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Title: Clinical decision-making in action, the use of cardiopulmonary resuscitation in the accident and emergency department
Author: Brummell, Stephen Philip
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2013
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This thesis uses an ethnographic approach to examine resuscitation practices within the emergency department (ED). A wider understanding of cardiopulmonary resuscitation and the reasons for its use are required. This study builds on a small but important body of ethnographic work which locates the role of advanced technology within the broader context of death and dying. Participant observation of resuscitation attempts was undertaken in a semi-urban ED. Semistructured interviews provided a detailed description of staff roles and their perception of the event and were also undertaken in an urban ED to validate the interpretation of initial findings. Findings from this study are considered in relation to existing theories and literature and its contribution to the development of these theoretica1 perspectives is identified. Resuscitation decisions are shown to involve complex, tacit processes of categorisation, by which staff differentiate resuscitation situations. These categories are constructed by combining bodily and technical information that are indicative of dying, but given meaning by their social context. It is shown that in decision making staff employ concepts such as "downtime" and draw on their perceptions of "elderly" and "young". Resuscitation sometimes 'buys time' for emotional adjustment by the family but also enables staff to align "technical" with "bodily" dying. The process of alignment determines the point when resuscitation should be withdrawn, and provides time to facilitate dying and the construction of an acceptable death. Practices following unsuccessful resuscitation and dealing with the body are investigated. The enactment of laying-out is revealed to be appropriated by nursing staff, providing an intimate, informal "space" to unite bodily dying with social death. Body care remains relatively clandestine, and the importance of augmenting its status is considered. It is also shown how the formal clinical procedure of last-offices is an important means by which a "dead body" is constructed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available