Doctoral Defense in Nursing Science - Guðrún Jónsdóttir

On Tuesday, April 29, 2025, Guðrún Jónsdóttir will defend her doctoral dissertation in Nursing Science at the Faculty of Nursing and Midwifery, University of Iceland.
The dissertation is titled: End-of-Life Care Decision-Making for Patients with Neurological Diseases in an Acute Hospital Setting.

The opponents are Dr. Marianne Sofranas, post-doctoral fellow and faculty lecturer at the University of Ottawa and the Ingram School of Nursing, McGill University, Canada, and Jón G. Snædal, chief physician and clinical professor emeritus at the University of Iceland and Landspítali – The National University Hospital of Iceland.

The supervisor was Professor Helga Jónsdóttir. Other members of the doctoral committee were Professor Haukur Hjaltason, Professor Marianne Elisabeth Klinke, Professor Rúnar Vilhjálmsson, and Chief Physician Valgerður Sigurðardóttir.
The defense will be chaired by Professor Helga Bragadóttir, Dean of the Faculty of Nursing and Midwifery, and will take place in the Ceremonial Hall of the University of Iceland (Hátíðasalur) at 1:00 PM.

Abstract

The aim of the study was to deepen the understanding of the decision-making process regarding end-of-life care for patients with neurological diseases in an acute hospital setting. This study is a retrospective analysis of patient health records from the neurology ward at Landspitali National Hospital of Iceland, from January 2011 to August 2020. The decision-making was examined in terms of the time from hospital admission to the decision on end-of-life care, and from that decision to death. The frequency of more than twenty documented symptoms was analyzed, comparing patients who were documented as receiving end-of-life care to those who were not, and differences between patient groups were assessed. The role of healthcare professionals, particularly nurses, was also examined in relation to their involvement in decision-making.

Decision-making regarding end-of-life care for patients with neurological diseases can be complex due to unpredictable disease trajectories, cognitive impairment, and a high burden of symptoms. Furthermore, there are differences in disease progression between various groups of neurological patients. Patients with acute neurological diseases, such as stroke, often deteriorate rapidly and require quick decisions regarding end-of-life care, while those with progressive neurological diseases such as Amyotrophic Lateral Sclerosis and Parkinson’s disease or other extrapyramidal diseases typically experience a longer disease course. End-of-life decision-making requires collaboration between healthcare professionals, patients, and their relatives; however, uncertainty about disease progression can delay the initiation of end-of-life care. Nurses play a key role in symptom management, communication, and patient advocacy, although studies suggest their involvement in decision-making has been limited.

The main findings of this study were that most patients had treatment directives for end-of-life care. The time between the end-of-life care decision and death was short across all patient groups, averaging 1–3 days. This time span was significantly shorter for patients with acute neurological conditions (stroke) compared to those with chronic conditions such as ALS and Parkinson’s disease. A similar difference was found in the number of signs and symptoms indicating impending death, with stroke patients displaying more signs and symptoms. The most common symptoms among stroke patients were decreased consciousness, non-responsive communication status, and being bedbound. For patients with progressive neurological diseases, the most common symptoms were respiratory congestion, decreased consciousness, and being bedbound. Nurses played an important role in end-of-life care decisions, particularly as information brokers, advocates, and supporters. Key conclusions indicate a need for further research into the assessment of signs and symptoms of impending death, followed by the implementation of clinical guidelines aimed at ensuring that appropriate end-of-life care is provided in a timely manner for patients with neurological diseases.

About the Doctoral Candidate

Guðrún Jónsdóttir was born in 1968 in Akureyri. She graduated from Flensborgarskólinn in Hafnarfjörður in 1989 and received her B.Sc. in Nursing from the University of Iceland in 1994. She completed her master’s degree in Nursing from the same university in 2010.

Guðrún has over 30 years of experience in nursing, having worked in cardiology, pulmonary, and neurology departments. Her professional background spans both clinical nursing and managerial roles.
Alongside her doctoral studies, Guðrún has taught at the Faculty of Nursing and Midwifery, University of Iceland. In 2022, she was licensed as a specialist in nursing for chronically ill patients with a focus on palliative care, and she currently works as a nursing specialist at Landspítali – The National University Hospital.

Guðrún’s parents are Jón Trausti Guðjónsson and Þórdís Sigríður Guðmundsdóttir. She has two adult sons, Ásþór Aron and Jón Trausti. Her partner is Konstantin Michailov.