A grounded theory study : communication model about end-of-life care in the intensive care unit

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A grounded theory study : communication model about end-of-life care in the intensive care unit


Author: Wong, Lai-ming
Title: A grounded theory study : communication model about end-of-life care in the intensive care unit
Degree: M.Sc.
Year: 2010
Subject: Hong Kong Polytechnic University -- Dissertations
Physician and patient -- China -- Hong Kong
Nurse and patient -- China -- Hong Kong
Terminal care -- China -- Hong Kong
Intensive care nursing -- China -- Hong Kong
Grounded theory -- China -- Hong Kong
Department: School of Nursing
Pages: xi, 155 leaves : col. ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2356841
URI: http://theses.lib.polyu.edu.hk/handle/200/5686
Abstract: Background: End-of-life care (EOLC) has been increasingly recognized as an important issue in the intensive care. Communication has been identified as the key for improving end-of-life care in the literatures. However, it has been evaluated as poor in the current literatures and ineffective end-of-life communication has been evidenced that it has contributed to dissatisfactions in the end-of-life care and conflicts resulted in poor end of life care. In addition, it has been identified as a big challenge in the critical care settings because of the life saving mission of ICU and short dying process. Therefore an evidenced based communication model is needed to guide clinicians to communicate in order to promote better quality of end-of-life care. Aim: To develop a communication model through understanding and exploration on the communication process in Intensive Care Unit (ICU) EOLC in order to improve quality of EOLC in the ICU Study design: A qualitative Grounded Theory approach of Strauss & Corbin (1998) was adopted in this study to explore on the symbolic interaction of communication about end-of-life care in the intensive care unit. Open coding, axial coding and selective coding were adopted in the data analysis procedures to identify categories, discovering properties and dimensions of categories, relating categories to subcategories at different level of properties and dimensions as well as integrating and refining categories by relating them with core category identified. Results: In this study, 9 ICU nurses and 3 physicians were recruited for semi-structured interview. 5 informal conversations with patient's relatives, who are the key contact person of the patient, were conducted. Facilitating acceptance towards patient's impending death has been identified as the core category and goal of communication about ICU EOLC. Through exploration on the communication process of EOLC at the ICU, 10 antecedents altering the communication process, 6 communication processes about EOLC in the ICU and 3 possible outcomes were identified. A communication model about EOLC in the ICU was established. The interactions and linkage between antecedents, communication process and outcomes were integrated and illustrated in the communication model according to the core category of facilitating acceptance. Conclusion: Communication about end-of-life care was identified as the process of helping dying patient toward accepting the bad news in this study, more information were provided to clinicians on "What", "When" and "How" to communicate with dying patient's relatives in order to help them to accept patient's impending death by better understanding on the whole communication process as illustrated in the communication model generated. It would give some more information for clinicians. Hence effective communication could be achieved and promoted, and better quality of end-of-life care can be enhanced.

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