Elderly/Long-term Care

Nurses and physicians have different perspectives and roles in medical decisions affecting nursing home residents

Nurses and physicians are both very involved in the care of nursing home residents. However, their roles in and perspectives on medical decisionmaking for residents can be very different, concludes a new study. Jiska Cohen-Mansfield, Ph.D., A.B.P.P., and colleagues interviewed nurses and physicians involved in the care of 28 cognitively impaired nursing home residents who were unable to communicate their own wishes. In these cases, the resident either had a change in health status, change in a nonchronic condition that required medical followup by a doctor, or died from a nonchronic illness.

Five male physicians and two female nurse practitioners answered the medical staff questionnaire. The nurses who answered the nursing staff questionnaire included 1 nurse manager and 17 primary charge nurses (3 RNs and 15 LPNs).

Compared with physicians, nurses reported a greater degree of familiarity with the family's and resident's wishes. Physicians reported considering more treatment options and choosing more treatments for residents than nurses, probably because nurses did not see this as part of their role in some of the cases. In 65 percent of cases, doctors estimated that the condition was likely to improve with the treatment, while the nurses predicted improvement in only 48 percent of cases.

Both physicians and nurses agreed that physicians had a major role in decisionmaking that nurses did not. However, the gap in reported roles was greater based on physicians' reports compared with nurses' reports. Both physicians and nurses were generally comfortable with their medical decisions and had similar perceptions of the families' reactions to the decisions. However, the involvement of the nurse as a partner in these decisions was reported to be minor. In a third of the reported cases, physicians and nurses disagreed about whether advance directives had been followed.

The study was supported by the Agency for Healthcare Research and Quality (HS09833).

See "Medical decision-making in the nursing home: A comparison of physician and nurse perspectives," by Dr. Cohen-Mansfield, Steven Lipson, M.D., and Debra Horton, R.N., in the December 2006 Journal of Gerontological Nursing 32(12), pp. 14-21.

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