Journal of Gerontological Nursing

Interdisciplinary Care 

Medical Decision-Making in the Nursing Home: A Comparison of Physician and Nurse Perspectives

Jiska Cohen-Mansfield, PhD, ABPP; Steven Lipson, MD; Debra Horton, RN

Abstract

The purpose of this study is to clarify the perspectives of physicians and nurses in the medical decision-making process at the time of status change events in nursing home residents. The decision-making processes studied involved 28 cognitively impaired nursing home residents in a large suburban nursing home. In interviews, the authors ascertained the personal opinions of physicians and the nurses related to the status change event and the decision-making process using the Medical Decision-Making During a Status Change Event Questionnaire. Nurses reported a greater degree of familiarity with the family’s and resident’s wishes than did physicians. Physicians reported considering more treatment options and choosing more treatments for residents than nurses. Both physicians and nurses reported that the physicians had a major role in decision-making and that nurses did not, yet the gap in reported roles was greater based on physicians’ reports in comparison to nurse reports. In a third of the reported cases, physicians and nurses disagreed about whether advance directives had been followed. These findings reflect a division of roles and perspectives of nurses versus physicians in the medical decision-making process. This study demonstrates the ability of the questionnaire to reveal several key differences in perceptions of care. This information could be useful in developing forums for communication among the professionals to enhance mutual understanding.

Abstract

The purpose of this study is to clarify the perspectives of physicians and nurses in the medical decision-making process at the time of status change events in nursing home residents. The decision-making processes studied involved 28 cognitively impaired nursing home residents in a large suburban nursing home. In interviews, the authors ascertained the personal opinions of physicians and the nurses related to the status change event and the decision-making process using the Medical Decision-Making During a Status Change Event Questionnaire. Nurses reported a greater degree of familiarity with the family’s and resident’s wishes than did physicians. Physicians reported considering more treatment options and choosing more treatments for residents than nurses. Both physicians and nurses reported that the physicians had a major role in decision-making and that nurses did not, yet the gap in reported roles was greater based on physicians’ reports in comparison to nurse reports. In a third of the reported cases, physicians and nurses disagreed about whether advance directives had been followed. These findings reflect a division of roles and perspectives of nurses versus physicians in the medical decision-making process. This study demonstrates the ability of the questionnaire to reveal several key differences in perceptions of care. This information could be useful in developing forums for communication among the professionals to enhance mutual understanding.

Authors

Dr. Cohen-Mansfield is Director, and Dr. Lipson is Senior Research Associate, Research Institute on Aging, CES Life Communities, Rockville, Maryland. Ms. Horton is Director, Bayada Private Duty Nursing Office, Baltimore, Maryland.

The research reported in this article was funded by grant HS09833-01 from the Agency for Healthcare Research and Quality.

Address correspondence to Jiska Cohen-Mansfield, PhD, ABPP, Research Institute on Aging, CES Life Communities, 6121 Montrose Road, Rockville, MD 20852; e-mail: cohen-mansfield@hebrew-home.org

10.3928/00989134-20061201-03

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