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Nurses' conceptions of decision making concerning life-sustaining treatment
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 2, p. 160-173Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

Place, publisher, year, edition, pages
2008. Vol. 15, no 2, p. 160-173
Keywords [en]
Adaptation; Psychological, Adult, Attitude of Health Personnel, Communication Barriers, Conflict (Psychology), Cooperative Behavior, Decision Making/ethics, Family/psychology, Humans, Life Support Care/ethics/*psychology, Nursing, Nurse's Role/psychology, Nursing Methodology Research, Nursing Staff; Hospital/ethics/*psychology, Patient Advocacy, Ethics, Patient Participation, Physician-Nurse Relations, Power (Psychology), Qualitative Research, Sweden, Uncertainty
National Category
Nursing Nursing
Identifiers
URN: urn:nbn:se:hj:diva-5679PubMedID: 18272607OAI: oai:DiVA.org:hj-5679DiVA, id: diva2:36499
Available from: 2008-06-10 Created: 2008-06-10 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Encountering ethical problems and moral distress as a nurse: Experiences, contributing factors and handling
Open this publication in new window or tab >>Encountering ethical problems and moral distress as a nurse: Experiences, contributing factors and handling
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore and describe what nurses find ethically problematic and morally distressing in their work, the factors contributing to the arising of ethically problematic situations and the actions reported taken in order to handle them, thus creating an ethical climate.

Descriptive as well as correlational and exploratory designs were employed in the four papers on which this thesis is based. A total of 283 nurses from 21 acute care wards at four Swedish hospitals participated. Interviews were analyzed using qualitative content analysis and the critical incident technique, and questionnaires were analyzed using descriptive and non-parametric statistics.

The nurses described ethical problems and moral distress related to decision making about life-sustaining treatment, but also when they experienced difficulties in preserving a patient’s integrity and when they could not give care that was necessary and safe. Inadequate communication between healthcare staff, the physicians’ ways of handling potentially ethically problematic situations and patients’ poor state of health, which hindered their participation in decisions concerning them, were some of the factors that could contribute to the rise of an ethically problematic situation. Among the actions described as being used to handle ethical problems and moral distress, some were explicitly stated to promote a positive ethical climate, i.e. a perceived positive handling of ethical issues. These were supporting each other in the working group, using policies and routines as help, giving care based on the needs of patients and their next of kin and daring to speak out, thus contributing to setting a standard for behavior. Having the need for explanations and information satisfied and working as a team also promoted a positive ethical climate.

In conclusion, the professional role of being a nurse seems to be of importance not only when it comes to what situations are experienced as ethically problematic and morally distressing, but also concerning what factors may contribute to the rise of them. Perceiving a positive ethical climate may mediate these experiences.

Place, publisher, year, edition, pages
School of Health Sciences, Jönköping University, 2011. p. 67
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 20
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-16429 (URN)978-91-85835-19-5 (ISBN)
Public defence
2011-11-11, Forum Humanum, Hälsohögskolan, Jönkping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-21 Created: 2011-10-20 Last updated: 2014-05-20Bibliographically approved

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Silén, MaritAhlström, Gerd

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