Factors Influencing the Initiative Behavior of Intensive Care Unit Nurses toward End-of-Life Decision Making: A...

Area of Science:

• Nursing
• Medical Ethics
• Healthcare Management

Background:

• The importance of intensive care unit (ICU) nurse initiative in end-of-life (EOL) decision-making is recognized, yet specific studies on nurses' proactive roles in EOL situations are limited.
• Understanding the factors influencing nurse initiative is crucial for improving EOL care quality.

Purpose of the Study:

• To investigate the role of facilitators, barriers, and perceived stress on the initiative behavior of ICU nurses in EOL decision-making.
• To explore the mediating effect of perceived stress on the relationship between facilitators/barriers and nurse initiative in EOL contexts.

Main Methods:

• A cross-sectional descriptive study was conducted using questionnaires.
• Data were collected from registered ICU nurses in five tertiary general hospitals in Zhejiang Province, China.
• The questionnaire included demographics, scales for facilitators/barriers, perceived stress, and EOL decision-making initiative behavior.

Main Results:

• ICU nurses' EOL decision initiative behavior scored an average of 5.54 (range 2-10), indicating a medium level.
• Facilitators positively correlated with initiative behavior, while barriers negatively correlated.
• Facilitators/barriers significantly predicted initiative behavior (β=0.698, p<0.001) and had an indirect effect through perceived stress (mediating effect 6.31%).

Conclusions:

• ICU nurses' initiative in EOL decision-making is at a moderate level.
• Intervention strategies should focus on reducing barriers and stress by enhancing inter-team collaboration, nurse-patient communication, role clarity, and emotional support.
• These improvements can increase ICU nurse initiative and participation in EOL decision-making processes.