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Directives Limiting Care in the Perianesthesia Setting: A Foucauldian Case Study Report.

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Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses
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Summary

Adult patients

Keywords:
DNRFoucaultadvance directivescase studyperioperative nursingresuscitation orders

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Area of Science:

  • Medical Ethics
  • Anesthesiology
  • Qualitative Research

Background:

  • Current guidelines mandate reconsidering do not resuscitate (DNR) orders before anesthesia.
  • However, these directives are often suspended in the perianesthesia setting.
  • The communication surrounding these limitations is not well-documented.

Purpose of the Study:

  • To explore decision-making processes regarding resuscitative status for adult patients with limiting directives during anesthesia.
  • To understand how patients, families, and clinicians navigate these discussions.
  • To investigate the literature gap on communication about advance directives in perianesthesia.

Main Methods:

  • A qualitative inquiry employing a Foucauldian Poststructural Case Study Design.
  • Data collection through interviews and observations of patients, families, and perianesthesia clinicians.
  • Contextualizing analysis used for rigorous data examination.

Main Results:

  • Four dominant discourses influencing patient and clinician choices were identified.
  • A pervasive "We'll just suspend" discourse in perianesthesia culture leads to directive suspension.
  • Identified barriers include time constraints, reluctance to discuss advance directives, and unclear responsibilities.
  • Patients' difficulty translating advance directives and power dynamics can hinder honoring patient choices.

Conclusions:

  • Even with policies for advance directive reconsideration, patient choices and decision-making agency can be constrained.
  • Perianesthesia environments may limit patients' ability to uphold their advance directives.
  • Further research is needed to improve communication and adherence to patient wishes.