Navigating Life's End: Task-Centered Versus Event-Centered Orientations Among Respiratory Therapists Withdrawing...

Area of Science:

• Medical Sociology
• End-of-Life Care
• Respiratory Therapy

Background:

• Terminal extubation, the planned withdrawal of mechanical ventilation, poses significant challenges for respiratory therapists (RTs).
• RTs' perspectives on their role during end-of-life care are underexplored.
• Max Weber's concept of ideal types provides a framework for understanding professional roles.

Purpose of the Study:

• To explore how respiratory therapists understand and enact their roles during terminal extubation.
• To identify different orientations RTs adopt in end-of-life care scenarios.

Main Methods:

• An interpretive description qualitative study.
• Semi-structured video interviews were conducted with 29 RTs in Canada and the United States.
• Analysis utilized Max Weber's ideal types to understand RTs' professional orientations.

Main Results:

• A continuum of two orientations was identified: task-centered and event-centered.
• Task-centered RTs prioritize technical aspects and emotional detachment.
• Event-centered RTs focus on the shared human experience, integrating emotional presence and clinical skills.
• Institutional support for event-centered practices is limited.

Conclusions:

• RTs' approaches to terminal extubation are influenced by a convergence of instrumental, value-rational, affective, and traditional motives.
• Recommendations include RTs' inclusion in decision-making and debriefing, blended training in technical and relational skills, and supportive policies.
• These changes can reduce burnout, enhance collaboration, and improve patient and family end-of-life care.