Delayed clarification: information, clarification and ethical decisions in critical care in Norway
Delayed clarification: information, clarification and ethical decisions in critical care in Norway Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the e...
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| Veröffentlicht in: | Journal of advanced nursing 2000-12, Vol.32 (6), p.1485-1491 |
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| container_title | Journal of advanced nursing |
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| creator | Bunch, Eli Haugen |
| description | Delayed clarification: information, clarification and ethical decisions in critical care in Norway
Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision‐making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants. |
| doi_str_mv | 10.1046/j.1365-2648.2000.01613.x |
| format | Article |
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Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision‐making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.</description><identifier>ISSN: 0309-2402</identifier><identifier>EISSN: 1365-2648</identifier><identifier>DOI: 10.1046/j.1365-2648.2000.01613.x</identifier><identifier>PMID: 11136417</identifier><identifier>CODEN: JANUDP</identifier><language>eng</language><publisher>Oxford UK: Blackwell Science Ltd</publisher><subject>Bereavement ; Bioethics ; Blood & organ donations ; Brain death ; Case studies ; Critical care ; Critical Care - standards ; Data collection ; Decision Making ; Ethical aspects ; Ethics ; Ethics, Medical ; Freedom ; Grounded theory ; Health professionals ; Humans ; Intensive Care Units ; Interviews ; Medical Futility ; medicine ; neurosurgical trauma ; Norway ; Nurses ; Nursing ; observations ; Patient Care Team ; Physician-Nurse Relations ; Physicians ; Professional-Family Relations ; Prognosis ; Time Factors ; Tissue and Organ Harvesting ; Trauma ; Trauma, Nervous System - diagnosis ; Trauma, Nervous System - nursing ; Trauma, Nervous System - surgery</subject><ispartof>Journal of advanced nursing, 2000-12, Vol.32 (6), p.1485-1491</ispartof><rights>Copyright Blackwell Science Ltd. Dec 2000</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4933-ef46ede4e42175a8f0a8fddc703d0feebf6be111c565a262cba90c237dc03e6e3</citedby><cites>FETCH-LOGICAL-c4933-ef46ede4e42175a8f0a8fddc703d0feebf6be111c565a262cba90c237dc03e6e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2648.2000.01613.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2648.2000.01613.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,30999,31000,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11136417$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bunch, Eli Haugen</creatorcontrib><title>Delayed clarification: information, clarification and ethical decisions in critical care in Norway</title><title>Journal of advanced nursing</title><addtitle>J Adv Nurs</addtitle><description>Delayed clarification: information, clarification and ethical decisions in critical care in Norway
Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision‐making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.</description><subject>Bereavement</subject><subject>Bioethics</subject><subject>Blood & organ donations</subject><subject>Brain death</subject><subject>Case studies</subject><subject>Critical care</subject><subject>Critical Care - standards</subject><subject>Data collection</subject><subject>Decision Making</subject><subject>Ethical aspects</subject><subject>Ethics</subject><subject>Ethics, Medical</subject><subject>Freedom</subject><subject>Grounded theory</subject><subject>Health professionals</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Interviews</subject><subject>Medical Futility</subject><subject>medicine</subject><subject>neurosurgical trauma</subject><subject>Norway</subject><subject>Nurses</subject><subject>Nursing</subject><subject>observations</subject><subject>Patient Care Team</subject><subject>Physician-Nurse Relations</subject><subject>Physicians</subject><subject>Professional-Family Relations</subject><subject>Prognosis</subject><subject>Time Factors</subject><subject>Tissue