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Date of Award

2017

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

Thesis Committee Chairperson

Lynda Cessario, PhD, CNS, CNE, RN

Second Reader

Dhahah Eckert, MS, ANP, RN

Abstract

A qualitative action research study, guided by Parse’s theory of human becoming (1992), was conducted to investigate the barriers and facilitators for nurse practitioners to truth telling of critical prognoses of six months or less to patients and their families. A purposeful sample of four nurse practitioners was solicited and obtained via a Facebook posting. The design of this study was phenomenology. The setting was determined by the participants and included: the physicians’ lounge and family waiting area at the workplace of participants. Participants responded to interview questions generated by the researcher in face-to-face interviews. Data analysis identified various barriers and facilitators to truth telling of critical prognosis of six months or less including the intention to preserve hope, intention to promote autonomous decision making, conflicting provider perspectives, collaborative relationships, communication skills, level of experience, and denial. It can be concluded from this study that the nurse practitioners sampled believe that nurse practitioners favor truthful disclosure and possess an obligation to provide a truthful prognostic picture to patients and their families. The implications from this study suggest that the truthful disclosure of critical prognostic information is a necessary yet challenging function of any clinical practice that is focused on supporting and promoting autonomous decision-making and the achievement of patient centered goals. Furthermore, the preservation of patient autonomy should supersede other moral principles often used to justify non-disclosure of critical prognostic information. Recommendations for further research include: (a) additional investigation exploring this phenomenon, (b) utilization of a larger sample size, and (c) implementation of the action plan with comparison study to evaluate the effectiveness of the suggested interventions.

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