• Verpleegkundig beleid

• Ja

The rising prevalence of incurable diseases, particularly among ageing populations with multiple chronic conditions, presents significant challenges for healthcare systems. Cardiovascular diseases, cancer, and chronic respiratory illnesses remain leading causes of global mortality. Patients in terminal stages require care that not only addresses physical symptoms but also respects individual values, cultural backgrounds, and preferences. In this context, palliative care plays a vital role in enhancing quality of life. Treatment decisions in such cases are complex and often involve life-prolonging treatments (LPT) with uncertain benefits. Shared decision-making (SDM) aims to align these decisions with patient preferences through collaboration among patients, relatives, nurses, and physicians. Despite nurses’ close contact with patients, their role in SDM remains underutilised and poorly embedded in practice. This thesis explores the role of hospital nurses in SDM around LPT decisions and is structured in three parts. Part I examines nurses' current and preferred roles and how they are perceived by nurses and physicians. Part II explores the emotional impact of nurse involvement, specifically moral distress. Part III identifies tools to support communication and decision-making and concludes with an implementation guide for SDM in clinical settings. Chapter 2 presents findings from a 2019 survey of 179 Dutch hospital nurses. While nurses believe they should play an active role in advocating for patients, a gap persists between their preferred and actual involvement—particularly in communication and support during decision-making. Organisational barriers, time constraints, and lack of training were cited as key obstacles. Nurses also reported a need for better information transfer and collaboration with physicians. Targeted training and structural support are recommended to empower nurses and improve alignment between treatment and patient preferences. Chapter 3 builds on this with qualitative data from 18 interviews with nurses across Dutch hospital settings. Nurses described roles ranging from assessing decision quality to facilitating SDM. Six conditions for effective involvement were identified: timely information transfer, a culture valuing nurse input, strong physician relationships, adequate skills, sufficient time, and meaningful patient relationships. The findings underscore the need for structured support and training to strengthen nurses’ contributions to SDM. In Chapter 4, 15 physicians from various hospital types were interviewed to explore how they perceive nurses’ roles in LPT decisions. While physicians retain final responsibility, they acknowledged nurses as valuable partners, particularly in complex cases. Nurses’ close contact with patients and families enables them to provide insights into patient preferences. However, views on the extent of nurse involvement varied, with barriers including time pressure and acute care demands. The findings highlight the need for interprofessional collaboration and institutional support. Chapter 5 examines the moral distress experienced by 23 nurses involved in LPT decisions. Distress was particularly high when nurses were excluded from decisions or administered treatments they viewed as futile. Additional strain arose when physicians dismissed ethical concerns or gave unrealistic expectations. Addressing this requires ethical training, sustainable support, and structural integration of nurse involvement. Chapter 6 presents a systematic review of tools supporting SDM in hospitals. Seven studies were included, highlighting Question Prompt Lists and Decision Aids as effective means to reduce patient anxiety and improve engagement. These tools enhanced understanding but had limited impact on satisfaction or decision quality. Further development of culturally sensitive tools is needed. Chapter 7 reflects on the gap between patient-centred intentions and clinical reality. Many patients remain unaware of treatment options and rely heavily on physicians, with minimal nurse involvement. A five-step implementation plan is proposed: clarifying roles, aligning organisations, providing training, tailoring strategies, and ensuring sustainability. Recognising and supporting nurses’ roles is essential to realising SDM. With shared commitment, this vision can become reality.

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