Thesis (D. Min.)--Western Seminary, Portland, OR, 2001. / Abstract. Includes bibliographical references (leaves 295-301).

Thesis (M.A.)--Catholic Theological Union at Chicago, 2003. / Vita. Includes bibliographical references (leaves 51-52).

<p> This study explored the lived experience of death in the hospital intensive care unit (ICU) from the perspective of surviving family members. More specifically, attention was placed on the experience of withdrawing life-support for a loved one. A phenomenological approach was adopted, and a convenience sampling technique was employed with family members in a community in Southern California. Four (4) caregivers of dying patients were interviewed to explore the lived experience of removal of life-support for a loved one. The caregiver reactions were categorized into seven themes that were common to all four participants: (a) overall experience, (b) mental perspective, (c) ambivalence about care, (d) perceptions of technology, (e) the decision, (f) aftermath, and (g) suggestions for others. The themes were discovered through implementation of transcendental phenomenology in which the researcher's past experience was bracketed out from interpretations of the interviews. Thus, the participants&rsquo; words were taken without preconception to the greatest extent possible. Even though the outcomes were identical&mdash;the death of the patient&mdash;the circumstances leading up to the decisions were each very different. Each circumstance had bioethical ramifications, including breaches in scope of practice, communication breakdown, and caregiver reactions. The results suggest several areas of improvement including those areas that were suggested by the participants themselves. The intention of this research is to shed light on this experience for mental healthcare professionals, such as psychologists and social workers who provide care for the families before, during, and/or after the experience of a loved one&rsquo;s death in the ICU. Moreover, it is hoped that this research will help mental health clinicians to better understand the needs of professional healthcare providers who are exposed to these untenable circumstances on a regular basis.</p>

This dissertation examines the extent to which individual-level and social network-level factors explain disparities in living donor kidney transplantation (LDKT) and considers the moral implications. Paper One examines whether patient characteristics explain racial disparities in the rate of donor presentation and LDKT in a sample of 752 potential kidney recipients and 654 potential kidney donors. Propensity score matching and subclassification were used to balance the patient characteristics. Survival models revealed that only 24% of blacks compared to 39% of whites would have at least one potential donor evaluated within the first year, even after accounting for differences in the distribution of patient characteristics. Thus, lower rates of donor presentation among black recipients cannot be explained by differences in individual-level characteristics. Paper Two examines whether differences in social networks contribute to disparities in LDKT. Using interview and medical record data from a representative sample of 389 dialysis patients in Greater Boston and a subsample of 302 alters, we found that social network characteristics, especially network size, were strongly predictive of pursuing LDKT. Significant racial disparities in health and medical distrust among social networks of black patients present compelling evidence for network effects. Fewer network members of black patients may be eligible for donation owing to compositional health differences, and those eligible may be less willing to donate due to greater distrust or poor socioeconomic position. Paper Three argues that society ought to be concerned with previously neglected disparities in LDKT, specifically the fraction stemming from disparities in social networks because networks provide one pathway by which inequalities can be perpetuated throughout society and over time. Insofar as social networks are influenced by an unjust distribution of social forces, and social networks influence life chances by restricting (or enhancing) one’s ability to obtain a LDKT, then life chances of dialysis patients are unjustly determined by social networks. Potential policies aimed at providing compensatory damages to patients whose networks have been adversely affected by the unjust influence of social determinants are examined.

<p> The purpose of this qualitative study was to discover strategies that hospital administrators can use to obtain support from physicians as they pertain to corporate compliance, while still remaining accountable and loyal to healthcare organizations. By interviewing eight physicians and eight hospital administrators, the study sample was used to gather information on behaviors that influence and affect physician participation in corporate compliance programs. Using the grounded theory design of qualitative research was most appropriate for this study. The use of purposive sampling was most appropriate for this study and produced data for a comparative analysis. The comparative analysis allowed for the generation of a grounded theory by first extracting primary themes for the collected data. Twelve primary themes emerged from the content analysis, which produced four categories, producing a grounded theory, The Hospital Compliance Leader Theory. The hospital compliance leader theory indicates that hospital administrators can engage physicians in corporate compliance programs, while maintaining physician loyalty. To accomplish this, the healthcare leaders must incorporate each of the following: (a) use appropriate training programs while understanding the challenges the physicians face; (b) bridge the artificial gap between hospitals and physicians by educating physicians on the potential consequences the hospital faces because of noncompliance; (c) training physicians on corporate compliance, emphasizing the benefits to patient care with full support from the administrative leadership team; and (d) mandating physician compliance training and focusing the training on the greatest compliance risk areas.</p>

