Nurse's, physician's and family member's experiences of withholding or withdrawing life‐sustaining treatment process in an intensive care unit

Abstract

Aims:To explore nurse's, physician's and family member's experiences of withholding or withdrawing life-sustaining treatment in an intensive care unit. Background: In South Korea, withholding or withdrawing life-sustaining treatment is legalised by the enforcement of the Hospice, Palliative Care and Life-sustaining Treatment Decision-making Act (2018). The Act (2018) is the first legal ground for making decisions regarding life-sustaining treatment in South Korea. Design: Focused ethnography. The standards for reporting qualitative research checklist is used. Methods: Interview data are collected between August 2018 and January 2019 using semi-structured interviews with 23 nurses, 10 physicians and four family members in a South Korean intensive care unit. The interview data are analysed following the thematic analysis of Braun and Clarke.Results: An overarching theme of 'constructing death' is identified from the experiences of nurses, physicians and family members regarding withholding or withdrawing life-sustaining treatment in a South Korean intensive care unit. Family members had the strongest power in the withholding or withdrawing life-sustaining treatment process whilst the process had to be based on medical consideration. All the research participants shared the purpose and motivation of withholding or withdrawing lifesustaining treatment as the dying patient's dignity. Due to the South Korean national health insurance system, the relationships between medical staff and family members were driven by customer ideology. Conclusion:The impact and linkage of the context of familism culture and health insurance with the process of withholding or withdrawing life-sustaining treatment in South Korea are shown in this research. The findings of this research inspire future studies to uncover the impact of the cultural context in the decision-making process of a patient's death, to explore the dynamics of family members under cultural values and to explore the influence of the healthcare system and medical costs on the relationships between medical staff and family members.

Navigating tensions when life‐sustaining treatment is withdrawn: A thematic synthesis of nurses' and physicians' experiences

“…In addition, two studies were included from the references in the full‐text review. Therefore, 16 articles were ultimately chosen for the thematic synthesis (Aita & Kai, 2010; Blythe et al., 2022; Brooks et al., 2017; Choi et al., 2022; Efstathiou & Ives, 2018; Espinosa et al., 2010; Gallagher et al., 2015; Hsieh et al., 2006; Jensen et al., 2013; Orr et al., 2022; Pattison et al., 2013; Robertsen et al., 2019; Taylor et al., 2020; Vanderspank‐Wright et al., 2011; Wiegand et al., 2019; Workman et al., 2003).…”

“…(nurse) (Choi et al, 2022) I think the ultimate decision is the consultant's, of what is going to be done. with it or not.…”

“…(nurse) (Choi et al, 2022) On the other hand, intensive care and treatment are therapeutic priorities and may collide with the decision to withdraw life-sustaining treatment. The consideration of therapeutic priority was predominantly shared among physicians, particularly surgeons, since they have a clear goal for the patient's recovery.…”

“…(nurse) (Choi et al, 2022) Sometimes talking with families about treatment withdrawal, I ask myself 'Am I a monster?' Because the questioning and the attitude of some families…”

“…(nurse) (Choi et al, 2022) Likewise, when family members refuse to withdraw life-sustaining treatment and instead choose to continue treatment, this decision can conflict with the patient's ability to have a comfortable and dignified dying process. Intensive care, including resuscitation to restore the cardiopulmonary system, is enormously invasive and painful.…”