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Lo, Bernard. "End-of-Life Care after Termination of SUPPORT." Hastings Center Report 25, no. 6 (November 1995): S6. http://dx.doi.org/10.2307/3527848.
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Thacker, Karen S. "Nurses' Advocacy Behaviors in End-of-Life Nursing Care." Nursing Ethics 15, no. 2 (March 2008): 174–85. http://dx.doi.org/10.1177/0969733007086015.
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Nursing professionals are in key positions to support end-of-life decisions and to advocate for patients and families across all health care settings. Advocacy has been identified as the common thread of quality end-of-life nursing care. The purpose of this comparative descriptive study was to reveal acute care nurses' perceptions of advocacy behaviors in end-of-life nursing practice. The 317 participating nurses reported frequent contact with dying patients despite modest exposure to end-of-life education. This study did not confirm an overall difference in advocacy behaviors among novice, experienced and expert nurses; however, it offered insight into the supports and barriers nurses at different skill levels experienced in their practice of advocacy.
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Sanders, Lee M., and Thomas A. Raffin. "The Ethics of Withholding and Withdrawing Critical Care." Cambridge Quarterly of Healthcare Ethics 2, no. 2 (1993): 175–84. http://dx.doi.org/10.1017/s0963180100000888.
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For the 17 centuries since Hippocrates called for “the most desperate remedies in desperate cases,” physicians have adhered steadfastly to two cooperative goals: to prolong life and to relieve suffering. ut during the past 50 years, mechanical interventions at the edge of life have thrown those aims into dramatic conflict. Cardiopulmonary resuscitation, mechanical ventilation, feeding tubes, and the intensive care unit have postponed physiologic death for many patients who are anencephalic, comatose, or in a persistent vegetative state or prefer death to a life of suffering and pain. Demands from patients' families and cries for social justice have compelled physicians, hospital personnel, and the Supreme Court to analyze concepts long reserved for university philosophers. Although decisions are made daily to withhold and withdraw life support, society is gradually agreeing upon an ethical framework that balances hopeful science with dignified death. This article outlines that ethical framework, reviews recent legal precedents, and suggests practical guidelines for their application.
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Van der Meulen, Anne Pier S., Maaike A. Hermsen, and Petri JCM Embregts. "Restraints in daily care for people with moderate intellectual disabilities." Nursing Ethics 25, no. 1 (April 4, 2016): 54–68. http://dx.doi.org/10.1177/0969733016638141.
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Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings. Research question: What do support staff consider as restraints on freedom and how do they justify these restraints? Research design: In this study, data were collected by semi-structured interviews. Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands. Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee. Findings: Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger. Discussion: In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence. Conclusion: Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.
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Campbell, Margaret L., John W. Hoyt, and Lawrence J. Nelson. "Healthcare Ethics Forum ’94: Perspectives on Withholding and Withdrawal of Life-Support." AACN Advanced Critical Care 5, no. 3 (August 1, 1994): 353–59. http://dx.doi.org/10.4037/15597768-1994-3018.
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Picozzi, Mario, Sara Roggi, and Alessandra Gasparetto. "Role of Clinical Ethics Support Services in End-of-Life Care and Organ Transplantation." Transplantation Proceedings 51, no. 9 (November 2019): 2899–901. http://dx.doi.org/10.1016/j.transproceed.2019.03.086.
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LLOYD, LIZ. "Mortality and morality: ageing and the ethics of care." Ageing and Society 24, no. 2 (March 2004): 235–56. http://dx.doi.org/10.1017/s0144686x03001648.
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This paper focuses on the circumstances of death and dying in old age. It considers the ways in which social policies and social gerontology reflect the values of independence, autonomy and citizenship, and it considers the implication of these values for older people who are dependent on others for care and support at the end-of-life. It discusses the complexity of the relationship between ageing and dying, by exploring recent research from the fields of social gerontology and the sociology of death and dying. Arguing that a long-term perspective is required to understand fully the circumstances of older people's deaths, it analyses the third age/fourth age dichotomy as a conceptual model. The task of developing knowledge about the links between ageing and dying requires consideration of moral and ethical principles. The article examines the conceptual frameworks developed by feminists who argue for an ethics of care as a central analytic referent in social policy. The feminist ethics-of-care approach provides a powerful critique of the moral framework of independence and autonomy as characterised in contemporary policies and practices. Feminist ethicists argue that the inter-relatedness of human beings and the importance of the social context have been overlooked in the preoccupation with individual rights – as reflected more generally in policies and social life. It is argued in the paper that the need for care at the end-of-life highlights these shortcomings. The feminist ethics of care has considerable potential to illuminate our understanding of dependency and care, and to generate both new approaches to policy and practice in health and social care and theoretical perspectives in gerontology.
