Family members' informal roles in end-of-life decision making in adult intensive care units.

Background: To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process.

Objective: To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units.

Methods: Ethnographic study.

Intensive care unit cultures and end-of-life decision making.

Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM.

Actualizing Gadow's moral framework for nursing through research.

The purpose of this paper is to describe how Sally Gadow's perspectives on existential advocacy as the moral framework for the nurse-patient relationship were synthesized with a general theory of motivation, self-determination theory (SDT), to inform the design of a study in which the influence of interpersonal care on the process of tobacco dependence treatment was explored. Consistent with the tenets of existential advocacy, participants who perceived their care providers as interpersonally sensitive and bringing more of their whole selves to the care encounter reported more autonomous motivation and felt competence for stopping smoking. The integration of existential advocacy with SDT, which led to the empirical work in which Gadow's ideas were actualized and her model supported, is described.

Ethics and managed care.

Managed care in the USA is best understood in the context of the history of health care. It is an effort to manage the soaring costs of health care while retaining quality. Many ethical concerns arise because managed care organizations (MCOs) have dual purposes: to realize profits and to provide quality care.