Abstract This paper explores the experience of family members who are engaged in decision-making related to the withdrawal or withholding of life-sustaining interventions from another family member. It explains that the methodology used consists of a sample of four to five families who are contacted through ICU family conferences in one or two hospitals in which the conferences are concerned with the withholding or withdrawal of lifesupport from a family member. The paper looks at how certain factors may be identified from family members' experiences that help to determine why the decision-making process is subject to wide variation.
The paper also notes that it is expected that certain family members engage in more effective decision making than others and that particular families engage in more effective decision making than other families. The paper highlights the fact that family decisions are rendered easier or more problematic by such variables as the person's prognosis, whether an acute or chronic illness is involved, perceived quality of life, degree of suffering, and the presence of an advance directive. The paper concludes that preparation for death most especially needs to be based in a team approach, and the emphasis should be upon the relationship between nurses and families and that the future needs of the family should be proactively considered once death has occurred.
From the Paper "Nurses and other healthcare providers normally initiate the discussion that lead to withdrawal of life-support but patients and families make the final decision. The experience of decision making is different for family members when an acute illness is involved from a situation of chronic illness. After a period of denial, families of patients with acute illness or injury can recognize the need for withdrawal of support much more quickly (McHale Wiegand, 2006). Certain behaviors by healthcare providers can increase the level of distress experienced by the patient's family."
An analysis of the factors that impact on the quality of the family's experience in the withdrawal of lifesupport from a loved one in ICU (intensive care unit).
Abstract This paper discusses families' experiences with the withdrawal of lifesupport from a loved one in ICU (intensive care unit) and how it is not uniform for all families because of the operation of certain factors which influence the decision-making process. Finally, the paper discusses the impact of the support that these families receive and how it is the major factor that influences the quality of the family's experience.
Table of Contents:
Statement of the Problem and Purpose
Literature Review
Research Question
Theoretical Framework
Hypothesis #1
Data Collection
Research Design #1
Statistical Analysis #1
Hypothesis #2
Sampling Strategy #2
Data Collection #2
Research Design #2
Statistical Analysis #2
Conclusion
From the Paper "Making decisions related to the withdrawal of life support in the ICU is one of the most demanding experiences the family will ever face. Nurses play a key role in the effectiveness of the decision making process and it is their understanding of the stages involved in that process which can determine the quality of the outcome. As McHale Wiegand (2006) maintains, as more families become involved in end-of-life decisions, it is essential that current research be assessed, the gaps in knowledge be identified, and that new directions for ongoing research should be established. Little is actually known about the interaction of nurses with families in this situation; what is certain is that the interaction is not uniform and that nurses need to realize what will be most effective with families who are experiencing high levels of stress."
Abstract The paper presents a research proposal tol explore and comprehend the experience of family members who are engaged in decision-making related to the withdrawal or withholding of life-sustaining interventions from another family member. The paper discusses the significance of the phenomenon to nursing and provides an overview of the methodology to be used in the study.
Outline:
Identification of Phenomenon of Interest
Statement of Research Purpose
Significance of the Phenomenon to Nursing
Research Question
Overview of Methodology
From the Paper "The decision to remove life-sustaining interventions in the Intensive Care Unit (ICU) comprises a momentous event that encapsulates diverse experiences for families. Since clients often are incapable of communication, family members may confront severe complexities or even dilemmas in attempting to make end-of-life care decisions. This is primarily because of the nature of technology that is used in the ICU which is actually used for to opposing purposes of prolonging and terminating life. Exploring families' experiences is a significant phenomenon of concern to clients' families and the health care team, as well as for the provision of client-centered care."
Abstract This research proposal involves an examination of how the decision to remove life-sustaining interventions in the intensive care unit (ICU) comprises a most significant event that encapsulates diverse experiences for families. The methodology used consists of a sample of four to five families who will be contacted through ICU family conferences in one or two hospitals. The research design is based on interpretive phenomenology, according to the work of M. van Manen and its focus on direct experience. The paper maintains that family members' experience of decision making related to withdrawal of lifesupport is subjective, but also universal in many respects. The decision to withhold or withdraw interventions involves a complex process that occurs in stages. The paper concludes that the goal of the study is to show how this process is either facilitated or made more problematic for families.