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Fæø, Stein Erik, Frøydis Kristine Bruvik, Oscar Tranvåg, and Bettina S. Husebo. "Home-dwelling persons with dementia’s perception on care support: Qualitative study." Nursing Ethics 27, no. 4 (January 27, 2020): 991–1002. http://dx.doi.org/10.1177/0969733019893098.
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Background Over the last years, there has been a growth in care solutions aiming to support home-dwelling persons with dementia. Assistive technology and voluntarism have emerged as supplements to traditional homecare and daycare centers. However, patient participation is often lacking in decision-making processes, undermining ethical principles and basic human rights. Research objective This study explores the perceptions of persons with dementia toward assistive technology, volunteer support, homecare services, and daycare centers. Research design A hermeneutical approach was chosen for this study, using a semi-structured interview guide to allow for interviews in the form of open conversations. Participants and research context Twelve home-dwelling persons with dementia participated in the study. The participants were recruited through municipal daycare centers. Ethical considerations Interviews were facilitated within a safe environment, carefully conducted to safeguard the participants’ integrity. The Regional Committee for Medical and Health Research Ethics, Western Norway (Project number 2016/1630) approved the study. Findings The participants shared a well of reflections on experience and attitudes toward the aspects explored. They described assistive technology as possibly beneficial, but pointed to several non-beneficial side effects. Likewise, they were hesitant toward volunteer support, depending on how this might fit their individual preferences. Homecare services were perceived as a necessary means of care, its benefits ascribed to a variety of aspects. Similarly, the participants’ assessments of daycare centers relied on specific aspects, with high individual variety. Discussion and conclusion The study indicates that the margins between whether these specific care interventions were perceived as supportive or infringing may be small and details may have great effect on the persons’ everyday life. This indicates that patient participation in decision-making processes for this group is—in addition to be a judicial and ethical requirement—crucial to ensure adequate care and support.
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Weimand, Bente M., Christina Sällström, Marie-Louise Hall-Lord, and Birgitta Hedelin. "Nurses’ dilemmas concerning support of relatives in mental health care." Nursing Ethics 20, no. 3 (January 29, 2013): 285–99. http://dx.doi.org/10.1177/0969733012462053.
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Relatives of persons with severe mental illness face a straining life situation and need support. Exclusion of relatives in mental health care has long been reported. The aim of this study was to describe conceptions of nurses in mental health care about supporting relatives of persons with severe mental illness. Focus group interviews with nurses from all levels of mental health care in Norway were performed. A phenomenographic approach was used. The nurses found that their responsibility first and foremost was the patient, especially to develop an alliance with him or her. Additional premises for supporting relatives were the context framing the nursing care, aspects of the actors, and relational concerns between them. Competing or contradictory demands were found within these premises. Two paths were identified concerning the nurses’ support of relatives: seeing the relative in the shadow of the patient or as an individual person.
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Mitchell, Gemma. "A Right to Care: Putting Care Ethics at the Heart of UK Reconciliation Legislation." Industrial Law Journal 49, no. 2 (August 22, 2019): 199–230. http://dx.doi.org/10.1093/indlaw/dwz016.
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Abstract This article will examine how a right to care could be applied in the UK to better support people’s ability to balance their paid work and caring responsibilities. I will argue that this would inject the ethic of care into the body of work–life balance legislation to better value caring relationships and carers. This is important because paid work is currently prioritised in this body of legislation. I will argue that better valuing caring labour is key to achieving transformative changes in both the workplace and the division of caring labour.
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Elmore, James, David Kenneth Wright, and Maude Paradis. "Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research." Nursing Ethics 25, no. 8 (December 28, 2016): 955–72. http://dx.doi.org/10.1177/0969733016679468.
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Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
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Deng, Renli, Jianghui Zhang, Liuliu Chen, Jiarui Miao, Jiazhong Duan, Yeyin Qiu, Doris Leung, Helen Chan, and Diana TF Lee. "The effectiveness of a modified advance care planning programme." Nursing Ethics 27, no. 7 (June 26, 2020): 1569–86. http://dx.doi.org/10.1177/0969733020922893.
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Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society.
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Holmberg, Bodil, Ingrid Hellström, and Jane Österlind. "End-of-life care in a nursing home: Assistant nurses’ perspectives." Nursing Ethics 26, no. 6 (June 27, 2018): 1721–33. http://dx.doi.org/10.1177/0969733018779199.
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Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.
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Ohnsorge, Kathrin, Heike R. Gudat Keller, Guy AM Widdershoven, and Christoph Rehmann-Sutter. "‘Ambivalence’ at the end of life." Nursing Ethics 19, no. 5 (September 2012): 629–41. http://dx.doi.org/10.1177/0969733011436206.
