Lived Experience of Primary Decision - Makers Regarding Do-Not-Resuscitate Instruction: Using Parse's Method

Eun Young Lee; Sung Rae Shin

doi:10.7475/kjan.2019.31.5.540

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Lee and Shin: Lived Experience of Primary Decision - Makers Regarding Do-Not-Resuscitate Instruction: Using Parse's Method

Original Article

Korean J Adult Nurs 2019;31(5):540-551.

Published online: 21 October 2019

DOI: https://doi.org/10.7475/kjan.2019.31.5.540

Lived Experience of Primary Decision - Makers Regarding Do-Not-Resuscitate Instruction: Using Parse's Method

Eun Young Lee¹, Sung Rae Shin^2,

¹Chief Nurse, Inje University Sanggye Paik Hospital Internal Medicine Intensive Care Unit, Seoul, Korea

²Professor, School of Nursing, Sahmyook University, Seoul, Korea

Corresponding author: Shin, Sung Rae https://orcid.org/0000-0001-8812-8313 School of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Korea. Tel: +82-2-3399-1588, Fax: +82-2-3399-1594, E-mail: shinsr@syu.ac.kr

Received 12 July 20198 September 2019 Accepted 28 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the significance and structure of the painful experience of primary decision-makers regarding the Do-Not-Resuscitate (DNR) instruction.

Methods

This study was a qualitative research based on Parse's qualitative research method. Participants were 7 family members who were primary decision-makers for regarding DNR instruction for the family member from July 28, to October 6, 2018.

Results

The core concepts of the difficulties of the participants were Distress emerging from the pitiful condition of the patient, guilt, sadness and regret, Seeking comfort for loved ones, Uncertainty of DNR decision, Planning the resumption of daily life and decision about own DNR. The painful experience of participants can be defined as the process of empowering the patient through verbal communication with them, by valuing them, and by enabling them to overcome their limitations.

Conclusion

The result of this study is expected to contribute to a deep understanding of primary DNR decision-makers'suffering and developing guidelines for nursing care for health care professionals and primary DNR decision-makers who provide end-of-life care to the patients.

Keywords: Family, Pain, Qualitative research, Resuscitation

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Table 1.

Language-Arts of the Seven Participants

Participants	Language-arts
GA	The painful experience of "GA" is overcoming the guilt of deprivation of the father's revived opportunities, the suffering of observing the physical distress of the patient, and struggle from economical pressure as a main caregiver by relying on self-satisfaction coming from the therapeutic attitude of the medical staff and the power of The Absolute. It is the process of planning and choosing the best for the future of family.
NA	The painful experience of "NA" is the process of deciding DNR alone in an irreversible state of old patients (spouse), and overcoming the feeling of sadness, fear of being left alone, and the pressure as a main caregiver with gratitude through faith. It is the process of deciding one's DNR in the mist of confusion of reversing the DNR decision hoping for the revival of patient and at the same time for the sake of patient's peaceful death.
DA	The painful experience of "DA" is overcoming pitifulness, guilt and poverty with the support of the family members after the decision for DNR to lessen financial burden on children. It is a process of pursuing comfortable death and hoping for the return of daily life by the resumption of economic activities.
LA	The painful experience of "LA" is the uncertain sequence of DNR decisions due to the fear of future days and the possibility of DNR reversal. It is the process of overcoming the stigma, suffering, and preparation of death through self-defense after deciding DNR as the prior choice of the patient (father) as a sign of impending death by a doctor
MA	The painful experience of "MA" is deciding and accepting the death of spouse on behalf of children and at the same time deciding own DNR while overcoming pitifulness, regret, physical and financial burden as a main caregiver with her strong will and with the support from family members.
BA	The painful experience of "BA" is hoping for revival of the patient from the best treatment with a sense of duty to make up for her carelessness and at the same time feeling of uneasiness, frustration and financial pressure after deciding DNR including the rejection of use of life extension devices.
SA	The painful experience of "SA" is the process of choosing DNR to ease the pain of a patient (spouse) and to relieve financial burden of the offspring, and overcoming from guilt, heartbreak, and financial burden as a main caregiver through the efforts of one's own hands. It is a process of deciding own DNR, planning economical activities for preparation of death and family living.

DNR=do not resuscitate.

Table 2.

Heuristic Interpretation of the Core Concepts

Core concepts	Structural transposition	Conceptual integration
Distress emerging from the pitiful condition of the patient, guilt, sadness, and regret	Compassion for patient	Languaging
Seeking comfort for loved ones	Peaceful death as a ultimate goal	Valuing
Ambivalence of DNR decision	The reality of family burden and the process of hoping for recovery	Enabling-limiting
Planning the resumption of daily life and decision of own DNR	Expectation for the return of daily life with self-awareness of DNR	Powering, originating
Structure	Lived experience of primary decision - makers regarding Do-Not-Resuscitate instruction is complicated by distress emerging from the pitiful condition of the patient, guilt, sadness, regret, with ambivalence of DNR decision yet seeking comfort for loved ones, and planning the resumption of daily life with decision of own DNR.
Structural transposition	Lived experience of primary decision - makers regarding Do-Not-Resuscitate instruction is the process in which they experience compassion for patient yet having hope of revival but peaceful death as a ultimate goal and at the same time expecting for the return of daily life with self-awareness of DNR.
Conceptual integration	Lived experience of primary decision - makers regarding Do-Not-Resuscitate instruction is the human becoming process through powering and originating accompanied with languaging, valuing, enabling-limiting.
Metaphorical emergings	Before the decision, anxiety trapped me in a cold sweat as in climbing the mountain and after the decision, descended but still drenched in sweat

DNR=do not resuscitate.

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