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Researching Advanced Life Support Report (Assessment)

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Updated: May 10th, 2022

In their 2009 study Factors that influence decisions about cardiopulmonary resuscitation: the views of doctors and medical students, Tyrer et al. strived to identify and categorize factors that affect cardiopulmonary resuscitation (CPR) -related decision-making in the clinical environment. The deployed research methodology can be best defined in terms of a qualitative inquiry. The authors composed six focus groups out of the seventeen currently practicing physicians and four medical students, which volunteered to participate in the study. The participants were asked to elaborate on their experiences of applying CPR to patients and on what they consider accounted for the challenges of defining the extent of every individual patient’s eligibility to be subjected to the earlier mentioned procedure.

After having conducted the study’s empirical phases, the authors came to identify four major factors, which appear to exert a considerable influence on how the participants usually go about making CPR-related positive or negative decisions. These factors can be outlined as follows: 1) the specifics of patients’ diagnosis/prognosis/age, 2) the considerations of what would be the quality of post-CPR patients’ lives, 3) the opinions of other doctors/staff members, 4) the legally binding wishes of patients and of their close relatives. The authors concluded their study by suggesting that, “Doctors might benefit from support or training to improve communication with patients and families about resuscitation to provide greater consistency in this aspect of patient care” (p. 568).

Even though there can be only a few doubts, as to the fact that the study’s authors did apply a considerable effort in conducting their study, there are a number of methodological drawbacks to it:

  1. The fact that the collected data cannot be referred to as being cross-sectionally sound. As it was mentioned earlier, the body of this study’s participants accounted for only twenty-one individuals. Moreover, as it appears from the study, four of them (medical students) did not have any de facto experiences of attempting CPR in practice. According to the authors, “Participants… were identified opportunistically via colleagues working in the palliative care setting” (p. 565). In its turn, this suggests that the study’s qualitative findings provide us with only a preliminary insight into the researched subject matter, which can be vaguely interpreted (Sambunjak, Straus & Marusic 2010). In addition, while analyzing respondents’ elaborations on the subject matter in question, the authors made a deliberate point in allowing group-members perceptual subjectivity to affect the discursive significance of the collected data, “For each theme, due consideration was given to the words used by group members, the context, frequency, extensiveness” (p. 565). Even though the practice of analyzing the emotional subtleties of people’s attitudes towards a particular phenomenological issue is being considered fully appropriate in interpretative studies, the appropriateness of the same practice in qualitative studies can be referred to as being rather questionable. This is because it would represent a major challenge to quantify/categorize the obtained ‘perceptual’ data (Cresswell 2008).
  2. Non-observance of the principle of contextualization. Those who conduct a qualitative inquiry into what accounts for the actual mechanics of people’s decision-making must consider the possibility that the process in question reflects the concerned individuals’ culturally predetermined behavioral inclinations. This refers to the so-called principle of contextualization (Klein & Myers 1999). Unfortunately, the study by Tyrer et al. appears to be rather unobservant of the earlier mentioned principle. This is because, despite having provided readers with extensive factual information, in regards to the specifics of participants’ professional characteristics, the authors did not make any mention of the particulars of group members’ ethnocultural affiliation. Yet, in light of recent breakthroughs in the fields of biology and psychology, there can be very few doubts as to the fact that the manner, in which people indulge in decision-making, does signify the in-depth characteristics of their ‘brain wiring’. These characteristics, however, cannot be discussed outside of the specifics of people’s culture/ethnicity (Lesser et al. 2011). The fact that the authors skipped mentioning it undermines the study’s objective value even further.
  3. Non-observance of the principle of multiple interpretations. It nowadays became a commonplace practice among researchers to interpret the significance of their studies’ findings from a variety of different angles, as the foremost mean of ensuring the overall academic legitimacy of their qualitative research projects (Kleining & Witt 2001). In their study, however, Tyrer et al. refrained from providing readers with different interpretative insights, as to what the obtained data may indicate. Partially, this can be explained by the apparent straightforwardness of the deployed research apparatus. Nevertheless, this does not change the fact that the analyzed study does suffer from the extent of its interpretative integrity having been considerably weakened.
  4. The study’s lack of innovative insights. As we have noted earlier, the authors concluded their study by suggesting that clinicians would benefit from being provided with additional support, while deciding in favor or disfavor of the CPR’s application. Nevertheless, the specifics of what should be considered circumstantially appropriate support, in this respect, have not been identified. In the study, there is also an apparent absence of any qualitatively new recommendations, as to how clinicians should go about increasing the level of their professional excellence, in regards to CPR decision-making. Yet, it is specifically the prospect of defining new dimensions to the studied phenomena, which is supposed to provide scientists with a rationale to subject it to a qualitative inquiry, in the first place (Goussinsky et al. 2011).