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Health-care professionals in end-of-life care are frequently confronted with patients who seem to be ‘ambivalent’ about treatment decisions, especially if they express a wish to die. This article investigates this phenomenon by analysing two case stories based on narrative interviews with two patients and their caregivers. First, we argue that a respectful approach to patients requires acknowledging that coexistence of opposing wishes can be part of authentic, multi-layered experiences and moral understandings at the end of life. Second, caregivers need to understand when contradictory statements point to tensions in a patient’s moral experience that require support. Third, caregivers should be careful not to negatively label or even pathologize seemingly contradictory patient statements.
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Paganini, Maria Cristina, and Regina Szylit Bousso. "Nurses’ autonomy in end-of-life situations in intensive care units." Nursing Ethics 22, no. 7 (September 29, 2014): 803–14. http://dx.doi.org/10.1177/0969733014547970.
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Background: The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses’ involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. Objective: To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Research design: Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Participants and research context: Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse’s experience in exercising autonomy relating to end-of-life decision-making. Ethical considerations: Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. Findings: The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Conclusion: Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process.
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McMAHON, ROBIN L. "An ethical dilemma in a hospice setting." Palliative and Supportive Care 1, no. 1 (March 2003): 79–87. http://dx.doi.org/10.1017/s1478951503030013.
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The codes of ethics of the National Hospice and Palliative Care Organization and the National Association of Social Workers support ethical standards of client self-determination and confidentiality. Lack of societal consensus on the parameters of a terminally ill person's right to die continues to confound at times the health care field, including hospice programs. This article explores an actual case where a hospice social worker faced an ethical dilemma related to the sanctity of life versus patient autonomy. While a more seasoned social worker might have chosen a different alternative to the dilemma, this case illustrates the importance of creating an interdisciplinary rather than multidisciplinary hospice team and the need for ongoing dialogue on how to support patient choice.
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Chang, Yuanmay, Chin-Feng Huang, and Chia-Chin Lin. "Do-not-resuscitate orders for critically ill patients in intensive care." Nursing Ethics 17, no. 4 (July 2010): 445–55. http://dx.doi.org/10.1177/0969733010364893.
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End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients’ preferences about DNR are elicited and honored.
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Chan, Hui Yun. "The Underappreciated Role of Advance Directives: How the Pandemic Revitalises Advance Care Planning Actions." European Journal of Health Law 27, no. 5 (October 8, 2020): 451–75. http://dx.doi.org/10.1163/15718093-bja10029.
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Abstract Covid-19 continues to alter our way of living and dying. Much attention has focused on how to resolve pressing issues surrounding resource allocation and competing public health ethics. While these are important discussions, the legal and ethical dilemmas of treatment decisions remain highly critical. The urgency to ensure that life and death affairs are in order is magnified due to the possibility of becoming infected with Covid-19. However, many people continue to face challenges in organising their future medical care and treatment. This article explores how the pandemic affects advance care planning through the lenses of law and ethics. The range of Covid-19 implications on advance care planning demonstrates a paradigm shift from a primarily elective function to an essential role in healthcare delivery. This renewed appreciation to advance care planning offers the opportunity to support and sustain the important role that it could play during ordinary and extraordinary times.
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Suryadi, Taufik, and Kulsum. "Identification of Ethical and Medicolegal Problems in the Care of Patients in the Intensive Care Unit." Britain International of Exact Sciences (BIoEx) Journal 2, no. 2 (May 11, 2020): 547–55. http://dx.doi.org/10.33258/bioex.v2i2.231.
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Intensive care is an important part of a hospital that serves patients with critical illness conditions and requires continuous medical supervision and support. The complexity of the problems related to intensive care results in ethical and medicolegal problems. Some of the ethical and medicolegal problems identified can be in the form of priority problems for patients entering and leaving the intensive care room, facility limitations, treatment is useless, terminal state, directive advances, do not resuscitate, brain stem death, euthanasia, and micro-ethical problems that arise directly during patient care which can cause a bad experience for patients and reduce the quality of service. Problem solving can be done by applying clinical ethics, basic principles of bioethics and medicolegal as well as effective communication. Doctors who work in intensive care installations must have the ability to determine patient priorities, be able to communicate well with patients and / or their families, and be able to provide end-of-life care based on basic principles of bioethics. This capability will lead to good and complete medical services.
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Rejnö, Åsa, Gunilla Silfverberg, and Britt-Marie Ternestedt. "Reasoning about truth-telling in end-of-life care of patients with acute stroke." Nursing Ethics 24, no. 1 (September 23, 2016): 100–110. http://dx.doi.org/10.1177/0969733016664974.
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Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.
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Merizzi, Alessandra. "Virtual Dementia Tour®: limitations and ethics." Quality in Ageing and Older Adults 19, no. 2 (June 11, 2018): 146–55. http://dx.doi.org/10.1108/qaoa-11-2017-0042.
