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Nursing Ethics, Vol. 15, No. 2, 160-173 (2008)
DOI: 10.1177/0969733007086014

Nurses' Conceptions of Decision Making Concerning Life-Sustaining Treatment

Marit Silén

Jönköping University, Jönköping, Sweden, marit.silen{at}hhj.hj.se

Mia Svantesson

Örebro University and Örebro University Hospital, Örebro, Sweden

Gerd Ahlström

Jönköping University, Jönköping

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician—nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

Key Words: clinical ethics • dialysis • end-of-life decision making • interprofessional relationships • life-sustaining treatment • nursing


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