ALS--decision making under uncertainty: a positive approach.

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease. It is characterized by feelings of uncertainty and predictable crises points where difficult decisions have to be made by both the client and the family. These crises points involve progressive and sometimes sudden impairment in mobility, communication, nutrition and ultimately, respiratory function. This paper will use case analysis to illustrate the decisions that have to be made at each crisis point. A model will be presented that will focus on the nursing assessment of decision making behaviours of families experiencing the crisis of a debilitating illness. Emphasis will be on educating the client and family to anticipate what to expect and what decision making strategies they can use. In addition, recent literature will be presented that reviews nursing interventions designed to improve the quality of life of the client and family during these difficult time periods.