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Purpose Dementia care is an important aspect affecting the quality of life of people living with dementia. There are many studies that test the efficacy of methods of care in order to support and even increase the quality of life of dementia patients (e.g. Gridley et al., 2016; Thyrian et al., 2017). A novel approach developed by Beville (2002) called Virtual Dementia Tour® (VDT®) also aims to improve the care of people living with dementia in their middle and late stages of deterioration. VDT® is now becoming popular internationally (see www.provdt.co.uk/) and it is sold to the general public as an evidence-based method through which people can experience what it is like to live with dementia, aiming to increase empathy and improve the delivery of care. The purpose of this paper is to explore the validity of the VDT® intervention. Design/methodology/approach The author explores the original research article upon which the VDT® was developed, highlighting critical points and reviewing these through a rigorous selection of references. Findings The supporting evidence base is consistently weak on closer scrutiny, and in combination with anecdotal evidence of distress related to the VDT® experience, this analysis suggests a need for caution in implementation. Originality/value Although high-quality standards of care from the national guidelines (National Institute for Health and Clinical Excellence, 2010) ensure that health services implement evidence-based interventions, it may be important to discern that which is empirically based from that which is not.
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Abdel Razeq, Nadin M. "Physicians’ standpoints on end-of-life decisions at the neonatal intensive care units in Jordan." Journal of Child Health Care 23, no. 4 (January 3, 2019): 579–95. http://dx.doi.org/10.1177/1367493518814926.
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The purpose of this cross-sectional descriptive study is to explore pediatricians’ and neonatologists’ attitudes and standpoints on end-of-life (EOL) decision-making in neonates. Seventy-five physicians, employed fulltime to care for newborns in 23 hospitals in Jordan, completed internationally accepted questionnaires. Most physicians (75%) were supportive of using life-sustaining interventions, irrespective of the severity of the newborns’ prognosis and the potential burden of the neonates’ disabilities on their families. The general attitude of the physicians (59–88%) was against making decisions that limit life support at EOL; even those infants with what are, in fact, untreatable and disabling medical conditions (56–88%). Most physicians (77%) indicated that ethics committees should be involved in EOL decision-making based on requests from parents, physicians, or both. The results of this study indicate strong pro-life attitudes among the physicians whose role is to take care of infants in Jordan. The results also emphasize the need for (1) the creation of clear EOL–focused regulations and guidelines, (2) the establishment of special ethical committees to inform and assist healthcare providers’ efforts during EOL care, and (3) raised awareness and competencies regarding EOL and ethical decision-making among physicians taking care of newborns in Jordan’s intensive care units.
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Zimmermann, Tanja. "End-of-Life: Patientinnen und Patienten rechtzeitig einbinden." Kompass Dermatologie 9, no. 3 (2021): 134–35. http://dx.doi.org/10.1159/000517944.
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<b>Background:</b> Decisions to limit treatment (DLTs) are important to protect patients from overtreatment but constitute one of the most ethically challenging situations in oncology practice. In the Ethics Policy for Advance Care Planning and Limiting Treatment study (EPAL), we examined how often DLT preceded a patient’s death and how early they were determined before (T1) and after (T2) the implementation of an intrainstitutional ethics policy on DLT. <b>Methods:</b> This prospective quantitative study recruited 1.134 patients with haematological/oncological neoplasia in a period of 2×6 months at the University Hospital of Munich, Germany. Information on admissions, discharges, diagnosis, age, DLT, date and place of death, and time span between the initial determination of a DLT and the death of a patient was recorded using a standardised form. <b>Results</b>: Overall, for 21% (n = 236) of the 1.134 patients, a DLT was made. After implementation of the policy, the proportion decreased (26% T1/16% T2). However, the decisions were more comprehensive, including more often the combination of ‘Do not resuscitate’ and ‘no intense care unit’ (44% T1/64% T2). The median time between the determination of a DLT and the patient’s death was similarly short with 6 days at a regular ward (each T1/T2) and 10.5/9 (T1/T2) days at a palliative care unit. For patients with solid tumours, the DLTs were made earlier at both regular and palliative care units than for the deceased with haematological neoplasia. <b>Conclusion:</b> Our results show that an ethics policy on DLT could sensitise for treatment limitations in terms of frequency and extension but had no significant impact on timing of DLT. Since patients with haematological malignancies tend to undergo intensive therapy more often during their last days than patients with solid tumours, special attention needs to be paid to this group. To support timely discussions, we recommend the concept of advance care planning.
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Zimmermann, Tanja. "End-of-Life: Patientinnen und Patienten rechtzeitig einbinden." Kompass Onkologie 8, no. 2 (2021): 84–85. http://dx.doi.org/10.1159/000516879.