Outline:
Introduction
Research Design
Theoretical Underpinning
Strengths and Limitations of Design
Participant Selection
Study Setting
Data Collection
Data Analysis
Steps to Ensure Rigor
Dissemination of Findings
Conclusion
From the Paper "The theory underlying this study ultimately is found in the writings of Heidegger (1975, p. 11) who maintained that the individual worldview is not relative because whenever a worldview is developed, what it contains "can be formulated in propositions and rules which are related in their meaning to a specific really existing world". Individual experience, then, reflects universal experience. According to Phillips and Brown (1993), a critical hermeneutic approach proves useful in investigating the management of meaning. The approach is based on hermeneutics as an area of philosophy which relates to the theory and practice of interpretation, but is critical because it enables self-conscious reflection on social conditions. When the hermeneutic perspective is combined with a critical approach, the result is a structured approach to the analysis of the role of meaning in people's experience (Phillips & Brown, 1993). Researchers use the approach to associate ideas and symbols in ways which will explain the creation or maintenance of a permanent pattern of social relations. These include any activity which affects the network of symbols through which the individual or group understands reality. Critical hermeneutics is especially useful since it extends existing interpretive approaches (Phillips & Brown, 1993). The method can be used in longitudinal studies, in studies comparing cultural management, or in the study of groups and inter-group conflict."
Abstract In this article, the writer notes that the decision to remove life-sustaining interventions in the intensive care unit (ICU) is a crucial event for persons responsible for end-of-life care decisions. Research into families' experiences with decisions to withdrawlife sustaining interventions from a family member has indicated that the decisions made by the patient's immediate family can impact their perceptions and their psycho-social status. The writer discusses that appropriate educational and emotional support for families appears to improve their level of comfort regarding end-of-life decision-making and can facilitate the quality of the family's experience when dealing with difficult choices for a loved one. However, the literature in these areas demonstrates incongruity regarding how to best affect positive outlook among family members, and also the type of educational information needed and the methods required to deliver it. The writer therefore seeks to clarify which strategies are most effective in promoting a positive familyexperience when immediate family members make end-of-life decisions for a loved one receiving clinical health services.
Outline:
Introduction
Statement of the Problem and Purpose
Literature Review
Research Question
Hypotheses
Theoretical Framework
Hypothesis 1
Hypothesis 2
Conclusion
From the Paper "Making decisions related to the withdrawal of life support in the ICU is one of the most demanding experiences the family will ever face. Nurses play a key role in the effectiveness of the decision making process and it is their understanding of the stages involved in that process which can determine the quality of the outcome. As McHale Wiegand maintains, as more families become involved in end-of-life decisions, it is essential that current research be assessed, the gaps in knowledge be identified, and that new directions for ongoing research should be established. Little is actually known about the interaction of nurses with families in this situation; what is certain is that the interaction is not uniform and that nurses need to realize what will be most effective with families who are experiencing high levels of stress."
This paper presents a study exploring what family members experience when deciding to withhold or discontinue life-sustaining treatment from a loved one.
Abstract The paper discusses a research study that will explore the experience of family members who are engaged in decision-making related to the withdrawal or withholding of life-sustaining interventions from another family member. The paper examines the role of healthcare providers in this situation, presents the research question and looks at the methodology to be used.
Outline:
Identification of Phenomenon of Interest
Statement of Research Purpose
Significance of the Phenomenon to Nursing
Research Question
Overview of Methodology
From the Paper "Life-sustaining interventions have the potential to increase the life span of patients, yet termination of these interventions in ICUs is steadily increasing. Whereas providing the options regarding withholding or withdrawing treatment is common in the ICU environment, assisting family members as they struggle with these decisions on a personal level is extremely problematic (Abbott, Sago, Breen & Abernethy, 2001). The decision to withhold or withdraw these interventions involves a complex process for family members and occurs in stages (McHale Wiegand, 2006). For many family members, they are forced to become involved with decisions about which they have little or no information and have no preparation (McHale Wiegand, 2006)."
Abstract In this article, the writer explains that lifesupport is the methodology in which modern technology implements machines in order to sustain life in critical situations. The writer notes that modern technology has offered more and more advanced tools of lifesupport. The writer points out however, that there are several key issues which prove that lifesupport is not always one-hundred percent beneficial, and these have raised some serious ethical questions. The writer discusses that the various ethical concerns over lifesupport sometimes fail to compete with the medical benefits of the technical advances which allow doctors to sustain life in order to find a way to restore that life to its former vigor. The writer maintains that despite it proving inefficient for some areas of the population, lifesupport does prove beneficial in the resuscitation of many individuals.
From the Paper "Yet, there have been recent efforts to pre-discuss such threatening situations in the case of patients who have recently been diagnosed with a terminal illness. Recent studies have shown that the nature of the illness and or trauma can lead great insight into the benefits or cons of life support within individual cases. If an individual patient has more than one medical issue which would prove threatening to sustaining life in the event life support is needed, data shows that chances of recovery are lower than individuals who are only suffering from one medical condition or trauma. Therefore the nature and number of medical conditions should prove influential in each individual's decision to choose life support or not in the event that he or she would need it."
