Medical end-of-life decisions in Belgian pediatric intensive care units: nurses' involvement and attitudes

Objective End-of-life decisions with a possible or certain life-shortening effect (ELDs) occur at pediatric intensive care units (PICUs). It is, however, not clear how nurses are involved in those decisions. The aim of this study is to investigate to what extend nurses are confronted with ELDs and involved in the initiation, decision-making and implementation, and to explore their attitudes towards those decisions.

Method Anonymous questionnaires were distributed to all nurses working at five of the seven PICUs in Belgium (N=141). Nurses were asked to recall the most recent child they have cared for and for whom an ELD had been taken, and to describe their role. Attitudes were asked by means of statements and using a Likert-scale.

Results Response rate was 63% (N=89). Most nurses (86%) had cared for a child for whom an ELD was taken. Nurses initiated the decision in 17%, participated in the decision-making in 50%, and had a particular role in the implementation in 90% of all ELDs. In 61% nurses were involved in the administration of life-ending drugs with the physician's presence and in 31% without the physician's presence. Few nurses (6%) would not participate in any form of life termination in children and most nurses (78%) were prepared to cooperate in the administering of life-ending drugs. The majority of nurses (89%) was also in favor of an adaptation of the law, making termination of life legally possible in some cases.

Conclusions Belgian PICU nurses are often involved in the implementation of ELDs, even in administering life-ending drugs, while there participation in the decision-making process is rather limited. They think life-termination among terminally ill children must be possible and legally regulated in certain circumstances. Given their crucial role, those nurses should be involved more actively in the discussion about these decisions.