Showing papers by "Sandra Petronio published in 2011"
TL;DR: Bloggers' critical incidents that activate privacy rule changes demonstrate that impression management triggers, personal safety identity triggers, relational triggers, and legal/disciplinary triggers resulted in greater alteration of individual privacy rules used to protect these bloggers from the privileged online community of individuals granted access to an individual's blog.
82 citations
TL;DR: Examination of disclosure predicaments nurses experience in critical care and emergency units at a large urban hospital shows that nurses regulate patient privacy in the role of stakeholder confidants, and there are several specific strategies that nurses use to manage disclosure predicament they encounter.
Abstract: At times, nurses receive patient disclosures that have the potential to create challenges resulting in needs for strategies to manage patient information and expectations. This study examines disclosure predicaments nurses experience in critical care and emergency units at a large urban hospital. Utilizing the constant comparative method to identify disclosure themes guided by the principles of communication privacy management (CPM), the findings show that nurses regulate patient privacy in the role of stakeholder confidants. Second, disclosure predicaments occur in three different contexts: during the course of nurses' professional routine; when the nurses created safe terminals or havens for patients to talk; and when family matters became an inseparable part of caring for the patient. Third, the results indicate that there are several specific strategies that nurses use to manage disclosure predicaments they encounter. The lens of CPM is used to interpret these findings and offers a context in which to better understand the needs of nurses concerning patient disclosive behavior and privacy issues for nurses.
51 citations
TL;DR: To examine the frequency of surrogate decisions for in‐hospital do‐not‐resuscitate (DNR) orders and the timing of DNR order entry for surrogate decisions, a large number of patients with DNR problems are receiving surrogate decisions.
Abstract: OBJECTIVES: To examine the frequency of surrogate decisions for in-hospital do-not-resuscitate (DNR) orders and the timing of DNR order entry for surrogate decisions.
DESIGN: Retrospective cohort study.
SETTING: Large, urban, public hospital.
PARTICIPANTS: Hospitalized adults aged 65 and older over a 3-year period (1/1/2004�12/31/2006) with a DNR order during their hospital stay.
MEASUREMENTS: Electronic chart review provided data on frequency of surrogate decisions, patient demographic and clinical characteristics, and timing of DNR orders.
RESULTS: Of 668 patients, the ordering physician indicated that the DNR decision was made with the patient in 191 cases (28.9%), the surrogate in 389 (58.2%), and both in 88 (13.2%). Patients who required a surrogate were more likely to be in the intensive care unit (62.2% vs 39.8%, P<.001) but did not differ according to demographic characteristics. By hospital Day 3, 77.6% of patient decisions, 61.9% of surrogate decisions, and 58.0% of shared decisions had been made. In multivariable models, the number of days from admission to DNR order was higher for surrogate (odds ratio (OR)=1.97, P<.001) and shared decisions (OR=1.48, P=.009) than for patient decisions. The adjusted hazard ratio for hospital death was higher for patients with surrogate than patient decisions (2.61, 95% confidence interval (CI)=1.56�4.36). Patients whose DNR orders were written on Day 6 or later were twice as likely to die in the hospital (OR=2.20, 95% CI=1.45�3.36) than patients with earlier DNR orders.
CONCLUSION: For patients who have a DNR order entered during their hospital stay, order entry occurs later when a surrogate is involved. Surrogate decision-making may take longer because of the greater ethical, emotional, or communication complexity of making decisions with surrogates than with patients.
41 citations