I BATHINI PURITYKHANYILE DECLARES THAT "AN ANALYSIS OF PATIENT'S AWARENESS AND ATTITUDE TO END OF LIFE DECIDES". This was based on an analysis conducted to determine awareness and attitude of patients in end-of-life issues.
BACKGROUND OF THE STUDY
Griffiths (1999) used a phenomenological method in the United Kingdom to explore the value of personal autonomy in issues of consent. It was concluded that in practice assisted suicide and voluntary euthanasia take place covertly, despite the prohibitive legal system.
PROBLEM STATEMENT
OBJECTIVES OF THE STUDY
RESEARCH QUESTION
SIGNIFICANCE OF THE STUDY
DEFINITION OF TERMS
The landing unit in this study refers to a ward, which provides high-level care for patients who are transferred out of the intensive care unit. The outpatient department in this study refers to the casualty section of the hospital where treatment is given to clients with minor illnesses or injuries.
CONCLUSION
LITERATURE REVIEW
- INTRODUCTION
- THE DISTINCTION BETWEEN KILLING AND LETTING DIE
- THE RIGHT TO CHOOSE
- THE POTENTIAL FOR ABUSE
- THE CARE PROVIDERS' VIEW
- THE LEGAL PERSPECTIVE
- THE MEDICAL PERSPECTIVE
- THE RELIGIOUS PERSPECTIVE
- THE CULTURAL PERSPECTIVE
- A CONCEPTUAL lVIODEL
- CONCLUSION
It showed that traditional values and group belonging influenced end-of-life decision-making in the elderly. Ethical bases will be strengthened by support, which looks at factors that influence the patient's decision-making in end-of-life issues.
RESEARCH METHODOLOGY
INTRODUCTION
THE APPROACH
THE STUDY DESIGN
POPULATION STUDIED
They were in the intensive care unit and were undergoing emergency treatment such as artificial ventilation, invasive monitoring and/or dialysis. We compared the above category of patients with five patients who were outpatients with Ininor diseases and had never been placed in an intensive care unit. These participants were selected from a total of approximately eighty-five patients seen each day among the injured.
They were chosen based on their consent to participate in the study after receiving an explanation about the study from the researcher.
SAMPLI G PROCEDURES
For this reason, the researcher selected a sample of ten participants, as shown in table 3.1 on page twenty nine. The aim was to identify whether an experience of serious illness and admission to the intensive care unit, as opposed to no admission and minor illness, has any influence on individual's attitudes regarding end-of-life care.
RESEARCH SETTING
DATA COLLECTION PROCEDURES
Interviews were collected from the third day after transfer from the intensive care unit, when the patient's state of mind was clear from sedation. The first interview was conducted to explain the purpose of the study and to obtain permission to participate in the study. Consecutive interviews were appropriate for the health status of the participants so that for participants after intensive care, the need not to tire the patient required that the interviews be divided into three sessions.
Tape recording was used to collect data so that it was recorded verbatim. Some of the data regarding the patient's health status was collected from medical records, by writing notes.
DATA ANALYSIS
This process allows for the discovery of shared themes across participants, but also a search for natural variations in the data" (Wilson, 1985 p. 28). The researcher consulted a statistician to help with the coding of the data using the NVIVO software program The researcher attempted to become immersed in the data by listening to tapes and transcribing the tapes from Zulu to English under the guidance of the researcher's supervisor.
Interpretations involve making sense of the data “the lesson learned” as described by Lincoln and Guba (1985), cited by Creswell (1997).
ETHICAL CONSIDERATIONS
Participants were assured that the information collected would be kept confidential and used for research purposes only for the study and that no names would be associated.
THE ASPECT OF CREDIBILITY AND CONFIRMABILITY
The researcher eliminated bias by describing her point of view in the appendix, in parentheses. Exposure of the researcher's opinion was carried out on purpose due to the constant verification that it does not affect the collection and analysis of data; we also checked this with the researcher's mentor. To strengthen the validity of the study, the researcher used the assistance of an independent researcher to evaluate and monitor data coding using NVIVO software.
Throughout the study, researcher member control was used by the researcher, using a fellow researcher to check and monitor the data collected and assist in the translation from Zulu to English.
CONCLUSION
In this chapter, the researcher starts by coding the data using the NVIVO open coding program, transforms it from raw data by creating nodes and identifying themes, and finally connects all new ideas.
AWARENESS OF PATIENT'S RIGHTS
- The right based ethics! patient's rights
- Valoe based ethics
Mental status was selected by the researcher to determine whether participants thought it would limit decision-making ability. In this category, the researcher investigated the familiarity of the respondents with the inclusion of family members as surrogates for decision-making. To examine this relationship, the researcher examined the decision-making ability score, which was investigated in the categories of consent to initiate life support.
In this aspect, the researcher compared the responses of inpatients and outpatients to the category of substitute decision making.