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<b>Background:</b> Decisions to limit treatment (DLTs) are important to protect patients from overtreatment but constitute one of the most ethically challenging situations in oncology practice. In the Ethics Policy for Advance Care Planning and Limiting Treatment study (EPAL), we examined how often DLT preceded a patient’s death and how early they were determined before (T1) and after (T2) the implementation of an intrainstitutional ethics policy on DLT. <b>Methods:</b> This prospective quantitative study recruited 1.134 patients with haematological/oncological neoplasia in a period of 2×6 months at the University Hospital of Munich, Germany. Information on admissions, discharges, diagnosis, age, DLT, date and place of death, and time span between the initial determination of a DLT and the death of a patient was recorded using a standardised form. <b>Results:</b> Overall, for 21% (n = 236) of the 1.134 patients, a DLT was made. After implementation of the policy, the proportion decreased (26% T1/16% T2). However, the decisions were more comprehensive, including more often the combination of ‘Do not resuscitate’ and ‘no intense care unit’ (44% T1/64% T2). The median time between the determination of a DLT and the patient’s death was similarly short with 6 days at a regular ward (each T1/T2) and 10.5/9 (T1/T2) days at a palliative care unit. For patients with solid tumours, the DLTs were made earlier at both regular and palliative care units than for the deceased with haematological neoplasia. <b>Conclusion:</b> Our results show that an ethics policy on DLT could sensitise for treatment limitations in terms of frequency and extension but had no significant impact on timing of DLT. Since patients with haematological malignancies tend to undergo intensive therapy more often during their last days than patients with solid tumours, special attention needs to be paid to this group. To support timely discussions, we recommend the concept of advance care planning.
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Gedge, E., M. Giacomini, and D. Cook. "Withholding and withdrawing life support in critical care settings: ethical issues concerning consent." Journal of Medical Ethics 33, no. 4 (April 1, 2007): 215–18. http://dx.doi.org/10.1136/jme.2006.017038.
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Jordan, Portia, I. Clifford, and M. Williams. "THE EXPERIENCES OF CRITICAL CARE NURSES WITH REGARD TO END-OF-LIFE ISSUES IN THE INTENSIVE CARE UNIT." Africa Journal of Nursing and Midwifery 16, no. 2 (January 21, 2015): 71–84. http://dx.doi.org/10.25159/2520-5293/35.
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Nurses in the intensive care unit might be faced with emotional conflict, stress and anxiety when dealing with end-of-life issues and thus need to be supported. In understanding the experiences of nurses, enhanced support can be given in order to assist nurses to deal better with end-of life issues in the intensive care unit. The purpose of the study was to explore and describe the experiences of nurses’ with regard to end-of-life issues in the intensive care unit. A qualitative, explorative, descriptive and contextual research design using a semi-structured interview approach was used. The target population for the study comprise twenty registered nurses in the intensive care unit. Of the twenty nurses, only nine were willing to participate in the study. Purposive sampling method was used to interview nine nurses in a private intensive care unit. Data collected was thematically analysed, using Tesch’s method. Four major themes were identified, namely: (1) conflicting emotions; (2) family relations; (3) multi-disciplinary team relations; and (4) supportive strategies when dealing with end-of-life issues. The study concluded that nurses experienced different emotions, conflict and stress when dealing with end-of-life issues in the intensive care unit. A need for supportive relations with family members, the multi-disciplinary team and support from management were reported. Immediate debriefing, enhancing communication amongst multi-disciplinary team members, having a permanent counsellor or pastoral counselling, an ethics committee and training programmes in place to address end-of-life issues are a few of the support strategies that can assist critical care nurses in dealing with end-of-life issues in the intensive care unit.
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Zuzelo, Patti Rager. "Exploring the Moral Distress of Registered Nurses." Nursing Ethics 14, no. 3 (May 2007): 344–59. http://dx.doi.org/10.1177/0969733007075870.
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Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as `unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations.
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Burke, Greg F. "Lessons Learned in Palliative Care." Ethics & Medics 43, no. 10 (2018): 1–4. http://dx.doi.org/10.5840/em2018431016.
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The Catholic Church has a long history of providing health care, particularly for the dying as an extension of Christ’s command of charity to one’s neighbor. The Western medical tradition has in most ways adopted this approach. However, such an approach is clearly under assault in an increasing secular medical world view dominated by utilitarian ethics and an idea of autonomy that recognizes no moral boundaries. The support for physician-assisted suicide and euthanasia, as well as threats at the beginning of life, can be understood as a logical conclusion to this expansive view, which puts man at the center of all existence. The Christian health profession must answer this movement with reason animated by love.
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Gustafsson, Gabriella, Sture Eriksson, Gunilla Strandberg, and Astrid Norberg. "Burnout and perceptions of conscience among health care personnel: A pilot study." Nursing Ethics 17, no. 1 (January 2010): 23–38. http://dx.doi.org/10.1177/0969733009351950.
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Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group.
