are submitted under a separate, later deadline and therefore did not appear in the journal with the general abstracts. Congratulations to these CNS students and their faculty mentors.