Abstract This paper examines the controversial issue of withholding medical care and nutrition from a patient with a terminal illness or on lifesupport. There have been several cases which have reached the high courts recently in which this matter is being argued. This paper explores which body has the right to decide if this treatment should be stopped - the medical facility, the family members or the court.
From the Paper "What care is 'futile'? Throughout the years, the question of whether or not to withhold certain treatments to terminally ill patients has been addressed. Do we continue to treat people who are still alive, even if we know that there is no hope? This is a question that has been asked over and over again by various parties. This notion is an ethical dilemma because it involves the notion of ending a life by witholding medical attention. Some religious groups feel that patients should be treated at all costs up until the end, while other people disagree with the notion and say this is immoral; these people have such a low quality of life, they should be relieved of their pain and suffering as fast as possible. Much like abortion, another ethical dilemma, it is difficult to say which side is right or wrong. Hence, an analysis into the situation must be consiered."
Abstract The paper provides a literature review on the effect that family and community support has on the outcomes of drug abuse treatment programs and then presents a proposal that will study the impact of family and social support on prison inmates who are attempting to successfully complete drug treatment programs. The paper explains the design of the study that will be both qualitative and quantitative in nature and will be conducted through the instrument of a survey/questionnaire administered to a randomly selected sampling of female inmates in the prison system. A survey that will be utilized in the study is included with the paper.
Outline:
Abstract
Introduction
Literature Review
Data and Methods
From the Paper "An evaluation funded by the National Institute of Justice entitled: "An Outcome Evaluation of the Forever Free Substance Abuse Treatment Program: One-Year Post-Release Outcomes" states that women who are drug-dependent "pose a serious problem for criminal justice authorities for several reasons" as the rate of women imprisoned has grown at a rate much faster than that of men and the needs of female prisoners are different and more diverse that that of male prisoners. This is problematic because jurisdictions generally do not have treatment programs that are specifically appropriate for and designed for females in prison with drug abuse and dependence problems. Because of relapses in use of drugs the rate of women turning around and heading right back to prison are extremely high. Previous research findings suggest that drug abuse treatment in combination with family and social support is more successful than treatment in the absence of such support."
Abstract This paper examines the use of quality of life measures in health care. Topics covered include: How quality of life is determined, the criteria assessed and who determines the criteria. The political and ethical implications for patient care are also discussed. The paper concludes that despite the ethical concerns and poor quality of measurement related to quality of life indices, they are indeed being used today to make both political and clinical decisions across a wide variety of medical conditions and situations. The paper includes articles referred to in the text.
From the Paper "Several ethical issues are associated with quality of life measures, the first and most important one being whether any decisions should be made using quality of life considerations given the very serious limitations regarding data accuracy. In other words, if clinicians can't trust that they have measured what their instruments purport to measure in an accurate and stable manner, why would they even want to make any decisions using these measures as a foundation? And if they do make decisions on the basis of such measures, the question of whether such decisions are ethical or moral must be raised."
Abstract This paper discusses that withholding and withdrawing treatment appears to be more acceptable to physicians than that of shortening life. The author defines "withholding treatment" as the decision either not to start or not to increase treatments that may sustain life, while ?withdrawing treatment? is defined as removing a life-sustaining intervention that is being used on a patient; "active shortening" of the dying process is an act specifically performed to end life, such as an intentional overdose, which is not "active euthanasia" because most ICU patients can not actively participate in the decision. The paper points out that the role of law is to articulate the minimum standards that professionals must achieve in the care of patients.
Table of Contents
Definition
Geographical Perspective
Ethics and Legal Considerations
Law and the Withholding or Withdrawal of Care
Physicians Personal Perspective
Summary
From the Paper "For example, in the United States, the care of patients at the end of their lives has become care that actively involves the patient, or if the patient is unable to participate in the decision making process, those family members who hold power of attorney to make such decisions for them. In North America, there is a trend toward earlier abandonment of life sustaining therapies. In Europe, active euthanasia is common in the Netherlands and Belgium although it is practiced legally in only one European country. The overall incidence of the withdrawal of life sustaining measures in European ICUs is not known, although withholding and withdrawing life support is actively used by most European intensivists, shortening of the dying process remains rare."
