title: Nurses' role and care practices in decision-making regarding artificial ventilation in late stage pulmonary disease.
abstract: BACKGROUND
  Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role. Research question and design: We have investigated how nurses experienced their own role in decision-making processes regarding mechanical ventilation in later stages of chronic obstructive pulmonary disease and how they consider the patients' role in these processes. We applied a qualitative approach, with six focus-group interviews of nurses (n = 26). Ethical considerations: The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained.
  
  
  RESULTS
  The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation.
  
  
  CONCLUSIONS
  Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses' absence in participation in the decision about mechanical ventilation.
  
  
  CONCLUSIONS
  To be able to advocate for the patients' and their own right to be included in decision-making processes, nurses need an awareness of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses' participation in decision-making processes.
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Heidi
authors.initials: H
authors.lastname: Jerpseth
authors.affiliation: Akershus University Hospital, Norway.
authors.forename: Vegard
authors.initials: V
authors.lastname: Dahl
authors.affiliation: University of Oslo, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Nortvedt
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Kristin
authors.initials: K
authors.lastname: Halvorsen
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008171:Lung Diseases / Q000451:nursing* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009664:Norway; D024802:Nurse's Role / Q000523:psychology*; D010465:Perception; D036301:Qualitative Research; D012121:Respiration, Artificial / Q000451:nursing*; D016414:Resuscitation Orders
keywords: Chronic obstructive pulmonary disease; caring values; end-of-life decision-making; mechanical ventilation; nursing ethics