Nurses' role and care practices in decision-making regarding artificial ventilation in late stage pulmonary disease.
Original version
Jerpseth, H., Dahl, V., Nortvedt, P., & Halvorsen, K. (2016). Nurses’ role and care practices in decision-making regarding artificial ventilation in late stage pulmonary disease. Nursing ethics, 0969733015626600. http://dx.doi.org/10.1177/0969733015626600Abstract
Background:
Decisions regarding whether or not to institute mechanical ventilation during the later
stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically.
Caring for these patients is a multifaceted process where nurses play a crucial role.
Research question and design:
We have investigated how nurses experienced their own role in
decision-making processes regarding mechanical v
entilation in later stages of chronic obstructive
pulmonary disease and how they consider the patients’ role in these processes. We applied a qualitative
approach, with six focus-group interviews of nurses (n
¼
26).
Ethical considerations:
The Regional Committees for Medical and Health Research Ethics approved the
study. Voluntary informed consent was obtained.
Findings:
The nurses found themselves operating within a cure-directed treatment culture wherein they
were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-
making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also
experienced inadequate interdisciplinary cooperation.
Discussion:
Lack of communication skills, the traditional hierarchical hospital culture together with
operating in a medical-orientated treatment culture where caring values is rated as less important might
explain the nurses’ absence in participation in the decision about mechanical ventilation.
Conclusion:
To be able to advocate for the patients’ and their own right to be included in decision-making
processes, nurses need an awaren
ess of their own responsibilities. This requires personal courage,
leadership who are capable of organising common interpersonal meetings and willingness on the part of
the physicians to include and value the nurses’ participation in decision-making processes.