At the same time, however, there are a number of apparent strengths to the analyzed study, which also need to be mentioned:

  1. The fact that this study is being concerned with filling the discursive gaps in previously conducted CPR-related studies. According to the authors, “(Prior to their study) there has been no research to identify the information that doctors take into account when they make decisions about CPR” (p. 564). Given the fact that the study’s official aim was to identify the environmental factors that affect CPR-related decisions, on the part of clinicians, we can well confirm that the authors did succeed in addressing the task. This is because; it is not only that Tyrer et al. were able to provide readers with the empirically collected data, as to what can be considered these factors, but they also outlined the sets of circumstances, under which doctors’ exposure to the informational inputs is being capable of affecting the line of their pro-CPR or contra-CPR reasoning. This, of course, does suggest that, despite its earlier mentioned weaknesses, the study by Tyrer et al. did contribute to the CPR-related research.
  2. The authors’ perceptual/cognitive objectivity. While conducting their study, the authors strived to remain thoroughly objective in how they went about collecting the empirical data and interpreting this data’s practical implications. The validity of this statement can be illustrated in regards to the authors’ tendency to provide rationale-based explanations to the CPR-related subjective judgments/opinions, on the part of participants. This, of course, suggests the authors’ awareness of another important principle of conducting qualitative research – namely, the principle of suspicion (Clarke 2004).
  3. The study’s discursive relevance to what now accounts for the qualitative dynamics in the field of bioethics. Even though in their study, the authors did remain faithful to the above-mentioned principle, it nevertheless did not prevent them from ensuring a thoroughly progressive sounding of the conducted inquiry. The legitimacy of this statement can be explored in relation to the authors’ promotion of the idea that clinicians may never overlook the importance of adjusting their CPR-related decisions to be fully consistent with patients’ wishes (Cox et al. 2006). In its turn, this suggests that the authors are being aware of the fact that, as time goes on, the validity of Western orthodox approaches to treating patients, concerned with ‘curing’ rather than with ‘healing’, continues to be undermined (Saks 2003). Thus, it will not be much of an exaggeration to suggest that the analyzed study is indeed being ideologically compatible with current dynamics, within the conceptual framework of the Western medical paradigm.

I believe that, due to having been exposed to the study by Tyrer et al., I did manage to increase the extent of my professional adequacy, as an anesthesia technician. In particular, I was able to confirm the validity of my convictions that:

  1. While attempting CPR on patients, clinicians should pay close attention to what accounts for the specifics of the concerned individuals’ diagnosis, mental condition and age. As it was shown by Tyrer et al., the majority of their study’s participants did express their belief in the appropriateness of applying a ‘circumstantially sound’ criteria, within the context of them deciding on whether CPR should be attempted or not. One of the possible explanations for this is that, as time goes on, more and more clinicians realize that it is no longer appropriate to assess the appropriateness of CPR-related decisions from a strictly legal perspective. This is because ongoing technological progress in the field of medicine renders many healthcare-related legal conventions outdated. Apparently, it is being only a matter of time, before the medical principle ‘do not harm’ will refer not only to the concerned patients’ physical but also emotional well-being (Ardagh 2000).
  2. In order to be considered eligible to make CPR-related decisions, anesthesia technicians should prove their perceptual quick-mindedness. As it appears from the study, the effectiveness of participants’ CPR-related decision-making suffered from the fact that, while facing the challenge of giving/non-giving a ‘go ahead’ for resuscitation to be performed on patients, they had to promptly decide in favor of following the specific set of applicable rules and regulations. What hampered them even more, in this respect, is that while following these rules and regulations, they also had to take into consideration the suggestions/opinions of their colleagues. What it means is that, when it comes to making CPR-related decisions, clinicians must be ready to filter out (mentally) the intended resuscitation’s circumstantially irrelevant legal aspects (Kidby 2003).
  3. Anesthesia technicians should be willing to explain to patients that the de facto effectiveness of CPR rarely accounts for more than 10%-15%, even when attempted in hospitals. According to the study’s findings, one of the CPR’s main discursive impediments is the fact that, while deciding on whether to provide doctors with their consent to be subjected to CPR (if circumstances call for it), many patients nevertheless remain thoroughly arrogant of the procedure’s reduced ability to serve as a ‘lifesaving tool’ (Pritham 2003). This, of course, could not result in anything else but in creating additional obstacles, on the way of anesthesia technicians trying to come up with circumstantially justified decisions of whether to attempt CPR or not. Therefore, while addressing my professional duties, I will make a deliberate point in educating patients on this particular subject matter.
  4. The considerations of what would account for the quality of life, on the part of post-CPR patients, should be incorporated into the very matrix of CPR-related decision-making. The study’s findings indicate that many participants believed that the appropriateness of attempting CPR on patients should also be assessed, in regards to what appear to be the concerned individuals’ chances to enjoy a quality-living, in case of the CPR’s success. I can only subscribe to the idea – it does not make any logical sense to bring patients back to life if there is no rationale-based reason to expect that they would welcome it (Hyman 2006; Robinson, Cupples & Corrigan 2007). Being a responsible anesthesia technician, I will do my best while promoting the idea that the conceptual premise of today’s bioethics should be revised, as largely outdated – especially when the process of designing ethical guidelines for the application of CPR is being concerned.

