The meaning of Being as a nurse involved in the work of death investigation. A North American view and its implications to practice in England.

Abstract

This research study explored the meaning of ¿Being¿ (i.e. Heidegger¿s four philosophical concepts of Being-in the-world, fore-structures, time and space) as a nurse involved in the work of death investigation in the USA. The objectives were to: reveal the hidden meaning of Being; transfer the findings into an English context by examining what nurses could offer beyond their current role boundaries in an area not currently practised to the extent that nurses make to other medical specialities; and finally put forward developments that would need to take place to ensure such proposals were successful in making an effective difference to health care. In the USA there are two systems of death investigation, the Coronial and Medical Examiner system. The Coroner is an elected county or state position with varied educational and professional requirements. Some Coroner positions have been filled by registered nurses as they have put themselves forward successfully for election. In contrast, the Medical Examiner is an appointed county or state position who must be a licensed physician and a qualified pathologist or forensic pathologist in most cases. Within the Medical Examiner systems death investigators may also be appointed of which some have been filled by registered nurses. It was under the interpretive paradigm that a Heideggerian hermeneutic study was undertaken. Snowball sampling was instigated to reach a hidden population and collect qualitative data by means of unstructured interviews, non-participant observations, interrogation of historical records and the keeping of a personal reflective diary. The seven phase analysis process underpinned by the hermeneutic circle was developed to enable a synopsis of the shared meaning of Being to be revealed through the presentation of paradigm cases that encompass stories and themes. Of the 22 nurses found to be working as either death investigators or Coroners in the USA who fulfilled the inclusion criteria, 17 nurses from 11 States in the USA consented to take part. Fore-structures concerning age (average 37), gender (82% were women) and professional experience (majority came from an adult nursing background with emergency department or critical care experience) are discussed. Overall participants were interviewed for a total of 78 hours in 11 States, five of which were also observed in practice for a total of 142 hours in 3 States, giving a total of 220 hours of interview and observational data. The interpretive analysis revealed the three major paradigms of: the authentic and inauthentic reality of Being (the death investigator nurse in action); the everydayness and averageness of Being (community outreach) and the publicness of Being (mass fatality care). This study reveals knowledge concerning the meaning of Being as a nurse involved in the work of death investigation in the USA. Aspects of this illuminated landscape have propositioned for the advancement of nursing clinical practice to replace and further develop the current coroner¿s officer and soon to be implemented medical examiner officer role in England and Wales. Hence recommendations are made for practice development and further research in England.