Chronic limb-threatening ischaemia and confronting amputation: A Heideggerian derived understanding of Being-with and discourse.
Being-with
amputation
chronic limb-threatening ischaemia
clinician presence
decision-making
family
hermeneutic Heideggerian phenomenology
revascularisation
treatment options
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
14
01
2023
received:
06
09
2022
accepted:
23
01
2023
medline:
21
8
2023
pubmed:
16
2
2023
entrez:
15
2
2023
Statut:
ppublish
Résumé
To explore the notion of Being-with and authentic discourse for people making decisions about major amputation. Chronic limb-threatening ischaemia is a devastating disease with a high burden of pain and complex wounds. Patients may deteriorate suddenly after multiple revascularisation procedures and, amputation is offered when further reperfusion is considered futile. Delayed decisions about amputation have negative consequences for patients, families and health systems, yet little attention is given to training clinicians for the sophisticated communication required. Clinicians need to engage in authentic discourse about amputation to create shared meaning and facilitate decision-making. Qualitative study using hermeneutic Heideggerian phenomenology. Twelve patients offered major amputation, and 13 family participants from three vascular units in Australia engaged in 42 semi-structured interviews, representing 19 cases of chronic limb-threatening ischaemia. Hermeneutic phenomenology using the Heideggerian tenet of Being-with as an analytic framework, a philosophically based understanding of Being-with and Discourse related to treatment discussions and decisions was derived. The research was reported in accordance with the COREQ checklist. Effective discourse between the person and family was hampered by changed circumstances of Being-with, characterised by guilt, and a retreat from discourse through deficient discourse and filtering information. Clinician Being-with was hampered by discourse that was deficient, poorly delivered, discordant and disconnected through a lack of empathetic listening. There were also examples of enhanced clinician Being-with that made room for more constructive discourse and more timely decisions about amputation. Heidegger's construct of Being-with provides a useful framework to reveal the role of authentic discourse in improving patient and family experience and decisions about treatment. This study did not engage consumers other than as patient and carer participants. Decisions about amputation are often difficult for patients or family members who may be substitute decision-makers. A better understanding of the experience may assist clinicians in their interactions with patients and families.
Sections du résumé
AIMS AND OBJECTIVES
OBJECTIVE
To explore the notion of Being-with and authentic discourse for people making decisions about major amputation.
BACKGROUND
BACKGROUND
Chronic limb-threatening ischaemia is a devastating disease with a high burden of pain and complex wounds. Patients may deteriorate suddenly after multiple revascularisation procedures and, amputation is offered when further reperfusion is considered futile. Delayed decisions about amputation have negative consequences for patients, families and health systems, yet little attention is given to training clinicians for the sophisticated communication required. Clinicians need to engage in authentic discourse about amputation to create shared meaning and facilitate decision-making.
DESIGN
METHODS
Qualitative study using hermeneutic Heideggerian phenomenology.
METHODS
METHODS
Twelve patients offered major amputation, and 13 family participants from three vascular units in Australia engaged in 42 semi-structured interviews, representing 19 cases of chronic limb-threatening ischaemia. Hermeneutic phenomenology using the Heideggerian tenet of Being-with as an analytic framework, a philosophically based understanding of Being-with and Discourse related to treatment discussions and decisions was derived. The research was reported in accordance with the COREQ checklist.
FINDINGS
RESULTS
Effective discourse between the person and family was hampered by changed circumstances of Being-with, characterised by guilt, and a retreat from discourse through deficient discourse and filtering information. Clinician Being-with was hampered by discourse that was deficient, poorly delivered, discordant and disconnected through a lack of empathetic listening. There were also examples of enhanced clinician Being-with that made room for more constructive discourse and more timely decisions about amputation.
CONCLUSIONS
CONCLUSIONS
Heidegger's construct of Being-with provides a useful framework to reveal the role of authentic discourse in improving patient and family experience and decisions about treatment.
NO PATIENT OR PUBLIC CONTRIBUTION
UNASSIGNED
This study did not engage consumers other than as patient and carer participants.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
Decisions about amputation are often difficult for patients or family members who may be substitute decision-makers. A better understanding of the experience may assist clinicians in their interactions with patients and families.
Types de publication
Journal Article
Langues
eng
Pagination
6559-6573Informations de copyright
© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
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