In conclusion, it would be thoroughly appropriate to suggest that, despite the study’s earlier mentioned weaknesses, it is indeed being capable of helping readers (assumed to consist of healthcare professionals) to broaden their intellectual horizons, in general, and of providing them with a number of new qualitative insights into what accounts for the CPR’s proper application, in particular.

References

Ardagh, M 2000, ‘Futility has no utility in resuscitation medicine’, Journal of Medical Ethics, vol. 26 no. 5, pp. 396-399.

Clarke, L 2004, ‘The value of qualitative research’, Nursing Standard, vol. 18 no. 52, pp. 41-44.

Cox, C et al. 2006, ‘Implications of cultural diversity in do not attempt resuscitation (DNAR) decision-making’, Journal of Multicultural Nursing & Health, vol.12 no. 1, pp. 20-28.

Cresswell, J 2008, Qualitative, quantitative, and mixed-method approaches, Sage, London.

Goussinsky, R et al. 2001, ‘Teaching qualitative research for human services students: a three-phase model’, The Qualitative Report, vol.16 no. 1, pp. 126-146.

Hyman, D 2006, ‘Rescue without law: an empirical perspective on the duty to rescue’, Texas Law Review, vol 84 no. 3, pp. 653-737.

Kidby, J 2003, ‘Family-witnessed cardiopulmonary resuscitation’, Nursing Standard, vol. 17 no. 51, pp. 33-36.

Klein, H & Myers, M 1999, ‘A set of principles for conducting and evaluating interpretive field studies in information systems’, MIS Quarterly, vol. 23 no. 1, pp. 67-94.

Kleining, G & Witt, H 2001, ‘Discovery as the basic methodology of qualitative and quantitative research’, Forum: Qualitative Social Research, vol. 2 no. 1, pp. 2-27.

Lesser, I et al. 2011, ‘Effects of race and ethnicity on depression treatment outcomes: the CO-MED trial’, Psychiatric Services, vol. 62 no. 10, pp. 1167-1179

Pritham, R 2003, ‘Medicine, myths, and the movies: Hollywood’s misleading depictions affect physicians, patients alike’, Postgraduate Medicine, vol. 113 no. 6, pp. 9-10

Robinson, F, Cupples, M & Corrigan, M 2007, ‘Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: a qualitative study’, Palliative Medicine, vol. 21 no. 4, pp. 305-312.

Saks, M 2003, ‘Bringing together the orthodox and alternative in health care’, Complementary Therapies in Medicine, vol.11 no. 3, pp. 142-145.

Sambunjak, D, Straus, S & Marusic, 2010, ‘A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine’, Journal of General Internal Medicine, vol. 25 no. 1, pp. 72-78.

Tyrer, F et al. 2009, ‘Factors that influence decisions about cardiopulmonary resuscitation: the views of doctors and medical students,’ Postgraduate Medical Journal, vol. 85, pp. 564–568.

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