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Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units

Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units
Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units
Background - The process of withdrawal of treatment in Critical Care environments has created ethical and moral dilemmas in relation to end of life care in the UK and elsewhere. Common within this discourse is the differing demands made on health professionals as they strive to provide care for the dying patient and family members. Despite reports that withdrawal of treatment is a source of tension between those nurses and doctors involved in the process, the role of the nurse in facilitating withdrawal of treatment has received relatively little attention.
Objectives – To illustrate how differing dying trajectories impact on decision-making underpinning withdrawal of treatment processes, and what nurses do to shape withdrawal of treatment.
Design - Qualitative methods of enquiry using clinical vignettes and applying Charmaz’s grounded theory method.
Methods and settings - Single audio-recorded qualitative interviews with thirteen critical care nurses from four Intensive Care specialities: Cardiac; General; Neurological and Renal were carried out. Interviews were facilitated by an end-of-life vignette developed with clinical collaborators.
Findings – Across critical care areas four key dying trajectories were identified. These trajectories were shaped by contested boundaries associated with delayed or stalled decision-making around how withdrawal of treatment should proceed. Nurses provided end of life care (including collaborative and action-oriented skills) to shape the dying trajectory of patients so as to satisfy the wishes of the patient and family, and their own professional aims.
Conclusions - Differing views as to when withdrawal of treatment should commence and how it should be operationalised appeared to be underpinned by the requirements of the role that health professionals fulfil, with doctors focusing on making withdrawal of treatment decisions, and nurse’s being tasked with operationalising the processes that constitute it. Multidisciplinary teams need a ‘shared’ understanding of each other’s roles, responsibilities, aims, and motivations when planning and implementing the dying trajectory of withdrawal of treatment.


0020-7489
1466-1474
Long-Sutehall, Tracy
92a6d1ba-9ec9-43f2-891e-5bfdb5026532
Willis, Helen
c45d8f81-28b5-4906-92ae-4d60a5c9b411
Palmer, R.
1ae45e5e-32d6-4983-9d28-b8c252c3b787
Ugboma, D.
7fa9da18-fd36-4ba9-bdf1-0fa2c4224395
Addington-Hall, Julia
87560cc4-7562-4f9b-b908-81f3b603fdd8
Coombs, Maureen
e7424ed2-6beb-481d-8489-83f3595fd04c
Long-Sutehall, Tracy
92a6d1ba-9ec9-43f2-891e-5bfdb5026532
Willis, Helen
c45d8f81-28b5-4906-92ae-4d60a5c9b411
Palmer, R.
1ae45e5e-32d6-4983-9d28-b8c252c3b787
Ugboma, D.
7fa9da18-fd36-4ba9-bdf1-0fa2c4224395
Addington-Hall, Julia
87560cc4-7562-4f9b-b908-81f3b603fdd8
Coombs, Maureen
e7424ed2-6beb-481d-8489-83f3595fd04c

Long-Sutehall, Tracy, Willis, Helen, Palmer, R., Ugboma, D., Addington-Hall, Julia and Coombs, Maureen (2011) Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units. International Journal of Nursing Studies, 48 (12), 1466-1474.

Record type: Article

Abstract

Background - The process of withdrawal of treatment in Critical Care environments has created ethical and moral dilemmas in relation to end of life care in the UK and elsewhere. Common within this discourse is the differing demands made on health professionals as they strive to provide care for the dying patient and family members. Despite reports that withdrawal of treatment is a source of tension between those nurses and doctors involved in the process, the role of the nurse in facilitating withdrawal of treatment has received relatively little attention.
Objectives – To illustrate how differing dying trajectories impact on decision-making underpinning withdrawal of treatment processes, and what nurses do to shape withdrawal of treatment.
Design - Qualitative methods of enquiry using clinical vignettes and applying Charmaz’s grounded theory method.
Methods and settings - Single audio-recorded qualitative interviews with thirteen critical care nurses from four Intensive Care specialities: Cardiac; General; Neurological and Renal were carried out. Interviews were facilitated by an end-of-life vignette developed with clinical collaborators.
Findings – Across critical care areas four key dying trajectories were identified. These trajectories were shaped by contested boundaries associated with delayed or stalled decision-making around how withdrawal of treatment should proceed. Nurses provided end of life care (including collaborative and action-oriented skills) to shape the dying trajectory of patients so as to satisfy the wishes of the patient and family, and their own professional aims.
Conclusions - Differing views as to when withdrawal of treatment should commence and how it should be operationalised appeared to be underpinned by the requirements of the role that health professionals fulfil, with doctors focusing on making withdrawal of treatment decisions, and nurse’s being tasked with operationalising the processes that constitute it. Multidisciplinary teams need a ‘shared’ understanding of each other’s roles, responsibilities, aims, and motivations when planning and implementing the dying trajectory of withdrawal of treatment.


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Published date: 14 December 2011
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339701
URI: http://eprints.soton.ac.uk/id/eprint/339701
ISSN: 0020-7489
PURE UUID: ea338722-7b54-406a-8895-4873b6d112c9
ORCID for Tracy Long-Sutehall: ORCID iD orcid.org/0000-0002-6661-9215

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Date deposited: 29 May 2012 10:43
Last modified: 15 Mar 2024 03:12

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Contributors

Author: Helen Willis
Author: R. Palmer
Author: D. Ugboma
Author: Maureen Coombs

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