Attitudes of Legal Guardians in the ICU – A qualitative report

Decision-making in intensive care units (ICUs) is often made by surrogates, since patients are unconscious or incompetent. In Israel, Legal Guardians (LGs), appointed by the court, are required to make these decisions. To qualitatively assess the attitudes of LGs required to make decisions on behalf...

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Bibliographic Details
Published in:Intensive & critical care nursing 2014-04, Vol.30 (2), p.86-92
Main Authors: Kuniavsky, Michael, van Heerden, Peter V., Kadmon, Ilana, DeKeyser Ganz, Freda, Linton, David M., Sviri, Sigal
Format: Article
Language:English
Subjects:
Adult
Advance Directives
Agreements
Attitude
Attitudes
Communication
Critical Care Nursing
Critical Illness
Decision Making
Female
Guardians
Hospitals
Humans
ICU
Informed consent
Intensive care
Intensive Care Units
Israel
Legal Guardian
Legal Guardians - psychology
Male
Middle Aged
Nursing
Ostomy
Patients
Qualitative research
Surrogate decision making
Surrogates
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Summary:Decision-making in intensive care units (ICUs) is often made by surrogates, since patients are unconscious or incompetent. In Israel, Legal Guardians (LGs), appointed by the court, are required to make these decisions. To qualitatively assess the attitudes of LGs required to make decisions on behalf of their relatives. Demographic and semi-structured questionnaires were used to assess the attitudes of LGs regarding difficulties, positive aspects and areas for improvement with regard to surrogate decision-making. The study sampled sixty-four LGs in two large Israeli hospitals. After reading and analysing the responses provided by the LGs, the authors categorised the pertinent topics raised using a thematic analysis. Themes were: bureaucratic and legal issues, unclear or unknown patient preferences and fear of outcomes. Family and medical staff support was stated as the most beneficial. Suggestions for improvement included alleviation of bureaucracy and improved communication with the medical staff. The importance of communication and bureaucratic difficulties, making the best decision for the patient and uncertainty regarding decision outcomes were found to be important issue for the LGs. The healthcare team should try and alleviate some of these burdens, mostly by improving communication with relatives, stressing and educating the importance of advance directives. Reporting the problems found in the decision making process of LGs to the legislators in order to revise and simplify the current legal requirements is advised.
ISSN:0964-3397
1532-4036
DOI:10.1016/j.iccn.2013.10.002