CARING FOR THE CRITICALLY-ILL PATIENT RECEIVING LIFE-SUSTAINING THERAPY: COMBINING DESCRIPTIVE AND NORMATIVE RESEARCH IN ETHICS.
Contributors: University of Washington.
Published: 1992
Number of pages: 185
Subjects: Health Sciences, Nursing.
Description: Decisions to withhold or withdraw therapy precede about half of all patient deaths in critical care. The purpose of this study was threefold: (a) to describe the lived experience of caring for critically-ill patients receiving life-sustaining therapy, (b) to examine the normative literature regarding the use of life-sustaining therapy, and (c) to compare and contrast the descriptive findings with the normative literature.

The first portion of this study was an analysis of the prevalent themes in the normative literature regarding the use of life-sustaining therapy. Three viewpoints were identified. The earliest focused on the actions of health care providers, the second on the preferences of patients, and the more recent on the intersection between the competing principles of beneficence and autonomy.

The descriptive portion of this study examined the nurses' view of the ethical components of the lived experience of caring for critically-ill patients receiving life-sustaining therapy. An existing database was utilized consisting of twelve, open-ended interviews with critical-care nurses from a single institution previously found to have excellent patient and organizational outcomes. Participants were asked to talk about a patient for whom they had cared. Data were analyzed using phenomenological methods. A model was developed illustrating a process of making connections between the patient, family and staff's lived experiences and the clinical reality for the patient. Making connections involved knowing, facilitating and guiding and occurred within an organizational environment characterized as accepting the personhood of the professional, tolerating ambiguity, and transcending roles.

Finally, the analysis of the normative literature and descriptive findings were compared and contrasted. First, retrospective case analysis, as used by ethicists to consider cases, was contrasted to the within case perspective described by the nurses. The within case perspective was found to allow increased moral and situational complexity, encourage greater knowledge of the patient as a whole person, hasten the timing of consideration of the ethical dimensions of a patient's case, permit the inclusion of multiple players in the case, demystify the role of the ethicist, and emphasize negotiation rather than contention. Second, nurses' ethical reasoning was critiqued using the normative literature and was found to infrequently contain major themes in ethics. Finally, the concepts of advocacy, moral outrage and the in-between role for nurses were examined in light of the model. These findings support the belief that a collaborative model decreases moral outrage but revealed a role for nurses that goes beyond supporting the patient's right to self-determination by acting as the patient's advocate.
Notes: Source: Dissertation Abstracts International, Volume: 53-09, Section: B, page: 4594.

Thesis (PH.D.)--UNIVERSITY OF WASHINGTON, 1992.

School code: 0250.