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Rasoal, Dara, Annica Kihlgren, Inger James, and Mia Svantesson. "What healthcare teams find ethically difficult." Nursing Ethics 23, no. 8 (August 3, 2016): 825–37. http://dx.doi.org/10.1177/0969733015583928.
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Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss. Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation. Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis. Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation. Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient’s/next-of-kin’s emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient’s autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have. Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders. Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.
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Stutts, Amy, and Johanna Schloemann. "Life-Sustaining Support: Ethical, Cultural, and Spiritual Conflicts Part I: Family Support— A Neonatal Case Study." Neonatal Network 21, no. 3 (April 2002): 23–29. http://dx.doi.org/10.1891/0730-0832.21.3.23.
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As medical knowledge and technology continue to increase, so will types of life-sustaining support as well as the public’s expectations for use of this support with positive outcomes. Health care professionals will continue to be challenged by the issues surrounding the appropriate use of life-sustaining support and the issues it raises. This is especially apparent in the NICU. When parents’ belief systems challenge the health care team’s ethical commitment to beneficence and nonmaleficence, a shared decision-making model based on mutual understanding of and respect for different viewpoints can redirect the focus onto the baby’s best interest. This article addresses three questions:1. How do nonmaleficence, beneficence, and concern about quality of life guide the use of life-sustaining support?2. To what extent should parental autonomy and spirituality influence treatment decisions?3. What efforts can the health care team make to support the family?
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Lind, Ranveig, Per Nortvedt, Geir Lorem, and Olav Hevrøy. "Family involvement in the end-of-life decisions of competent intensive care patients." Nursing Ethics 20, no. 1 (August 22, 2012): 61–71. http://dx.doi.org/10.1177/0969733012448969.
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In this article, we report the findings from a qualitative study that explored how relatives of terminally ill, alert and competent intensive care patients perceived their involvement in the end-of-life decision-making process. Eleven family members of six deceased patients were interviewed. Our findings reveal that relatives narrate about a strong intertwinement with the patient. They experienced the patients’ personal individuality as a fragile achievement. Therefore, they viewed their presence as crucial with their primary role to support and protect the patient, thereby safeguarding his values and interests. However, their inclusion in decision making varied from active participation in the decision-making process to acceptance of the physicians’ decision or just receiving information. We conclude that models of informed shared decision making should be utilised and optimised in intensive care, where nurses and physicians work with both the patient and his or her family and regard the family as partners in the process.
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Thompson, Lester James, and David Alastair Wadley. "Countering globalisation and managerialism: Relationist ethics in social work." International Social Work 61, no. 5 (July 21, 2016): 706–23. http://dx.doi.org/10.1177/0020872816655867.
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Social work developed from Christian caring and a eudaimonic desire for a worthwhile life. Although ethics continue to underpin the discipline, contemporary complexities of post-modernism, globalism and managerialism are destabilising the universalist moral intentions of practice and subsequently demotivating eudaimonic drives. Cultural and context-specific relativist influences are promoting an ethics of ‘fitting in’ which, without critical analysis, betrays client best interests by favouring formulaic absolutes. Alternative, relationist theory can support a critically reflective and care-ethics-driven practice that is motivating, clearer and focused on ontological consideration of dynamic client, practitioner and environmental needs. It can thus help social workers to situate themselves and achieve personal and professional transformation.
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Brownie, Sonya, and Louise Horstmanshof. "Creating the conditions for self-fulfilment for aged care residents." Nursing Ethics 19, no. 6 (February 20, 2012): 777–86. http://dx.doi.org/10.1177/0969733011423292.
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In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents.
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GOODMAN, KENNETH W. "Health Information Technology as a Universal Donor to Bioethics Education." Cambridge Quarterly of Healthcare Ethics 26, no. 2 (March 31, 2017): 342–47. http://dx.doi.org/10.1017/s0963180116000943.
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Abstract:Health information technology, sometimes called biomedical informatics, is the use of computers and networks in the health professions. This technology has become widespread, from electronic health records to decision support tools to patient access through personal health records. These computational and information-based tools have engendered their own ethics literature and now present an opportunity to shape the standard medical and nursing ethics curricula. It is suggested that each of four core components in the professional education of clinicians—privacy, end-of-life care, access to healthcare and valid consent, and clinician–patient communication—offers an opportunity to leverage health information technology for curricular improvement. Using informatics in ethics education freshens ethics pedagogy and increases its utility, and does so without additional demands on overburdened curricula.
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Cotogni, Paolo, Silvia Stragliotto, Marta Ossola, Alessandro Collo, and Sergio Riso. "The Role of Nutritional Support for Cancer Patients in Palliative Care." Nutrients 13, no. 2 (January 22, 2021): 306. http://dx.doi.org/10.3390/nu13020306.
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The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.
