|
| Information broker | Supporter | Advocate | Patient and family outcomes |
|
| Give information to physicians | Build trust | Advocate to physicians | Accept that patient is dying |
| (i) Patient and family preferences | (i) Introduce self and oncoming nurse | (i) Speak out in meetings | (i) Prepare |
| (ii) Emotional readiness | (ii) Practical needs | (ii) Question or coach | (ii) Help let go |
| (iii) Clinical condition of patient | (iii) Provide details about patient and daily care | (iii) Plant seeds | |
| (iv) Accept decisions | (iv) Time discussions around physician seen as most open | |
| (v) Explain equipment | | |
| (vi) Willing to talk | | |
| (vii) Rituals | | |
| (viii) Storytelling and life review | | |
| (ix) Help maintain hope | | |
| (x) Prepare for bad news | | |
| (xi) Assess readiness | | |
| (xii) Negative: ignore family and focus on technical details | | |
|
| Give information to family | Empathy | Advocate to family | Make better decisions |
| (i) Educate about disease process | (i) Emotional support | (i) Give clear information | (i) Get the truth from nurses |
| (ii) Explain equipment | (ii) Acknowledge feelings | (ii) Interpret information | (ii) Understanding of prognosis |
| (iii) Translate/interpret medical terms | (iii) Take time to listen | (iii) Explore goals | (iii) Trusting relationships, allowed family to ask more questions |
| (iv) Clarify | (iv) Support physicians as well as family members | (iv) Explain implications of decisions | (iv) Move along in decision making process |
| (v) Educate | (v) Allow family time to process information | (v) Encourage to consider what patient would want | (v) Good death |
| (vi) Give information only without interpretation | | (vi) Describe how patient is responding to treatment | (vi) Fear that families carry burden of guilt |
| (vii) Provide meaningless information | | (vii) Explain prognosis | (vii) Satisfaction with care |
| | (viii) Blunt at times | |
| | (ix) Tell family patient is dying | |
| | (x) Sometimes vague and not involved | |
|
| Mediate | | Extent of nursing advocacy: | |
| (i) Coordinate family meetings | | (i) 75% actively involved in EOL decisions | |
| (ii) 42%–54% discuss EOL decisions with patient or family members | |
| (ii) Consult other disciplines | | | |
| (iv) Request ethics consult | | | |
| (iii) Facilitate communication between family and medical team | | | |
| (iv) Ask physician to speak to family | | | |
| (v) Coach family in what to ask physicians | | | |
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