Advance Directives and End-of-Life Decision Making: Survey of Critical Care Nurses’ Knowledge, Attitude, and Experience

This article describes critical care nurses’ knowledge, attitudes, confidence, and experiences regarding advance directives and end-of-life decision making.

Intensive care units (ICUs) are the site of much end-of-life decision making. Decision making in the ICU should be governed by patients’ wishes, and advance directives are one way patients can make their end-of-life decisions known. Advance directives are defined as mechanisms by which individuals make known how they want medical treatment decisions made when they can no longer make the decisions for themselves. Advance directives can take the form of living wills, healthcare proxies, do-not-resuscitate orders, and durable powers of attorney. Healthcare providers play an important role in patients’ understanding and completion of advance directives. Ideally, advance directives should be completed before an acute illness occurs, in a less hectic and stressful environment. If patients come to the ICU without advance directives, critical care nurses, who spend more time with ICU...