ATTITUDES TOWARDS END OF LIFE DECISIONS
- Attitude towards withholding of life support
- Attitude towards withdrawing treatment
- Religion vs. attitude towards treatment termination
- Attitude towards financial status
- Attitude towards physician- assisted suicide
The researcher examined the category of the respondent's attitude towards the living will to make a decision about treatment choices. To examine this relationship, the researcher compared the responses of inpatients and outpatients to the category of attitude toward the living will. In order to be ready to make end-of-life decisions, the examiner looked at the responses of the participants to the living will.
All outpatients favored the living will and most inpatients had a negative attitude toward the living will.
CONCLUSION
It was noted that this result was also influenced by the amount of insight about illness, as those individuals who knew the prognosis of their illness considered the living will a valuable option. The fact that outpatients do not readily experience serious ill health was seen to influence their favorable attitude towards the living will, as death was not seen as an immediate reality for them.
DISCUSSION, CONCLUSION, SUMMARY, RECOMMENDATIONS, AND LIMITATIONS
INTRODUCTION
DISCUSSION
CONCLUSIONS
- Autonomy
- Informed consent
- Awareness about the living will
- Awareness of ordinary vs. extraordinary care
- Awareness about life support
- Family involvement vs. experience of severity of illness
The researcher concluded that health team members did not usually practice the concept of obtaining informed consent before treatment. The researcher expected decision-making to be based on full awareness and professional advice. The researcher concluded that although respondents knew about life support, knowledge of one aspect was not sufficient for informed decision making.
When comparing the participants' answers about family involvement and experiences with the severity of the disease, the researcher found that the number of outpatients and inpatients who wanted family involvement was the same.
VALUE BASED ETHICS
- Religion
- Culture
It was concluded that a lack of knowledge in this aspect hinders the decision-making process. In the data collected from the responses of the participants, it was noted that only one referred to culture to support views on decision-making. The researcher concluded that culture did not influence the decision-making of the respondents on end-of-life issues.
These results are not supported by those of Okuna et al (1999), where the Japanese considered cultural values to be the single most important determinant of end-of-life care decision-making.
ATTITUDES
- Financial status
- Withholding of life support
- Withdrawal of treatment
- Summary of the findings
It was noted that due to a lack of adequate knowledge about health issues, personal or patients' rights, patients were unaware of their autonomy in decision-making. Due to poor communication, the healthcare team does not ask the patient about the availability of a living will or discuss proxy decision making. The healthcare team reinforces this attitude of helplessness by neither informing the decision-making process nor involving the patients in this matter.
In this study, the results showed that the decision-making process is greatly influenced by religious beliefs.
RECOMMENDATIONS Implications for future trends
- Awareness campaigns
- Patient involvement and substitute decision-making
This could be done by handing out pamphlets to make patients aware of their rights and current hospital practices. Once the legislation is formulated, it should be distributed to patients and emphasis should be placed on their right to information. Educating the public masses about patients' rights can be done through the mass media.
Such preparation can be done by promoting open communication with the family and the patient about the subject of death.
IMPLICATIONS FOR FUTURE RESEARCH
The legal aspect of who can make end-of-life decisions should also be discussed, as it is important that such cases are concluded while the capacity to make decisions (in legal terms) is still viable.
LIMITATIONS
The interviews had to be conducted in Zulu, which was the mother tongue of the participants, and later translated into English for the sake of the study, so the researcher could not give direct spoken words of the participants. The biggest limitation of this study is that it cannot be generalized to the entire population, as the selection of the sample was purposive and the sample size is small. An ethical dilemma was encountered in that patients were not fully aware of the severity of their conditions, some were in denial and were reluctant to talk about their health status, and they did not want their health status to be included in the study.
The researcher noted that there is not much information on end-of-life issues, research and studies conducted in Africa, so the references used are mostly studies abroad.
CONCLUSION
The result of the study can be supported by the factors discussed in the conceptual model that the individual is able to make an informed, rational choice of his own free will and exercise his rights as a patient. backgrounds of professional support, family support and self-support also play a role. The role of nurses in AIDS care regarding voluntary euthanasia and assisted suicide: a call for further dialogue. I am a master's student at the above-mentioned university, taking a specialist course in nursing, intensive care and trauma, as a part-time student.
I request conducting research, interviews with patients, after admission to intensive care and with minor illnesses in the trauma department.
Faculty of Community & Development Disciplines
RESEARCH ETHICS COMMITTEE
The proposal meets the professional code of ethics of the
The proposal also meets the following ethical requirements
YES NO 1. Provision has been made to obtain informed consent of the
Do you have any knowledge about the living will, what is your opinion about it? IQ - What do you know about life support and intensive care admission. IQ- Have you heard of cases where terminally ill people request doctors to end their lives, what do you think?
RQ- Do you know if there is anything the government is doing about it.
