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Nursing decisions to navigate when dying patients become unresponsive

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Nursing decisions to navigate when dying patients become unresponsive

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Flinders University research published in the Journal of Advanced Nursing has examined how specialist palliative care nurses navigate these complex decisions and found they draw on clinical expertise, ethical judgment, close observation and family engagement to guide care during a patient's final days.

"Patients die in many different health care settings, but building relationships with a patient and their family greatly informs and influences nurses' decision-making," says research lead author Tricia O'Connor, a doctoral student at Flinders University.

Strengthening nurses' decision-making may support more timely recognition of care needs, improve assessment and management of distress or discomfort, promote person-centered care and enhance communication with families when patients are in their final days of life.

The study, which interviewed specialist palliative care nurses from a metropolitan palliative care service, highlighted the importance of knowing a patient's cues and wishes, with the resulting decisions made by nurses being linked to family engagement and the care needs of an unresponsive dying patient.

"Nurses' decision-making when caring for an unresponsive dying patient is complex," says O'Connor. "Decision-making is affected by communication, uncertainty, plus ethical and moral agency. Recognizing the vulnerability of unresponsive dying patients is essential to supporting person-centered care."

The average time from a patient becoming unresponsive to death is about two days, during which they may be unable to communicate pain, discomfort, fears or care preferences, making them particularly vulnerable.


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