Nurses' Role in Life Sustaining Treatment Decisions

This research will provide baseline data about nurses' role in life-sustaining treatment decisions for critically ill adult patients that will be used (1) in post-graduate education of military nurses to facilitate more effective, efficient, and ethical roles and interventions under combat and field conditions, and (2) in research for continued study of nurses' ethical decision roles during military health care reform. The specific aims of the study are to: (1) Measure the moral reasoning levels, decision-making style, self-perceived levels of nursing practice, and selected demographic characteristics of nurses working in two critical care units in a military hospital. (2) Describe nurses' ethical decision-making processes and their implementation of life-sustaining treatment decisions in the care of critically ill adult patients in a military hospital. (3) Identify the interactions between contextual (patient and institutional) variables, nurse variables, and life-sustaining treatment decisions and their implementations in the care of critically ill adult patients in a military hospital. (4) Develop a model(s) of nurses' ethical decision-making processes and their implementations of life-sustaining treatment decisions. A theoretical model based on Kohlberg (1981), Gilligan (1982), and Benner (1984); and empirical evidence of nurses' decision-making roles in life sustaining treatment decisions guides the descriptive, exploratory research design to answer five research questions. Phase I will involve measurement of levels of moral reasoning, ethical decision-making styles, self-perceived level of nursing practice, and selected demographic variables among nurses working on two critical care units in a large military hospital. Phase II will involve in-depth interviews of a purposeful sample of nurses at different levels of nursing practice for their narrative accounts of caring for critical ill adult patients and how life-sustaining treatment decisions for them were made and implemented. Phase II data will be analyzed for categories and themes related to ethical decision-making and the implementation of life-sustaining treatments. Descriptive and non-parametric statistics can be used to analyze the data from Phase I and their relationships to Phase II data.