Thesis (M. Nurs.)--University of Hong Kong, 2006.

This report focuses on the use of Watson's theory of human caring for Do Not Resuscitate (DNR) patients in acute medical-surgical wards. It discusses the dilemmas facing DNR patients and their nurses and explores the solutions to these dilemmas offered by Watson's theory. Traditional nursing practice places the nurse in a difficult situation by focusing on physical health. The report discusses the philosophical assumptions underlying Watson's theory. These assumptions led Watson to focus on nursing holistically, and to emphasise an integrated approach to nursing, which promotes the comfort of the patient physically, spiritually and emotionally. Her focus is on the broader aspects of caring such as involving the care domain of nursing, instead of the narrower view of nursing which focuses on care for the 'cure' only. This appproach is particularly relevant to DNR situations because these situations involve patients for whom there is no physical cure. Watson's holistic approach to caring offers the nurses of DNR patients guidelines for their practice and meaning for their nursing actions. Because current DNR decisions are often made by medical officers but implemented by nurses, it is the nurse who may be legally liable for the patient's death. This can cause anxiety for the nurses involved. Another cause of anxiety can be the traditional focus in nursing on physical cure. In the care of DNR patients, no such cure is possible. This can leave the nurse feeling distressed and incompetent. DNR the patients, may lack of autonomy and suffer feelings of insecurity. It is in these areas that Watson's ten carative factors can offer support, for both patients and nurses. / Master of Nursing

Cancer was the most common cause of the death in Taiwan in the past two decades. The recent advanced improvements of cancer treatment took endless encouragements and hopes to patients and their families, so they intended aggressively while dealing with the issue of death because of the decline of mortality rate and prolonged mean lifespan. It was difficult for families and doctors to decide whether to prolong life by life sustaing treatments (including cardiopulmonary resuscitation) or to sign Do-Not-Resuscitate (DNR) consent for terminal cancer patients .We want to analyze the related factors toward terminal cancer patients DNR and point out some ones correlated closely with the time of signing consent in this restrospective research. We corrected 80 DNR consents signed by terminal cancer patients or their families from one general teaching hospital in south Taiwan and analyzed factors toward the time of signing consents. Results of this study showed that the time of signing consents was very close with that of their death . Only 12.5% of the patients with survival more than 2 weeks after signing DNR consents, 55% of the patients or their families did not sign the consents until five days before their death, 30% of the patients died in 6-14 days after signing DNR consents, and there were even more twenty percent (21.25%) of the patients died in the day of which the consents were just signed by their families. The patients¡¦age, gender, kinds of their primary cancer, whether the pulmonary or pleural metastasis were present or not, and the treatments of these patients had no significant correlations with the time of signing DNR consents. Only three factors including of education level of patients, whether the patients¡¦illness was critical while signing consents and kinds of patients¡¦painkiller use contributed to the time of DNR signing significantly in this research. 72.5% of these patients had the degree for the primary school, and 80% of the patients or their families signed the consents just when the patients¡¦illness was critical. There were 32 patients with degree of the primary school and only 4 with degree of the junior high school within the patients wih survival more than 6 days after signing DNR consents (p value =0.003); There were 53.75% of the patients had ever used opioid painkillers while siging DNR consents, 25% of them had even received morphine for pain control. For the patients with survival more than 6 days after signing DNR consents, there were 18 patients prescribed opioid painkillers, and 26 patients without taking painkillers that meaned significant difference (p value =0.011); For the patients with critical illness while signing DNR consents, it meaned statistic difference for that 42 patients got survival more than 6 days and 23 patients with survival less than 6 days. (p value =0.000). We highly suggest to inforce the knowledge of hospice care to people in community and the colleagues of doctors and nurses by any kinds of education and introduction. We all need to pay more attentions to psychiatric status of terminal cancer patients and supply adequate help and care for them, so we could all get more close to meanings of human life.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M. Nurs.)--University of Hong Kong, 2006.

No description available.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Thesis (M.Nurs)--University of Western Sydney, Nepean, 1995. / Includes bibliography.

No description available.