Tags: physicians, culture, religion, geography, law
Abstract This provides a valid introduction to the feminist perspective on familylife, using concepts of conjugal roles, dual-burdens, equal opportunities, and various social policies as evidence to support the feminist viewpoint. It looks at how many feminist sociologists believe that marriage and familylife exploits and oppresses women and how the traditional nuclear family, supported by functionalist and New Right sociologists, displays a definitively clear division of labour where women are expected to be housewives allowing the men to work. It also discusses how they perceive the nuclear family to mainly benefit men as women's domestic functions in the home allow men to dominate paid work as well as encouraging a patriarchal ideology.
From the Paper "Many feminist sociologists believe that marriage and family life exploits and oppresses women. The traditional nuclear family, supported by functionalist and New Right sociologists, displays a definitively clear division of labour where women are expected to be housewives allowing the men to work. Using this ideology, the female role within the family should be concerned with motherhood and housework as she is biologically best suited to this service, while the male function is to provide and protect the family and to act as a disciplinary role model to his children. Feminist sociologists disagree with this and the view that the nuclear family benefits all in society. They perceive the nuclear family to mainly benefit men as women's domestic functions in the home allow men to dominate paid work as well as encouraging a patriarchal ideology."
This paper examines the ability of African-American families to exhibit resiliency can be understood through a consideration of their historical circumstances
Abstract This paper examines African-American history and the values that this community has, despite their history of slavery, discrimination and poverty. It examines the community's strong commitment to education, a strong work orientation, and sense of responsibility. This paper also includes a study of African-American resiliency that was developed by the author in order to find out what adversities African-Americans faced in the pursuit of their education. The results of this study were then analyzed, and compared to the findings of prior research done on the subject. The survey included questions about age; experiences of racism, or discrimination; family structure during childhood and who helped raise them; and motivating factor for staying in school.
From the paper:
"As slaves, black children were informally adopted and raised by other people in their immediate community rather than nuclear family arrangements. These extended family arrangements are still a prominent feature of contemporary African-American families and may be considered a major survival tool. The most important service provided by black kinship networks is support to single mothers, especially teen mothers. Hill's research has revealed that kin provide a wide range of support to young single mothers, often enabling them to complete their education or to obtain a job. Finally, the religious beliefs and behavior are strengths that exist among African-American families. In his research, Hill found that 82 percent of black adults said that religion was very important in their lives."
Abstract This paper explains that the experience of long-term poverty effects many child outcomes because the family stress created by this poverty can result in family dysfunction, depression among caregivers and derisory parenting. The author points out that the family-centered approach is a process for providing services to families, which fits many different "content areas" such as support for teen parents, family literacy or education for low-income children; however, it is not a set of exacting practices but rather a "philosophy" in which families are recognized as having unique anxiety, strengths and values. The paper relates adapting and coping strategies, which are designed to make the persons first realize their situation, evaluate them thoroughly and adopt an approach that would be most suited to them.
Table of Contents
Cause
Contributing Factors
Consequences
Challenges
Family-Centered Approach
Ecological Model
Role of Community
Changes
From the Paper "Child outcomes of high levels of family stress and ineffective forms of parenting include poor emotional adjustment, which may be externalized as various forms of hostility, or internalized as depression or low self-esteem. Healthy child adjustment, on the other hand, should appear as achievement and on-task behavior in school, persistence in difficult tasks, and enjoyment of daily life. The Family Stress Model is maintained by good evidence from respected psychologists and sociologists. Research findings from as long ago as the depression years of the 1930s; propose that children were protected from the possible adverse consequences of poverty so long as the relationship between adult caregivers was supportive and. Civic participation is also effected, including educational attainment, full-time employment, and positive psychosocial adjustment like self efficacy, lack of depressive symptoms."
Abstract This paper researches the effects autistic children can have on their family. The author reviews literature and studies on this issue and finds that, not only is familylife affected, it is common that parents of children with autism tend to show deficits in social interaction. Furthermore the progress and well being of siblings of an autistic child might be affected. These viewpoints are expanded on with the author explaining how early diagnosis and social support can help families cope with their child's developmental delay or disability.
Outline:
Introduction
Effects on Parents & Siblings
Effects on Life of Family in Normal Activities
Adapting and Coping Strategies
Findings
Summary & Conclusion
From the Paper "Autism is a disease that has a major impact upon the family of the child with this disorder, which include emotional, functional, social, financial, as well as others, which will be related in this study. The precise cause of Autism is not known however, researchers are examining the genetic and environmental causes and some state a belief that autism is likely a disorder that is biologically based. However, recently there have been reports, which address the potential of vaccines to cause this disorder as the number of children diagnosed as being Autistic has increased over recent years. Behavioral modification is the most prominent form of treatment being utilized presently to treat this disorder."
Tags: development disorders, behavioral disorders, social disorders, social support
