Date of Award
Doctor of Philosophy in Nursing (PhD)
Joan C. Engebretson, DrPH, RN, AHN-BC, Dissertation Chair
Laurence B McCullough
Amy O. Calvin
Objective: Describe critical care providers' cognitive constructions or their interpretation of the process of decision-making that influences both the technique of conversations and the recommendations given to parents regarding limitation or withdrawal of life sustaining treatments from terminally ill children in the PICU. Design: Qualitative Medical Ethnography. Setting: Tertiary care children's hospital affiliated with a college of medicine. Participants: Eleven critical care providers in the department of pediatrics (attending physicians, critical care fellows, pediatric nurse practitioners, physician assistants). Interventions: In depth, semi-structured interviews designed to explore the experiences of providers in the participation of end-of-life care decision-making. Measurements and Main Results: Findings from the data included concepts and themes that were then organized into a conceptual framework to help understand the decision making process for critically ill children at the end of life. The four major themes identified were: Expectations and Perspectives, Communication Enhancers and Inhibitors, Decision Enablers and Barriers, and Conversation Mechanics. Each theme consists of several concepts from the data that further inform the process. The Expectations and Perspectives theme explains differences between parents and providers that, if understood, can be managed more effectively. The themes focused on communication and decisions elucidate concepts that will improve the process and concepts that have been identified as barriers. The Conversation Mechanics theme provides insight into the process of acquiring the skills that providers have experienced. Conclusions: After conducting in-depth interviews with critical care providers who care for children at the end of life1 a conceptual framework is proposed to provide a better understanding of the decision-making process and to suggest interventions to make advancements.
Howells, Amy J., "Understanding the "Big Picture": End-of-life Decisions in the PICU" (2014). Dissertations (Open Access). 3.
communication; decision making; end-of-life care; PICU; qualitative research