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Evid Based Nurs 7:64 doi:10.1136/ebn.7.2.64
  • Qualitative

The covenantal or communal values of surgeons and intensivists influenced end-of-life care in 3 intensive care units


 
 Q How does end-of-life care differ in intensive care units (ICUs) that use different administrative models?

DESIGN

Ethnographic observation.

SETTINGS

Surgical ICUs in St Louis, Missouri and San Antonio, Texas, and a medical-surgical ICU in Auckland, New Zealand.

PARTICIPANTS

Approximately 600 physicians, nurses, allied health professionals, patients, family members, and friends.

METHODS

The first author spent 18 months in the ICU in Missouri; 3 weeks in the ICU in Texas; and 10 weeks in the ICU in New Zealand. Her participation varied by site and included observation of rounds, patient care, and end-of-life discussions with families, as well as interviewing health professionals.

MAIN FINDINGS

A semi-closed unit with conflicting ethics (Missouri). On this unit, surgeons and intensivists shared responsibility for patient care, but conceptualised this responsibility quite differently. Surgeons appeared to act based on a covenantal ethic, which focused on an individual commitment to battle death on each patient’s behalf. In other words, if a patient had a chance to live, it would be morally wrong to …

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