<p> This dissertation provides an ethical justification of surgical weight loss interventions for the treatment of obesity. Situating obesity as not merely a public health concern but also fundamentally a problem of clinical medicine confronting individual patients and physicians, the dissertation argues that the time frame of public health interventions is too long for individuals presently facing obesity and its deleterious physical and social co-morbidities. It argues that failure to address weight loss on an individual level, and specifically to consider the clinical appropriateness of weight loss surgery (WLS), raises serious questions about failure to respect autonomy and promote patient welfare. Moreover, social skepticism or rejection of WLS as a treatment option raises concerns about fairness, as this failure indicates that obesity is not regarded in relevantly similar ways to other life-threatening and health-impairing conditions. </p><p> The dissertation examines various reasons that obesity and its myriad interventions, including WLS, are inadequately addressed in the clinical setting. It argues that considerations with cultural and ethical valence play a critical role in obesity's different and unfair treatment within clinical medicine. Gendered and theologically informed attributions of blame, self-blame, shame, and self-stigma influence the attitudes and actions of both patients and clinicians with regard to addressing obesity. Inappropriate and conceptually confused ascriptions of responsibility impede social acceptance of, and access to, WLS. The dissertation's criticism and subsequent reconceptualization of these ascriptions of responsibility from a perspective informed by feminist epistemology and ethics provide the foundation upon which to consider reform of current clinical practices surrounding treatment of obesity. This dissertation concludes that WLS is both ethically and clinically justified.</p>

<p> The images of dissected pregnant women in William Hunter's atlas <i> Anatomia Uteri Humani Gravidi</i> published in 1774 were among the first realistic, highly detailed illustrations of fetal development and pregnant female physiology. Commissioned by Hunter, the images established scientific truth about female reproductive anatomy, a previously misunderstood field, and aided in the elevation of the work of male-midwives to that of respected obstetricians. The fetal image he presented, like a Lacanian mirror, also opened the door into the psyche of William Hunter. Driven by his passion for anatomical research, Hunter pursued the uncharted territories of female anatomy and fetal development in a narcissistic path of self-aggrandizement. The thesis herein compares Hunter's images to historical images to examine Hunter's unique and innovative qualities. Hunter's images demystify the Jungian maternal archetype and reflect his desire to create artful images. The ethical use of the human body in the arts is also discussed.</p>

<p> Healthcare systems are under pressure to eliminate disparities of care. Communication methods used with Limited English Proficiency (LEP) patients was presented in the literature as an essential component to deliver quality and equal care. Several strategies have been implemented to assess and target the communication methods between patients and health care teams. The challenge for health systems workers is to address communication barriers to eliminate disparities of care and medical errors. The purpose of the present qualitative case study was to explore if communication barriers affect the understanding of LEP research participants while participating in the informed consent process during clinical trials. Communication barriers during the informed consent process may affect clinical trial outcomes. In the study, the use of a triangulation data gathering method was associated with a qualitative case study. Data regarding barriers of communication during the informed consent process were gathered by performing semistructured interviews. The study population included six principal investigators, five interpreters, and nine LEP research participants. Data analysis involved reviewing the emerging themes from participants&rsquo; responses. Results indicated four major themes supporting communication challenges. The themes included authority figure, cultural sensitivity, communication barriers, and education. The study suggested the need for further research regarding communication barriers during the clinical trials process.</p>

<p> Critical care nurses may experience burnout and stress because they are caring for an increasing number of dying patients in the intensive care setting. The purpose of the qualitative, existential phenomenological research study was to explore the experiences, perceptions, and needs of critical care nurses who provided care to dying patients receiving futile medical care and how their experiences may contribute to burnout and stress. Findings revealed that critical care nurses in the study experienced aversive memories associated with scents and sounds of death in intensive care, discomfort, ethical concerns, family issues, personal issues, and physician barriers, but burnout was not discussed. The sample consisted of four critical care nurses who worked in a hospital in Northern California. Data collection was conducted by unstructured interviews, and data analysis was accomplished using thematic analysis and additionally interpreted using NVivo 10 software. Authentic experiences when caring dying patients, barriers encountered while caring for dying patients and identifying resources for nurses caring for dying patients were three themes that emerged from the data analysis. Goodness of caring with intent to stay, meaningful engagement, death feelings/perceptions/scents/sounds, personal feelings, values neutral, advocating for patients, family issues, physician barriers, developing coping skills, colleague/communication support, and end-of-life education/training were the 11 sub-themes that were revealed during the data analysis. There is considerable need for continued research on how to develop and offer a range of supportive resources to help nurses care for themselves while caring for dying patients and their families, on integrating palliative care teams in intensive care units, and how health care organizations could benefit from developing palliative or comfort care units in their organizations.</p>

Thesis--Catholic Theological Union of Chicago, 1989. / Vita. Includes bibliographical references (leaves 66-68).