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This study describes the meaning intensive care unit nurses attach to their care of the brain dead patient. A phenomenological methodology was used because of its intent to understand experience as it is lived. Because these patients constitute a unique class of dead patients which require intensive nursing care and because of the scarcity of information available on the subjective experience of nurses who provide this care, the study was considered to be essential to fillful a gap in our knowledge. Data were collected through 28 interviews with 11 Caucasian female participants who work in the intensive care units of a tertiary and a quaternary care hospital within the greater Vancouver area. Their ages ranged from their early twenties to over forty years of age. They represented five religious demoninations with one participant having no religious affiliations. One nurse had cared for between two and five brain dead patients, four had provided care for six to ten brain dead patients, and six had cared for more than ten brain dead patients. Throughout the participants' accounts dissonance was the pervasive and unifying theme. The dissonance was seen in the form of either personal or interpersonal discord. The former was seen in relation to five areas: the participant's philosophy about nursing, traditional nursing care activities, the concept of brain death, organ retrieval and transplantation, and professional responsibilities in relation to meeting the nurse's own emotional needs. In contrast, the latter occurred between the nurse and families, physicians, the Pacific Organ Retrieval for Transplantation Team and nursing colleagues. Either form of dissonance results in personal distress and subsequent attempts to reduce the dissonance by distancing and/or designating another as the target of nursing care. / Applied Science, Faculty of / Nursing, School of / Graduate

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成5年4月6日 氏平伸子氏の博士論文として提出された

The health care system has, in many respects, been developed to oppose suffering. Yet health care’s almost compulsive urge to treat death as the enemy and to battle disease and injury with all available technology unavoidably results in suffering for someone. This paradox and its impact upon the decision-makers in critical care, has attracted some interest overseas, but none to date in Australia. This study sought to understand the interactions between the key stakeholders in end-of-life decision-making in critical care in the interests of developing strategies to ameliorate the avoidable suffering arising from these processes. A modification of Denzin’s Interpretive Interactionism (Denzin, 1989), was developed to apply the epistemological and ontological principles of the critical paradigm while preserving the advantages of Denzin’s design in the investigation of interactions. Semi-structured interviews with relatives, nurses and doctors from a variety of critical care units in South-East Queensland and New South Wales, provided the data that enriches this study. Using the critical lens, analysis focussed on the interactions (and gaps and silences) between the decision-makers at the key moments of decision-making: initiation, maintenance or withdrawal of life-sustaining treatments. A model of 'best practice' with respect to end-of-life decision-making was produced and concrete recommendations made. This project has found that the amelioration of avoidable suffering in the critical care environment related to end-of-life decision-making requires policy and procedural changes at the organisational level.

Thesis (Ph.D.)--Duquesne University, 2009. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 266-289) and index.

Consent from the family of a possible donor directly influences organ donation rates. The process of obtaining consent, however, is often addressed during a time in which the family’s ability to make decisions is affected by the psychological trauma related to the sudden and unexpected reality of death. This research study implemented a qualitative interpretive descriptive design to gain insight into the way family members of brain-dead patients try make sense of the conflict they experience while faced with a compelling decision about organ donation. Data was collected during in-depth, unstructured, individual interviews with family members (n=8), representing the diverse population of the Western Cape Province in South Africa. Digitally voice-recorded interviews were transcribed, followed by thematic data analysis. Seven common themes emanated from the data, which clarified the family’s decisional conflict regarding organ donating to a certain degree. Although the findings of the study resonate with several similar international studies, it also brings new insight to the role played by the so-called key decision maker(s) in the family. The key decision maker carries the greatest weight in the family’s final decision, and must acquire an informed understanding of both brain death and organ donation. Understanding the role of the key decision maker may well be crucial to the supporting transplant coordinator during the time of decision-making. Recommendations were formulated for education, policy, practice and further research. / MCur, North-West University, Potchefstroom Campus, 2015

Consent from the family of a possible donor directly influences organ donation rates. The process of obtaining consent, however, is often addressed during a time in which the family’s ability to make decisions is affected by the psychological trauma related to the sudden and unexpected reality of death. This research study implemented a qualitative interpretive descriptive design to gain insight into the way family members of brain-dead patients try make sense of the conflict they experience while faced with a compelling decision about organ donation. Data was collected during in-depth, unstructured, individual interviews with family members (n=8), representing the diverse population of the Western Cape Province in South Africa. Digitally voice-recorded interviews were transcribed, followed by thematic data analysis. Seven common themes emanated from the data, which clarified the family’s decisional conflict regarding organ donating to a certain degree. Although the findings of the study resonate with several similar international studies, it also brings new insight to the role played by the so-called key decision maker(s) in the family. The key decision maker carries the greatest weight in the family’s final decision, and must acquire an informed understanding of both brain death and organ donation. Understanding the role of the key decision maker may well be crucial to the supporting transplant coordinator during the time of decision-making. Recommendations were formulated for education, policy, practice and further research. / MCur, North-West University, Potchefstroom Campus, 2015

Thesis (M.S.N.)--Marshall University, 2003. / Title from document title page. Document formatted into pages; contains iv, 56 p. Includes bibliographical references (p. 43-45).

Entwicklungen im Bereich der Medizin führen immer wieder zu einer Neuformulierung der Grenze zwischen Leben und Tod. Jüngere Skandale um die Vergabe von Spenderorganen sorgen für Diskussionen um die ethischen Grundlagen der Transplantationspraxis, zu denen die Definition des Hirntodes gehört. Zur Auseinandersetzung mit ethischen Fragen gehört, den eigenen Kulturraum näher zu betrachten und zu analysieren. Der chinesische Kulturraum soll dabei als Vergleichsebene dienen, sich mit einem anderen Zugang zu und einem anderen Verständnis von Bioethik zu beschäftigen. Die Disziplin der Bioethik im chinesischen Kulturraum ist zwar noch eine sehr junge, kann aber auf eine eigenständige Medizintradition (Traditionelle Chinesische Medizin) zurückgreifen. Dieser bioethischen Analyse liegen entsprechend alte Denktraditionen des Konfuzianismus, Buddhismus und Daoismus zugrunde. Die vorliegende Arbeit beinhaltet den ethisch-kulturellen Vergleich zwischen Deutschland und der Volksrepublik China, die Suche nach Unterschieden und Gemeinsamkeiten im Umgang mit Organtransplantation und Hirntodkonzept. Dabei geht es zum einen um die direkte Gegenüberstellung der gesetzlichen Regelungen, zum anderen erfolgt eine deskriptive-ethische Analyse auf Grundlage der vier Diskussionsebenen – diagnostische Tests, Todeskriterium, Todesdefinition, Menschenbild – um das Hirntodkonzept in beiden Ländern

Thesis (doctoral)--Uppsala University, 1995. / Includes bibliographical references (p. 215-225).