gms | German Medical Science

Objective: End-of-life-decisions (EOLD) are daily practice in the neurosurgical intensive care unit (ICU) setting. Non-clearly structured and documented EOLD can lead to conflict in the treatment team and have a negative impact on mental health and job satisfaction. With the aim of developing measures to improve or maintain mental health and job satisfaction, target group specific burdens and needs in EOLD need to be identified.

Methods: Between July to October 2018, physicians and nurses were asked about their subjective experience of the current definition, documentation and implementation of EOLD as well as their effects on job satisfaction and their emotion regulation with the help of semi-structured interviews in 12 ICUs of our institution. The answers were qualitatively evaluated according to the thematic analysis. In addition, the frequency of EOLD in everyday life and their significance for job satisfaction, perceived workload and emotional stress were quantified. A numerical rating scale was used to capture global satisfaction (0 = not at all satisfied to 10 = completely satisfied) with the current definition, documentation and implementation of EOLD.

Results: A total of 19 physicians (61%) and 12 (39%) nurses participated, half of whom (54%) had EOLD "daily" or "several times a week". Physicians were significantly more satisfied with the current definition, documentation and implementation of EOLD as the nursing staff (6.63 vs. 3.75; p < .001). The importance of job satisfaction was very high in both groups (8.16 vs. 8.42; p = n.s.), as well as the emotional stress (5.05 vs. 5.00; p = n.s.) and the workload (6.74 vs. 8.33; p = n.s.). Physicians addressed emotional stress caused by recurring escalation situations during weekend or overnight services, e.g. due to insufficient documentation that led to ethical conflicts, experienced helplessness or perceived disproportion of treatment. Nursing staff experiences emotional burden due to their lack of involvement in the EOLD process while still having to carry out the EOLD even if they do not agree. Reported measures for emotion regulation ranged from individual endurance to established rituals in the team.

Conclusion: The results of the present study indicate different needs of physicians over nurses in the context of EOLD. A reduction of emotional stress by EOLD could be achieved through a combination of structural measures and individual intervention to support emotional regulation.