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Ludlow, Kristiana, Johanna Westbrook, Mikaela Jorgensen, Kimberly E. Lind, Melissa T. Baysari, Leonard C. Gray, Richard O. Day, et al. "Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol." BMJ Open 11, no. 8 (August 2021): e048657. http://dx.doi.org/10.1136/bmjopen-2021-048657.
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IntroductionThere is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an ‘at-a-glance’ overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.MethodsThis mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.Ethics and disseminationThis study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University’s Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.
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Sampson, Elizabeth L., Alexandra Feast, Alan Blighe, Katherine Froggatt, Rachael Hunter, Louise Marston, Brendan McCormack, et al. "Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): protocol for a pilot cluster randomised trial." BMJ Open 9, no. 5 (May 2019): e026510. http://dx.doi.org/10.1136/bmjopen-2018-026510.
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IntroductionAcute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care.Methods and analysisCluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates).Ethics and disseminationApproved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter).Trial registration numberISRCTN74109734; Pre-results.
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Catlin, Anita, and Brian Carter. "Creation of a Neonatal End-of-Life Palliative Care Protocol." Neonatal Network 21, no. 4 (June 2002): 37–49. http://dx.doi.org/10.1891/0730-0832.21.4.37.
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Objective: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support.Study design: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period.Results/Conclusion: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of lifeextending interventions; family follow-up care; and necessary ongoing staff support.
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Stutts, Amy, and Johanna Schloemann. "Life-Sustaining Support: Ethical, Cultural, and Spiritual Conflicts Part II: Staff Support– A Neonatal Case Study." Neonatal Network 21, no. 4 (June 2002): 27–34. http://dx.doi.org/10.1891/0730-0832.21.4.27.
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As medical knowledge and technology continue to increase, so will the ability to provide life-sustaining support to patients who otherwise would not survive. Along with these advances comes the responsibility of not only meeting the clinical needs of our patients, but also of understanding how the family’s culture and spirituality will affect their perception of the situation and their decision-making process. As the U.S. continues to become a more culturally diverse society, health care professionals will need to make changes in their practice to meet the psychosocial needs of their patients and respect their treatment decisions. Part I of this series (April 2002) discussed how the cultural and spiritual belief systems of Baby S’s family affected their decisionmaking processes and also their ability to cope with the impending death of their infant. The development of a culturally competent health care team can help bridge the gap between culturally diverse individuals.This article addresses the following questions:1. What legal alternatives are available to the staff to protect the patient from suffering associated with the continuation of futile life-sustaining support?2. What conflicts might the staff experience as a result of the continuation of futile life-sustaining support?3. What efforts can be made to support members of the staff?4. What can be done to prepare others in the health care professions to deal more effectively with ethical/cultural issues?
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Reed, Frances M., Les Fitzgerald, and Melanie R. Bish. "District nurse advocacy for choice to live and die at home in rural Australia." Nursing Ethics 22, no. 4 (June 29, 2014): 479–92. http://dx.doi.org/10.1177/0969733014538889.
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Background: Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. Objectives: The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. Method: Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. Results: 34 international studies revealed themes of ‘the nursing relationship’, ‘environment’, ‘communication’, ‘support’ and ‘the holistic client centred district nursing role. Discussion: Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. Conclusion: It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.
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Pecanac, Kristen E., and Margaret L. Schwarze. "Conflict in the intensive care unit: Nursing advocacy and surgical agency." Nursing Ethics 25, no. 1 (March 31, 2016): 69–79. http://dx.doi.org/10.1177/0969733016638144.
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Background: Nurses and surgeons may experience intra-team conflict during decision making about the use of postoperative life-sustaining treatment in the intensive care unit due to their perceptions of professional roles and responsibilities. Nurses have a sense of advocacy—a responsibility to support the patient’s best interest; surgeons have a sense of agency—a responsibility to keep the patient alive. Objectives: The objectives were to (1) describe the discourse surrounding the responsibilities of nurses and surgeons, as “advocates” and “agents,” and (2) apply these findings to determine how differences in role responsibilities could foster conflict during decision making about postoperative life-sustaining treatment in the intensive care unit. Research design: Articles, books, and professional documents were explored to obtain descriptions of nurses’ and surgeons’ responsibilities to their patients. Using discourse analysis, responsibilities were grouped into themes and then compared for potential for conflict. Ethical considerations: No data were collected from human participants and ethical review was not required. The texts were analyzed by a surgeon and a nurse to minimize profession-centric biases. Findings: Four themes in nursing discourse were identified: responsibility to support patient autonomy regarding treatment decisions, responsibility to protect the patient from the physician, responsibility to act as an intermediary between the physician and the patient, and the responsibility to support the well-being of the patient. Three themes in surgery discourse were identified personal responsibility for the patient’s outcome, commitment to patient survival, and the responsibility to prevent harm to the patient from surgery. Discussion: These responsibilities may contribute to conflict because each profession is working toward different goals and each believes they know what is best for the patient. It is not clear from the existing literature that either profession understands each other’s responsibilities. Conclusion: Interventions that improve understanding of each profession’s responsibilities may be helpful to reduce intra-team conflict in the intensive care unit.
