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Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients
Örebro University, Department of Clinical Medicine.ORCID iD: 0000-0003-0679-5695
Örebro University, Department of Health Sciences.
2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 147-162Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate agreement between nurses’ and physicians’ opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses’ and physicians’ opinions regarding full or limited treatment when the answers given as ‘uncertain’ were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients’ wishes had a minor influence.

Place, publisher, year, edition, pages
2006. Vol. 13, no 2, p. 147-162
National Category
Social Sciences Interdisciplinary Nursing Humanities and the Arts Religious Studies
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-2975DOI: 10.1191/0969733006ne861oaOAI: oai:DiVA.org:oru-2975DiVA, id: diva2:135873
Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2018-01-13Bibliographically approved
In thesis
1. Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds
Open this publication in new window or tab >>Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics.

In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 16
Keywords
Clinical ethics, Life-sustaining treatment, End-of-life decisions, Attitudes, Nurses, Physicians, Inter-professional relations, Ethics consultation, Ethics rounds
National Category
Clinical Science
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-2093 (URN)978-91-7668-596-9 (ISBN)
Public defence
2008-05-16, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2017-10-18Bibliographically approved

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Svantesson, MiaThorsén, Håkan

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