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Dissertation/Thesis Abstract

A Situational Grounded Theory Study of Critical Care Nurses’ End-Of-Life Decision-Making with Family
by Clark, Laurel L., Ph.D., Barry University, 2020, 343; 28150075
Abstract (Summary)

Background: Decision-making in healthcare has shifted from a paternalistic, physician-centered approach to a shared clinician-patient/family decision-making model. With this shift and the rapid advancement of medical technology, end-of-life decision-making with family members has become even more relevant and rigorous for critical care nurse (CCN) practice. The CCN’s voice in end-of-life (EOL) decision-making with family members is essential to providing patient-centered goal concordant care at EOL. There has been ambiguity surrounding the CCN’s participation in shared EOL decision-making with family members.

Purpose: The purpose of this constructivist Situational Grounded Theory (SGT) study was to generate a theory of CCN’s voice in EOL shared decision-making with family members and increase situational awareness of the CCN’s voice in EOL shared decision-making with family members.

Philosophical Underpinning: This constructivist SGT methodology as articulated by Charmaz and Clarke was guided by an interpretivist postmodern paradigm and the philosophical tenets of symbolic interactionism and pragmatism.

Methods: Purposive, theoretical, and snowball sampling of CCNs in the U.S. was used. Semi-structured interviews and extant and elicited discourse material provided data for coding, categorizing, analyzing, mapping and thematizing the data. The conceptual categories generated a theory concerning the CCN in EOL decision-making with family members.

Results: A Situational Standing Praxis theory and Situational Analysis (SSP-SA) was co-constructed from the voices of experienced CCNs. Three conceptual categories: situational standing, symphonology work, and addressing systems, and a situational analysis further explicated the CCN processes and situatedness in EOL decision-making with family members. A middle-range theory and situational analysis provide a means for greater understanding and application in CCN EOL care and decisional support for family members.

Conclusions: The CCN voice is intrinsic and instrumental in a family member’s acquiescence towards EOL decisions for their loved one. The SSP-SA provides additional means and a mechanism for developing theory for EOL nurse practice, policy, education, and research. SSP-SA is positioned to advance health policy and enhance the care offered to family members of dying patients in the critical care setting.

Indexing (document details)
Advisor: Colin, Jessie M., Morton, Jamelah
Commitee: Colvin, Mary, Hart, Carolyn, McFadden, John
School: Barry University
Department: College of Health Sciences
School Location: United States -- Florida
Source: DAI-A 82/4(E), Dissertation Abstracts International
Subjects: Nursing, Communication, Medical Ethics
Keywords: End-of-Life, Family Members, Grounded Theory, Interprofessional, Shared decision-making, Voice
Publication Number: 28150075
ISBN: 9798678184276
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