The Enframing of Value Realization within the Quantitative Research

The important bit regarding the palliative states impact/effect is that the patients change in condition should elicit a specific change in the ethical foundation/motivation within the doctors - see chapter 3 for palliative care ethics. In the practice traced by the research papers this is not the case, the doctors facing the palliative patients, mediated by a new technology like TCT, the situation is most often resolved in favor of the doctors position of power and the need for empirical, quantifiable data generated in the process/experimental setups. The issues faced by the setup of quantitative typed interventions are that in order to function, the research setup pre-defines variables way in advance of the actual practical conduct of the research. That is the core of empirical research, the postulation of assumptions and parameters to be verified or falsified by empirical activity, and also a reason why empirical, quantitative research fits so well into the paradigm of acceptable data of the medical doctors - their knowledge generation works in exactly the same way, think medical double blind, RCT trials for a new kind of drug. This leads to the embedding of these presumed stakeholder conceptions and values in accordance with the researchers attitude towards them, as well as with assumed role conceptions that in terms of practical research outcomes provide inflexible.

The TCT should have an impact in terms of triggering a re-negotiation about which values and ethical conceptions are relevant and important between the stakeholders while also redistributing interpretative, issue-setting authority between the stakeholders, most significantly with the doctors experiencing yet another deterioration of their paternalistic vestiges – the one outlined above in my research questions/assumptions. Also since we investigate the introduction of a high-tech,

networking device into a very low-tech field of action between people the assumption was made that we would find a renewed iteration or fragment of the eternal freedom vs. security narration. Oddly enough in all the research conducted for this thesis and all the papers examined for this thesis, there is a peculiar absence of a proper ethical conflict between at least medical ethics and palliative care ethics as their respective stakeholders interact and develop the field – running counter to the previous sections explication of my research assumptions & questions regarding value formation and realization.

The derivative state of the technology itself might have some influence on the conflict situation - that is absence thereof: all the devices are adaptations of outside the field, consumer electronic goods, way after their market saturation/hype phases: ergo the stakeholders in their roles as doctors, nurses and patients are not independent actors suspended from thin air. They are part of society and are exposed to large scale developments in communicative tools as they take place, and how these devices reshape communicative behaviors - what is deemed an acceptable ethical set in dealing with this technology is derived from this macro-scale societal evolution.

This lack of a conflict has an impact on nursing disciplines as their role in the total care and team approaches is not what it could be – at least concerning the quantitative discourse analyzed here. A future conflict once one TCT approach has stabilized and permeated the field of palliative care seems inevitable from today's status of the field and effort of promoting TCT. Unspecified remnants of the low-tech attitude that shaped the nursing discipline, and the palliative nursing in specific, might linger in the nurses at present, coupled with realistic fears of reduced working hours and pay due to the TCT consultation eliminating "unnecessary" nursing visitation - one of the key economic and personnel allocation narratives/arguments that makes TCT so attractive for hospices/hospitals. Also the inherent distance of the TCT is something nurses with their expressed hands-on focus in practice have a hard time adapting to.

The primacy of the medical ethics narrative and its stabilization due to champion/gatekeeper status attached to the doctor means that the to be expected conflict simply is not realized, and only technology driven mediation is conducted within the primary care engagement between doctor and patient. With the added caveat that a terminal diagnosis tends to shift/suspend "minor" issues aside in the patients perception, leaving the background of technology utilization in terms of ethical appropriation to the professionals only. In that regard the nursing discipline is at a disadvantage despite the flattened hierarchies and team approaches. In absence of a stabilized TCT narrative as a tipping point, there is just a diffuse, unresolved issue subsumed under practicalities. Once QoL of the patient re-enters the discourse in light of failed attempts at quantitative attempts with small sample sizes, the nursing disciplines ethics and procedures might emerge strengthened.

4.8. An Academic Meta-Analysis of the Research Efforts into TCT in the Palliative Care