Working toward consensus: providers' strategies to shift patients from curative to palliative treatment choices.
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End-of-life decision making is a complex phenomenon and providers, patients, and families often have different views about the appropriateness of treatment choices. The results presented here are part of a larger grounded-theory study of reconciling decisions near the end of life. In particular, we examined how providers (N = 15) worked near the end of patients' lives toward changing the treatment decisions of patients and families from those decisions that providers described as unrealistic (i.e., curative) to those that providers described as more realistic (i.e., palliative). According to providers, shifting patients' and families' choices from curative to palliative was usually accomplished by changing patients' and families' understanding of the patient's overall "big picture" to one that was consistent with the providers' understanding. Until patients and families shifted their understanding of the patient's condition-the big picture-they continued to make what providers judged as unrealistic treatment choices based on an inaccurate understanding of what was really going on. These unrealistic choices often precluded possibilities for a "good death." According to providers, the purpose of attempting to shift the patient or proxy's goals was that realistic goals lead to realistic palliative treatment choices that providers associated with a good death. In this article we review strategies used by providers when they believed a patient's death was imminent to attempt to shift patients' and families' understandings of the big picture, thus ultimately shifting their treatment decisions. (+info)
Client narratives: a theoretical perspective.
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The role of subjective client narratives in health care represents a clinical and therapeutic tool, useful in complementing objective, scientific data. Of particular interest to mental health practitioners is the role narratives play as a therapeutic tool to guide clinical practice. This paper lays a foundation for understanding the importance of narrative in the psychotherapeutic process. It provides a brief overview of narrative theory and methods of structural analysis in order to provide a theoretical approach that can be utilized by nurses to address clients' needs. (+info)
An examination of the self-care concept uncovers a new direction for healthcare reform.
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The concept of self-care is multidimensional, with many defining elements. This paper describes the origin of this comprehensive concept. It examines the response of the nursing discipline to citizen self-care initiatives and the subsequent effects this response has had on the development of nursing knowledge. The evolution of self-care as a core concept within Canadian health policy is presented; the potential readiness fo citizens to accept self-care as an aspect of healthcare delivery is explored, identifying potential benefits and obstacles. The paper concludes with a proposed self-care approach to healthcare reform in Canada and the subsequent influence this approach may have on the discipline of nursing. The congruency between a self-care healthcare delivery system and the theoretical foundations and perspective of healthcare delivery held by the nursing discipline is discussed. The role nurses might assume in shaping a self-care healthcare delivery system is delineated. (+info)
Nurse participation in decisions regarding limitation of treatment.
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A vast literature exists on the ethical aspects of decisions to limit life-sustaining treatments, and much of it deals with the way decisions ought to be made. Little is known, however, about how decisions are made in actual clinical practice. Empirical studies have not investigated the decision-making process directly and, with one exception, have only focused on physician practices. Through the use of a case, this paper examines the nature of hospital cancer nurses' involvement in the decision-making process. Three practice domains are identified: assisting patients to reach a truly autonomous choice, helping families to understand and to cope with the realities of the situation, and communicating with and encouraging open communication among all those involved. In addition, the potential value of the in-between position of the nurse is noted, and nurse responsibilities are summarized. (+info)
A nursing analysis of the causes of and approaches for urinary incontinence among elderly women in nursing homes.
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Urinary incontinence is a widespread but often ignored problem among elderly women residing in nursing homes. Despite numerous research studies performed within this setting, few have been able to demonstrate lasting change in the care of and enduring outcomes in this population. However, neither the most commonly used definitions of incontinence nor current management approaches are meeting the needs of institutionalized frail elderly, particularly women, who are twice as likely as men to demonstrate symptoms of the condition. Costs in terms of quality of life and expense of care are staggering. Because many believe that a holistic approach may provide direction for management of urinary incontinence, and because nursing is a holistic profession, a solution to the challenges involved in treating incontinence among the elderly potentially lies in utilizing a nursing as opposed to medical framework for the analysis of factors and care. Specifically, the complexities of testing necessary to differentiate current diagnoses might be simplified by classifying incontinence in a different way, such as using nurse-identified levels of need as opposed to physiologically-based factors. The use of nursing theory to guide patient assessment and an evaluation of systems of care provides a fresh approach to this long-standing problem. (+info)
Concept analysis: aggression.
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The concept of aggression is important to nursing because further knowledge of aggression can help generate a better theoretical model to drive more effective intervention and prevention approaches. This paper outlines a conceptual analysis of aggression. First, the different forms of aggression are reviewed, including the clinical classification and the stimulus-based classification. Then the manifestations and measurement of aggression are described. Finally, the causes and consequences of aggression are outlined. It is argued that a better understanding of aggression and the causal factors underlying it are essential for learning how to prevent negative aggression in the future. (+info)
Nursing, obedience, and complicity with eugenics: a contextual interpretation of nursing morality at the turn of the twentieth century.
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This paper uses Margaret Urban Walker's "expressive collaborative" method of moral inquiry to examine and illustrate the morality of nurses in Great Britain from around 1860 to 1915, as well as nursing complicity in one of the first eugenic policies. The authors aim to focus on how context shapes and limits morality and agency in nurses and contributes to a better understanding of debates in nursing ethics both in the past and present. (+info)
Nurses' views on their involvement in euthanasia: a qualitative study in Flanders (Belgium).
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BACKGROUND: Although nurses worldwide are confronted with euthanasia requests from patients, the views of palliative care nurses on their involvement in euthanasia remain unclear. OBJECTIVES: In depth exploration of the views of palliative care nurses on their involvement in the entire care process surrounding euthanasia. DESIGN: A qualitative Grounded Theory strategy was used. SETTING AND PARTICIPANTS: In anticipation of new Belgian legislation on euthanasia, we conducted semistructured interviews with 12 nurses working in a palliative care setting in the province of Vlaams-Brabant (Belgium). RESULTS: Palliative care nurses believed unanimously that they have an important role in the process of caring for a patient who requests euthanasia, a role that is not limited to assisting the physician when he is administering life terminating drugs. Nurses' involvement starts when the patient requests euthanasia and ends with supporting the patient's relatives and healthcare colleagues after the potential life terminating act. Nurses stressed the importance of having an open mind and of using palliative techniques, also offering a contextual understanding of the patient's request in the decision making process. Concerning the actual act of performing euthanasia, palliative care nurses saw their role primarily as assisting the patient, the patient's family, and the physician by being present, even if they could not reconcile themselves with actually performing euthanasia. CONCLUSIONS: Based on their professional nursing expertise and unique relationship with the patient, nurses participating as full members of the interdisciplinary expert team are in a key position to provide valuable care to patients requesting euthanasia. (+info)