Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

How Providers Can Help Individuals Engage in Decision-making
Refer to the guideline, www.rnao.org/bestpractices, for complete reference
 
Nurse/patient relationship
Sharing of power and control
Communication and assessment
Promote discussion if families are struggling with conflict (Hsieh, Shannon, & Curtis 2006).
 
Emphasize the need to consider what information was essential for patients and relatives, use concrete examples and lay language, and provide time for decision-making (Hanna-Mari & Marja-Liisa, 2006).
 
Offer emotional and existential support through discussion, listening, being present and attending to patients and relatives (Hanna-Mari & Marja-Liisa, 2006).
Raise issues related to end-of-life care early in the course of a life-threatening illness (Thelen, 2005).
 
Provide resources on how to access reliable trustworthy information (National Advisory Committee: A Guide to End-of-life Care for Seniors, 2000).
 
Evaluate patients/ and their relatives’ competence for decision-making and support them in accepting the medical facts (Hanna-Mari & Marja-Liisa, 2006).
 
Approach the topic sensitively (National Advisory Committee: A Guide to End-of-life Care for Seniors, 2000).
Be aware of influence providers have in influencing decisions by critically analyzing /reflecting on extent to which they have control over patient/situation (Hilden & Honlasalo, 2006).
 
Clarify patients’ and relatives’ views (Hanna-Mari & Marja-Liisa, 2006).
 
Be available to listen to concerns and provide uninterrupted time (National Advisory Committee: A Guide to End-of-life Care for Seniors, 2000).
 
Reframe decisions regarding withholding sustaining treatment as allowing the disease to take its course rather than “not continuing treatments that merely prolong suffering.” (Lyness, 2004)
Patient’s and their family’s need to understand their overall medical condition to plan effectively and how their illness and various treatment options will affect them within the context of their daily lives (Davison & Torgunrud, 2007).
 
Recognize that each person has unique tolerance for discomfort and a unique drive to live (Loomis, 2009).
 
Recognized that people may choose to endure physical or emotional distress as part of their spiritual journey (Loomis, 2009).
Facilitate frank assessment of the likelihood of whether withholding or stopping sustaining treatment will be beneficial (Lyness, 2004).