Nurses' knowledge of--and role in--patients' end-of-life decision-making

The Code for Nurses as set forth by the American Nurses Association promotes the nurse as the patient's advocate protecting his/her rights and preventing unwanted intrusion, but based on the results of this study, the nurse is unprepared to be such an advocate. This may be due to a lack of knowledge about the law or a lack of confidence in discussing the issue with patients. The best time and place to prepare an advance directive are still in question. The point of admission into the hospital or other health care institution may be the time to verify the existence of an advance directive, but it is probably not the best time or place to construct one. This was reinforced by comments noted by the subjects responding to the questionnaire. Nurses may have an important role in the process, but this research shows that nurses do not feel comfortable talking about advance directives to patients and families. However, nurses need to be prepared to talk to the patient and family about this very important process and to operationalize their end-of-life decisions. Academic and health care institutions should assist nurses in gaining the knowledge and the confidence needed for this process.