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Western Journal of Nursing Research
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Doing What's Best

Decisions by Families of Acutely Ill Nursing Home Residents

Ruth Palan Lopez

MGH Institute of Health Professions, Boston, University of Pennsylvania, Philadelphia

When nursing home residents experience acute illness, the preference of family members is a major consideration in the choice between aggressive treatment and palliative care. Grounded theory method was used to explore decision making by family members of acutely ill nursing home residents. Analysis of 12 in-depth interviews with family members resulted in a theory, "doing what's best," that describes the basic psychosocial problem and response of family members. The problem was to make treatment decisions in the face of uncertain circumstances, and the response consisted of five subprocesses: protecting life, creating comfort, relying on religion, honoring wishes, and seeking guidance. Application of this theory to nursing practice can help nurses identify sources of uncertainty and support family members to clarify priorities for life prolongation or comfort, rely on religious or spiritual solace, translate resident wishes into individualized care plans, and provide knowledgeable guidance and support throughout the decision-making process.

Key Words: decision making • palliative care • nursing home • gerontology • qualitative methods

This version was published on August 1, 2009

Western Journal of Nursing Research, Vol. 31, No. 5, 613-626 (2009)
DOI: 10.1177/0193945909332911
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