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.
|Advisor:||Colin, Jessie M., Morton, Jamelah|
|Commitee:||Colvin, Mary, Hart, Carolyn, McFadden, John|
|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|
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