Narrative analysis of families’ experience in giving DNR consent for the critically ill patients

• Main Authors: Shu-Hua Tasi, 蔡淑華
• Other Authors: 辛幸珍
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/38804046078215635701

碩士 === 中國醫藥大學 === 護理學系碩士班 === 98 === Objective: Natural Death Act has been legislated in Taiwan for more than ten years. Do-Not-Resuscitation (DNR) was approved to improve the end-of-life care（EOL）for terminal cancer patient. However, for the non-cancer critically ill patients there are still no consensus in the management of their end-of-life. For most critically ill patients who are unable to express their wishes, their DNR consent should be signed by the families to prevent futile CPR before they die. For us understand the difficulties of families facing EOL decision, we conduct this study to explore families’ experience in giving DNR consent on behalf of the critically ill patients. Research methods: This study is based on qualitative research. A purposive sample of families who signed DNR for their critically ill families in their terminal stage were adopted from seven intensive care units in a mid-Taiwan hospital. To attempt to establish close relationships with those participants, researcher visited the families for several times since the patients were admitted in ICU and kept on taking field notes. If families’ emotion status were evaluated to be stable by phone, an indepth interview was conducted in approximately 2-6 months after the patient’s death. The interviews were audiotaped, transcribedt(verbatim) and were subject to qualitative content analysis. Results: A total of ten interviews data were analyzed , choosing four of ten stories writing into narrative text. These narrative texts combine in-deep ethical issues and the contexture of families’ struggling in the process of EOL decision-making. Three major theme were emerged from families’ subjective narratives : 1. multiple factors considered during making DNR consent for the critically ill patient. 2. Health care providers with compassionate and communication skills can improve the process of EOL decision-making. 3. EOL care and sufficient EOL cognition would help families and patients remain peaceful. Conclusion: Through the retrospective interviews, most of the families expressed their experience of EOL decision as shocking and conflicting. According to those participants narratives, it also imply that health care providers play an important role in families of EOL decision-making. Our study create an opportunities for a reflection upon health care providers’ role in terminal DNR in critical-ill patient to improve the patient peaceful death and to facilitate families won’t regret the EOL decision-making.