Item – Theses Canada

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OCLC number
645750594
Link(s) to full text
LAC copy
LAC copy
Author
Suurdt, Jeanette,1976-
Title
Surrogate decision making for the critically ill intensive care unit patient.
Degree
M. Sc. -- Queen's University, 2008
Publisher
Ottawa : Library and Archives Canada = Bibliothèque et Archives Canada, [2009]
Description
2 microfiches
Notes
Includes bibliographical references.
Abstract
'Background.' Although the technological complexity of the intensive care unit (ICU) is often focused on saving lives, creating consumer confidence in miraculous recovery, it is more frequently becoming a place to support the dying. Because of the serious nature of critical illness, patients are unable to communicate their needs and desires, leaving their families to make decisions for them. Although family members are often called upon to communicate the critically ill patients' wishes, values, and views, many report feeling anxious, unprepared for, and burdened with the task of making decisions for their family member (Azoulay et al, 2001; Chambers-Evans & Carnevale, 2005; Murphy et al, 1992; Sjokvist et al, 1999; Swigart et al, 1996). The distress which surrogate decision makers describe, may lead to difficulty mobilizing appropriate coping mechanisms, which may affect their ability to make appropriate decisions for their family member's care. Hence, a more in depth understanding of the surrogate's experience is critical to plan effective interventions and provide anticipatory guidance to support the process of making decisions around end of life care. 'Objective.' The purpose of the study is to describe the surrogate decision makers' appraisals of the demands of decision making for a critically ill adult intensive care unit patient and the coping strategies employed by them during this experience. 'Method.' A descriptive study design using a qualitative interviewing approach extracted perceived stressors and coping strategies used during the decision making process using systematic focused thematic analysis guided by Folkman and Lazarus' Stress and Coping Paradigm. 'Findings.' Respondents appraisals identified the following perceived stressors: doubt of self efficacy, unknowns, impingement of real life in the process, and problematic relay of information. The surrogates' perception of their ability to manage the decision making process required their awareness of the decision making role and magnitude of illness, their realization of their need to form partnerships with others, to have time to reflect to make the right decision, reflections on prior discussion and experience, and their appraisal of the patients' suffering. Participants described emotion and problem based coping strategies they employed during the task of making end of life decisions for the incapacitated critically ill intensive care patient. To emotionally justify their decisions, surrogates' referred to their understanding of patient wishes. They also sought solace and comfort from the health care staff. In addition, surrogates used strategies to solve problems encountered. These included dealing with others, employing strategies to decrease their uncertainty and mobilizing time to process the events unfolding. 'Conclusions.' End of life decisions in the intensive care are complex and demanding. A better understanding of the process may guide health care professionals in developing focused interventions to assist surrogates through a painful process with as little scarring as possible.
ISBN
9780494385449
0494385448