Unexpected Crisis Research Articles

Final choices: to live or to die in an age of medical technology

The staggering advances in medical technology over the past few decades have enormously increased the number of treatment techniques available at the concluding stages of life. For countless patients and families, this situation is challenging and confusing, especially if an unexpected crisis occurs in a hospital or hospice, or at home. Final Choices is an extraordinary presentation of the issues, options, and obstacles concerning the right and ability of a dying person to control his or her future. George M. Burnell, M.D., a psychiatrist with direct experience in grief and bereavement counseling, emphasizes the development of open communication within the family and with members of the treatment staff. He sensitively discusses many important concerns so as to facilitate such dialogue, for example: the questions to ask a doctor at the onset of illness; the fear of pain or physical deterioration (e.g., from AIDS or chemotherapy); the spiritual, legal, and financial counsel available to patient and family; the medical choices a patient may have in pursuit of a dignified death; the official documents to prepare (e.g., a living will, a power of attorney, a healthcare proxy) for the patient's last wishes; the possible merits of hospice care for the medical and spiritual benefits of patient and family. Featuring poignant case histories, Dr. Burnell describes in clear, nontechnical language the painful ethical and legal complications that surface when patients and families not pursue the possibility of do not resuscitate (DNR) orders in lieu of life-prolonging measures. Unlike other books in the field, Final Choices does not underplay the dilemmas posed by modern medical technology.Featuring a fascinating breakdown of landmark cases, the author weighs the opinions posed by the medical and legal communities, and the increasingly important role of a bioethics committee in its capacity as a family-hospital mediator. An extensive list of sample forms, charts, a he

Facilitating nurturant fathering behavior in the NICU

Many of the roles required of the father of a NICU infant are new and unfamiliar, difficult to carry out, unrehearsed, and yet called for in an unexpected crisis. At a time when they too need nurturing, fathers of high-risk infants are expected to adapt readily and be models of self-control. It is apparent from this investigation that the primary nurse is in a strategic position to assist the new father in his acquaintance with and early adjustment to his infant. Although some of the fathers will become actively involved with their children, others prefer less involvement in infant care taking and display minimal nurturant behaviors. A nurse must be able to recognize these differences and support a father's (and mother's) choice. A couple's sociocultural ideology and perceptions of the father's role, as well as the family dynamics and values, need to be given primary consideration in planning nursing care. In order for the nurse to fulfill an important teaching role for the fathers (parents) of NICU infants, the nurse must meet the needs of each individual father in relation to the family system. This requires systematic and nonjudgmental assessment and caring facilitation of paternal role development and early father-infant and father-mother-infant interactions.

Interpreting the unexpected: the case of AIDS policy making in Britain

ABSTRACTThis paper analyses the reactions of a government faced with an unpredictable and unexpected crisis with possible catastrophic long-term effects: the AIDS epidemic in the United Kingdom in the 1980s. First, the AIDS epidemic is defined as a case study of government forced to cope with uncertainty, moral ambiguity and the knowledge that there are no solutions, only ways of limiting the damage. Second, it examines the evolution of policy of British ministers, who initially preferred to ignore evidence of AIDS but were forced to act by signals threatening a popular backlash. They did so by creating a programme of action based on the advice and values of the medical profession and public health experts. The conclusion argues that this kind of policy response may be generalisable. When societies are faced with problems that do not appear to be soluble but which may imperil social cohesion they seek to create an elite consensus to treat them as technical matters, so insulating the policy process from possible disruptive populist pressures.

Abortion repeal in Hawaii: an unexpected crisis in patient care.

Because of psychological reactions in the nursing staff working with abortion patients, mental health consultations were requested by several hospitals in Hawaii after abortion became legal. Many of the nurses had strong emotional reactions to the abortion work. They reacted more strongly to saline abortions than to suction curettage because of the similarity to actual labor. Many of the nurses had trouble switching roles from traditional obstetric nurses to working with abortion patients. The authors concluded that "it is crucial to include nurses in the policy making processes... The option of not working on abortion cases must be kept open." Abortion cases should be segregated from general maternity cases to help avoid some of the conflicts in nursing care. The emphasis should be on first trimester abortions for medical and psychological reasons. More research is needed on the woman's attitude toward abortion and pregnancy, with special reference to delay in discovering pregnancy.