Barbara Ruth Jacobs, PhD
“Surrounding Death: A Phenomenology of the Withdrawal of Life-Sustaining Treatment”
About the thesis: Trauma, the fourth leading cause of death in the United States for all age groups combined, is the leading cause of death for those between the ages of 1 and 44. Nurse relationships with victims are usually of short duration, involve younger patients, and often require decision-making by surrogates at a time of sudden crisis. Medical futility and/or brain death may be reasons for withdrawal of life-sustaining treatment. The phenomenon of withdrawal of life-sustaining treatment (WLST) from the perspective of critical care nurses is the subject-object point-of-contact explicated in this research.
Introduction: The purpose of the study was to describe the phenomenon of WLST as given to six critical nurses through their experiences. The two research questions were, what is the fundamental structure of the phenomenon and what is the meaning of the experience of it. The theoretical foundation was interpretivism, the epistemology was constructionism, and the methodology was phenomenology. The method of inquiry was the existential phenomenological research method of Colaizzi. The researcher performed an individual phenomenological reflection (IPR) using imaginative presence. The empirical phenomenological reflection (EPR) analyzed data from transcripts of six dialogal interviews using Colaizzi’s protocol analysis. The result was the discovery of a fundamental structure of the phenomenon generated from its exhaustive description obtained from data analysis. The description was a play, Surrounding Death and included fifteen scenes (categories): the initial crash, going downhill, connecting and separating, feeling guilt, holding vigil, facing issues the staff, facing issues the family, gathering and deciding, cacophony to symphony, the last gathering, that’s it, moving beyond death, doubting the decision, knowing myself before, and knowing myself after.
Results: The discovered fundamental structure included essences such as: point-in-time reconciliation, decision-making focusing on a human being in absentia, covenantal gift, intimacy-with-moral strangers, finitude to being-in-the-world, inter-subjective empathy, referent requiem, and interiority or learning of self. It is anticipated that this phenomenology, when read by other nurses, will increase their awareness, understanding and knowledge of its meaning that will be transferable to future nursing practice.