[A pilot study on the perspectives of hemodialysis room nurses on promoting advance directives]

Previous studies have shown that patients with end-stage renal disease experience a lower than optimal quality of dying and achieve a lower rate of advance directives (ADs) completion. Patients are frequently unaware of their option to withdraw from dialysis and also believe their physicians would oppose such a decision. Where there are inherent difficulties for medical staff in discussing end-of-life (EOL) issues with patients, patients on dialysis often develop a trusting, almost familial relationship with their nurses, who play a vital role in assisting patient and family to make EOL care decisions.

The purpose of this study was to explore the perspectives on advance directive discussion strategies of nurses working in hemodialysis rooms.

This was a descriptive-correlational research study that targeted 55 nurses working in a hemodialysis room at a regional hospital in southern Taiwan. Structured questionnaires were developed for this study that collected basic demographic information and assessed participant perspectives on discussing ADs. Data were analysed using descriptive statistics and deductive statistics, including independent t test, one-way ANOVA and Pearson correlation.

Over 80% participants agreed that discussing ADs with patients could accurately identify patient preferences, improve EOL quality, and decrease family conflicts. However, 78.2% expressed that they did not have sufficient training to talk with patients about death and dying. Also, two-thirds (65.5%) worried about upsetting their patients, as they perceived their professional role as sustaining life (rather than helping prepare for death). Significant differences in discussing ADs with patients were found in respect to age and personal experience as well as with regard to whether the participant had discussed EOL care decisions with others.

Discussing ADs with patients may improve EOL quality. Lack of training and negative perspectives represent major barriers. Therefore, teaching nurses how to engage in EOL care dialogue with patients and paying attention to patient EOL needs represent crucial tasks ahead.