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Posted on June 21, 2017 at 5:00 AM

A new study in the July/August 2017 Dimensions of Critical Care Nursing  reports suggestions from 500 critical care nurses on how to improve end-of-life care obstacles.  

Major themes include:

  • Ensuring characteristics of a good death
  • Improving physician communication with patients and families
  • Adjusting nurse-to-patient ratios to 1:1
  • Recognizing and avoiding futile care
  • Increasing EOL education
  • Physicians who are present and ‘‘on the same page”
  • Need for more support staff
  • Not allowing families to override patients’ wishes

I want to second this final suggestion.  In my discussions with nurses this is a very common question.  The study’s quotes are consistent with my own experience:

  • “The most troubling aspect is when patients’ wishes are not followed.”
  • “Respect patients’ wishes NOT families!”
  • “Follow the patient’s DNR/POLST form regardless of the family’s wishes. The patient filled it out for a reason.”
As I have written several times, surrogates who contradict the patient’s own instructions or wishes can and should be replaced.  

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