Browsing by Author "Ferguson, Angela L."

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    Temporizing Uncertainty: A Constructivist Grounded Theory of Advanced Practice Palliative Care Nurses' Prognostication in Non-Malignant Illnesses
    (2019-07-09) Ferguson, Angela L.; Raffin Bouchal, D. Shelley; Simon, Jessica; Sinclair, Shane; Venturato, Lorraine; Duggleby, Wendy
    Palliative care nursing practices combine the science and art of nursing in unique ways. Prognostication is a valued core skill that requires knowledge, intuition, curiosity, conceptualization, and decision-making. The praxis of prognostication is complicated and foundational to the culture and work of advanced practice PCN. This researcher, a member of the group of study provides a unique glimpse into this culture of PCN. The study sought to understand and discover a theory about the experiences of prognostication of individuals with non-malignant illnesses by eleven PCN in a palliative care program, across care sectors. Ten of the eleven nurses were advanced practice nurses in consultant roles and one in a front-line home care position. All eleven nurses held positions that included the regular work of prognostication in fulfillment of their nurse-patient role, especially related to care transitioning. The experiences of these nurses were captured through observation of a nurse-patient prognostic consult followed by participant interviews. The data consisted of one-to-one interviews with each PCN which were then transcribed verbatim. Data analysis began following transcription with line-by-line coding. Analysis was strengthened by the constant comparison method and use of field notes and memoing. The analysis sought descriptions, patterns and relationships from the PCN for shared meaning around prognostication in non-malignant illnesses. There were three main categories that were identified which formulated the theoretical model of the factors and process of prognostication by advanced practice PCN. The core category of ‘Temporizing Uncertainty’ suggests that at the centre of the experiences of the complex process and decision-making in prognostication, PCN are subjected to conflicting and challenging cognitive and affective psychological factors that influence the conative work of prognostication. These findings offer insight into PCN practices and carry implications for education and future research in palliative care. The future aim is to enhance advocacy for end-of-life transitions for patients and their families faced with chronic illnesses and in supporting clinical decision-making.