Social science & medicine
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Social science & medicine · May 2016
Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.
Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. ⋯ This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances.
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There are surprisingly few discussions of the link between wellbeing and alcohol, and few empirical studies to underpin them. Policymakers have therefore typically considered negative wellbeing impacts while ignoring positive ones, used gross overestimates of positive impacts via a naïve 'consumer surplus' approach, or ignored wellbeing completely. We examine an alternative subjective wellbeing method for investigating alcohol and wellbeing, using fixed effects analyses of the associations between drinking and wellbeing within two different types of data. ⋯ Furthermore, drinking problems are associated with lower life satisfaction. Simple accounts of the wellbeing impacts of alcohol policies are therefore likely to be misleading. Policymakers must consider the complexity of different policy impacts on different conceptions of 'wellbeing', over different time periods, and among different types of drinkers.