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Shields, Linda, Roger Watson, Philip Darbyshire, Hugh McKenna, Ged Williams, Catherine Hungerford, David Stanley, et al. "Nurse participation in legal executions: An ethics round-table discussion." Nursing Ethics 25, no. 7 (December 16, 2016): 841–54. http://dx.doi.org/10.1177/0969733016677870.
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A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of opinions were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion.
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Bolcato, Matteo, Marianna Russo, Alessandro Feola, Bruno Della Pietra, Camilla Tettamanti, Alessandro Bonsignore, Rosagemma Ciliberti, Daniele Rodriguez, and Anna Aprile. "The Motion of the Italian National Bioethics Committee on Aggressive Treatment towards Children with Limited Life Expectancy." Healthcare 8, no. 4 (November 1, 2020): 448. http://dx.doi.org/10.3390/healthcare8040448.
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The motion of the Italian National Bioethics Committee entitled “Aggressive treatment or therapeutic obstinacy on young children with limited life expectancy” comprises a premise that rejects therapeutic obstinacy and makes 12 recommendations. Recommendation no. 1 states the general rules: it ascribes a cardinal role to a shared care plan, it supports pain management therapy and pain relief, it opposes ineffective and disproportionate clinical treatment and defensive medicine. The other recommendations are correlated to the enacting of a national law establishing clinical ethics committees in paediatric hospitals; participation of parents and their fiduciaries in the decision-making processes; recourse to courts only as extrema ratio in the event of irremediable disagreement between the medical team and the family members; accompaniment at the end of life also through continuous deep sedation combined with pain therapy; access to palliative care; the need to reinforce research on pain and suffering in children; clinical trials and research studies conducted in children; the training of doctors, healthcare personnel and psychologists, to support parents in emotional and practical terms; the facilitation of the closeness of parents to children in extremely precarious clinical conditions; the relevant role of the associations of parents of sick children. Comments are made, in particular, about the innovative recommendations respectively relating to the adoption of care planning, the establishment, by law, of clinical ethics committees in paediatric hospitals and the limitation of recourse to courts—only as extrema ratio—in the event of irremediable disagreement between the medical team and the family members.
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Vinay, Rasita, Holger Baumann, and Nikola Biller-Andorno. "Ethics of ICU triage during COVID-19." British Medical Bulletin 138, no. 1 (May 31, 2021): 5–15. http://dx.doi.org/10.1093/bmb/ldab009.
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Abstract Introduction The coronavirus disease 2019 pandemic has placed intensive care units (ICU) triage at the center of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria—e.g. medical prognosis, age, life-expectancy or quality of life—are ethically acceptable. The paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. Sources of data Published articles, news articles, book chapters, ICU triage guidelines set out by professional societies and health authorities. Areas of agreement Points of agreement in the guidelines that are widely supported by ethical arguments are (i) to avoid using a first come, first served policy or quality-adjusted life-years and (ii) to rely on medical prognosis, maximizing lives saved, justice as fairness and non-discrimination. Areas of controversy Points of disagreement in existing guidelines and the ethics literature more broadly regard the use of exclusion criteria, the role of life expectancy, the prioritization of healthcare workers and the reassessment of triage decisions. Growing points Improve outcome predictions, possibly aided by Artificial intelligence (AI); develop participatory approaches to drafting, assessing and revising triaging protocols; learn from experiences with implementation of guidelines with a view to continuously improve decision-making. Areas timely for developing research Examine the universality vs. context-dependence of triaging principles and criteria; empirically test the appropriateness of triaging guidelines, including impact on vulnerable groups and risk of discrimination; study the potential and challenges of AI for outcome and preference prediction and decision-support.
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Sahlberg-Blom, Eva, Britt-Marie Ternestedt, and Jan-Erik Johansson. "Patient Participation in Decision Making at the End of Life as Seen by a Close Relative." Nursing Ethics 7, no. 4 (July 2000): 296–313. http://dx.doi.org/10.1177/096973300000700404.
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The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process.
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Mouradian, Wendy E. "Deficits versus Strengths: Ethics and Implications for Clinical Practice and Research." Cleft Palate-Craniofacial Journal 38, no. 3 (May 2001): 255–59. http://dx.doi.org/10.1597/1545-1569_2001_038_0255_dvseai_2.0.co_2.
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A shift in emphasis from deficits to strengths to promote health and well-being in patients with congenital and acquired craniofacial conditions (CFC) is appropriate given the chronic, “incurable” nature of CFC. