Jezewski M A, Finnell D S
University of Buffalo, SUNY, Buffalo 14214, USA.
Cancer Nurs. 1998 Jun;21(3):212-21. doi: 10.1097/00002820-199806000-00009.
Patients, providers, and families are increasingly involved in end-of-life decisions (advance directives, health care proxy, do-not-resuscitate [DNR] status consents). These decisions can be complex processes whereby the participants in the process must come to terms with often painful and difficult decisions. The role perception of the nurse in end-of-life decision making is not well delineated. This chapter explores the results of a study that addresses the question, "What are the experiences of oncology nurses as they interact with patients and/or family members during the process of patients/families signing DNR consents. The grounded theory method of data collection and analysis was used to explore this question. The results of the study indicate that central to the process of consenting to DNR status is the degree of shared understanding about the meaning of DNR status among participants and the conflict that can occur when meanings are not shared. A model is presented that illustrates the connections between the meanings of DNR (patient, family, and provider) and congruence and conflict in the DNR consent process. Strategies are discussed that facilitate prevention or resolution of conflict in the DNR status decision-making process. Strategies used by the nurse to facilitate decision making by patient and families include communicating with, caring for, educating, advocating for, and collaborating with patients, families, and other providers.
患者、医疗服务提供者和家属越来越多地参与到临终决策中（预先指示、医疗保健代理人、不进行心肺复苏[DNR]状态同意书）。这些决策可能是复杂的过程，在此过程中参与者必须面对往往痛苦且艰难的决定。护士在临终决策中的角色认知尚未得到明确界定。本章探讨了一项研究的结果，该研究解决了“肿瘤护士在患者/家属签署DNR同意书的过程中与患者和/或家属互动时有哪些经历”这一问题。采用扎根理论的数据收集和分析方法来探究这个问题。研究结果表明，同意DNR状态过程的核心是参与者之间对DNR状态含义的共享理解程度，以及当含义未共享时可能出现的冲突。提出了一个模型，该模型说明了DNR（患者、家属和医疗服务提供者）的含义与DNR同意过程中的一致性和冲突之间的联系。讨论了有助于预防或解决DNR状态决策过程中冲突的策略。护士用于促进患者和家属决策的策略包括与患者、家属和其他医疗服务提供者沟通、照顾、教育、倡导和协作。
