Yi-Ping Tseng1,2, Lian-Hua Huang3,4, Li-Ling Hsu5,6, Tzu-Hsin Huang7,8, Suh-Ing Hsieh9,10, Shu-Fen Chi11,12, Yen-Fang Chou13,14. 1. a Medical College , National Taiwan University , Taipei , Taiwan. 2. b Taoyuan Chang Gung Memorial Hospital, Nursing Home , Chang Gung Medical Foundation , No. 26-8, Dongjiulukeng, Guishan Dist., Taoyuan , Taiwan, R.O.C. 3. c School of Nursing , University of Colorado , Boulder , Colorado. 4. d College of Medicine, Department of Nursing , National Taiwan University , No. 1, Sec 1, Jen-Ai Rd, Taipei , Taiwan, R.O.C. 5. e Teacher College , Columbia University , New York , NY , USA. 6. f Department of Nursing , Oriental Institute of Technology , , No.58, Sec. 2, Sichuan Rd., Banqiao Dist., New Taipei City 220, Taipei , Taiwan, R.O.C. 7. g Graduate Institute of Nursing , Taipei Medical University , Taipei , Taiwan. 8. h Taoyuan Chang Gung Memorial Hospital, Nursing Department , Chang Gung Medical Foundation , No.123, Dinghu Rd., Guishan Dist., Taoyuan , Taiwan, R.O.C. 9. i School of Nursing , University of Maryland at Baltimore , Baltimore , MD , USA. 10. j Nursing Department at Chang Gung University of Science and Technology, Taoyuan Chang Gung Memorial Hospital , N423, No. 261, Wenhwa 1st Road, Kweishan, Taoyuan , Taiwan, R.O.C. 11. k Department of Health Care Management , Chang Gung University , Taoyuan , Taiwan. 12. l Taoyuan Chang Gung Memorial Hospital, Nursing Department , Chang Gung Medical Foundation , Nursing supervisor, No. 123, Dinghu Rd., Guishan Dist., Taoyuan , Taiwan, R.O.C. 13. m Department of Nursing , Chang Gung University , Taoyuan , Taiwan. 14. n Taoyuan Chang Gung Memorial Hospital, Nursing Department , Chang Gung Medical Foundation , Nursing supervisor, No.123, Dinghu Rd., Guishan Dist., Taoyuan , Taiwan, R.O.C.
Abstract
BACKGROUND: Many nursing home residents lack autonomous decision-making capacity and rely on family members to make do-not-resuscitate (DNR) decisions. Making DNR decisions can be difficult and complicated for surrogates. However, surrogates' psychological experience in making these decisions for older relatives is not well studied. AIM: To understand the surrogates' psychological experience of making DNR decisions for older relatives in a nursing home. METHODS: The study subjects of this qualitative study were family surrogates of older residents in a nursing home of Taiwan. A self-constructed, semi-structured interview guided in-depth interviews, which were recorded. Content analysis was used to discover themes from verbatim record. RESULTS: Four themes were revealed: lack of psychological preparation, considering issues when making a decision, ambivalent emotional responses and impact of cultural factors. Fifteen subthemes were also found. CONCLUSIONS: Surrogates who must decide whether to make a DNR decision for older relatives experience great emotional conflict. Understanding surrogates' struggles may assist nursing and care staff in managing this difficult situation.
BACKGROUND: Many nursing home residents lack autonomous decision-making capacity and rely on family members to make do-not-resuscitate (DNR) decisions. Making DNR decisions can be difficult and complicated for surrogates. However, surrogates' psychological experience in making these decisions for older relatives is not well studied. AIM: To understand the surrogates' psychological experience of making DNR decisions for older relatives in a nursing home. METHODS: The study subjects of this qualitative study were family surrogates of older residents in a nursing home of Taiwan. A self-constructed, semi-structured interview guided in-depth interviews, which were recorded. Content analysis was used to discover themes from verbatim record. RESULTS: Four themes were revealed: lack of psychological preparation, considering issues when making a decision, ambivalent emotional responses and impact of cultural factors. Fifteen subthemes were also found. CONCLUSIONS: Surrogates who must decide whether to make a DNR decision for older relatives experience great emotional conflict. Understanding surrogates' struggles may assist nursing and care staff in managing this difficult situation.
Keywords:
decision-making; do-not-resuscitate; family surrogate; psychological experience