Variations in nurse involvement in end-of-life practices in intensive care units worldwide (ETHICUS-2): a prospective observational study.

Abstract Purpose explore global ICU nurse involvement in end of life decisions, ETHICUS-2 prospective multinational, observational study was performed. Methods This is a secondary analysis of data obtained from the ETHICUS-2 study. Patients were followed until ICU discharge, death, or 2 months from the first decision to limit life-prolonging therapies. Data were collected by an ICU clinician recording end of life decisions typically at the time of first limitation. Nursing related questions included: were withholding or withdrawing treatment discussed with nurses? Who initiated the end of life discussion? Was a nurse involved in making the end of life decision? Was there agreement between physicians and nurses. Global regions were compared related to these four questions. Results A significant difference was found between regions, (p< .001) with Northern Europe and Australia/New Zealand having the most discussion with nurses and Latin America, Africa, Asia and North America the least. The percentages of nurses who were involved end of life decision ranging between 3-44%, the differences were statistically significant. Agreement between physicians and nurses related to decisions resulted in wide range of responses (27-86%) (p < .001). The percentages of EOL decisions in which agreement between physicians and nurses was not applicable included a wide range of responses from 0-41% Conclusion A large variability in nurse involvement in end of life care in the ICU was found. Perhaps due to perception of physicians and nurses view of themselves. Varying levels of expertise and experience of clinicians.