and Organ Harvesting</subject><subject>Trauma</subject><subject>Trauma, Nervous System - diagnosis</subject><subject>Trauma, Nervous System - nursing</subject><subject>Trauma, Nervous System - surgery</subject><issn>0309-2402</issn><issn>1365-2648</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkU1v1DAQhq0K1G5L_wKKOMCFpOOPOAkSh6opBVQtB1pV4mI59kR4ySbFzqq7_x5nd1UEB4oly56Z5x179BKSUMgoCHm2yCiXecqkKDMGABlQSXm2PiCzx8IzMgMOVcoEsCNyHMICgHLG2CE5ojRighYz0tTY6Q3axHTau9YZPbqhf5e4vh38chu8_bOW6N4mOH6PYZdYNC7EZIiCxHg3brNGe5wS88E_6M0L8rzVXcDT_XlCbj9c3lx8TK-_XH26OL9Ojag4T7EVEi0KFIwWuS5biNtaUwC30CI2rWwwftzkMtdMMtPoCgzjhTXAUSI_IW92fe_98HOFYVRLFwx2ne5xWAVVxImhLEUZydf_JlnOqaDiSTAveFFICRF89Re4GFa-j-Mqxpmo4pqeLXeQ8UMIHlt1791S-42ioCZf1UJN9qnJPjX5qra-qnWUvtz3XzVLtL-FeyMj8H4HPLgON__dWH0-n0-3qE93ehdGXD_qtf-hZBwyV3fzK1XV9bevgtaq5r8AP9nAfQ</recordid><startdate>200012</startdate><enddate>200012</enddate><creator>Bunch, Eli Haugen</creator><general>Blackwell Science Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>200012</creationdate><title>Delayed clarification: information, clarification and ethical decisions in critical care in Norway</title><author>Bunch, Eli Haugen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4933-ef46ede4e42175a8f0a8fddc703d0feebf6be111c565a262cba90c237dc03e6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Bereavement</topic><topic>Bioethics</topic><topic>Blood & organ donations</topic><topic>Brain death</topic><topic>Case studies</topic><topic>Critical care</topic><topic>Critical Care - standards</topic><topic>Data collection</topic><topic>Decision Making</topic><topic>Ethical aspects</topic><topic>Ethics</topic><topic>Ethics, Medical</topic><topic>Freedom</topic><topic>Grounded theory</topic><topic>Health professionals</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Interviews</topic><topic>Medical Futility</topic><topic>medicine</topic><topic>neurosurgical trauma</topic><topic>Norway</topic><topic>Nurses</topic><topic>Nursing</topic><topic>observations</topic><topic>Patient Care Team</topic><topic>Physician-Nurse Relations</topic><topic>Physicians</topic><topic>Professional-Family Relations</topic><topic>Prognosis</topic><topic>Time Factors</topic><topic>Tissue and Organ Harvesting</topic><topic>Trauma</topic><topic>Trauma, Nervous System - diagnosis</topic><topic>Trauma, Nervous System - nursing</topic><topic>Trauma, Nervous System - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bunch, Eli Haugen</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of advanced nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bunch, Eli Haugen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed clarification: information, clarification and ethical decisions in critical care in Norway</atitle><jtitle>Journal of advanced nursing</jtitle><addtitle>J Adv Nurs</addtitle><date>2000-12</date><risdate>2000</risdate><volume>32</volume><issue>6</issue><spage>1485</spage><epage>1491</epage><pages>1485-1491</pages><issn>0309-2402</issn><eissn>1365-2648</eissn><coden>JANUDP</coden><abstract>Delayed clarification: information, clarification and ethical decisions in critical care in Norway
Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision‐making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.</abstract><cop>Oxford UK</cop><pub>Blackwell Science Ltd</pub><pmid>11136417</pmid><doi>10.1046/j.1365-2648.2000.01613.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Bereavement Bioethics Blood & organ donations Brain death Case studies Critical care Critical Care - standards Data collection Decision Making Ethical aspects Ethics Ethics, Medical Freedom Grounded theory Health professionals Humans Intensive Care Units Interviews Medical Futility medicine neurosurgical trauma Norway Nurses Nursing observations Patient Care Team Physician-Nurse Relations Physicians Professional-Family Relations Prognosis Time Factors Tissue and Organ Harvesting Trauma Trauma, Nervous System - diagnosis Trauma, Nervous System - nursing Trauma, Nervous System - surgery |
| title | Delayed clarification: information, clarification and ethical decisions in critical care in Norway |
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