title: Nurses' decision-making in ethically relevant clinical situations using the example of breathlessness: study protocol of a reflexive grounded theory integrating Goffman's framework analysis.
abstract: Decision-making (DM) in healthcare can be understood as an interactive process addressing decision makers' reasoning as well as their visible behaviour after the decision is made. Other key elements of DM are ethical aspects and the role as well as the treatment options of the examined professions. Nurses' DM to choose interventions in situations of severe breathlessness is such interactions. They are also ethically relevant regarding the vulnerability of affected patients and possible restrictions or treatment options. The study aims to explore which factors influence nurses' DM to use nursing interventions in situations where patients suffer from severe breathlessness.
  
  
  
  Qualitative study including nurses in German hospital wards and hospices. A triangulation of different methods of data collection-participant observation and qualitative expert interviews-and analysis merge in a reflexive grounded theory approach which integrates Goffman's framework analysis. It allows an analysis of nurses' self-statements about DM, their behaviour in relevant clinical situations and its influences. Data collection and analysis will be examined simultaneously.
  
  
  
  Informed consent will be gained from all participants and the institutional stakeholders. Ongoing consent has to be ensured since observations will take place in healthcare institutions and many patients will be highly vulnerable. The study has been evaluated and approved by the Witten/Herdecke University Ethics Committee, Witten, Germany. Results of the study will be published at congresses and in journal papers.
authors.affiliation: Institute for Ethics and Communication in Healthcare, Witten/Herdecke University, Witten, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Dunger
authors.affiliation: Institute for Ethics and Communication in Healthcare, Witten/Herdecke University, Witten, Germany.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Schnell
authors.affiliation: Department of Palliative Medicine, Ludwig-Maximilians-University Munich, Munich University Hospital, Munich, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D004417:Dyspnea / Q000451:nursing*; D004993:Ethics, Nursing; D005260:Female; D005858:Germany; D066296:Grounded Theory; D006801:Humans; D007258:Informed Consent; D008297:Male; D024802:Nurse's Role; D036301:Qualitative Research; D012107:Research Design
keywords: Framework Analysis; Reflexive Grounded Theory; breathlessness; nursing decision-making; participating observation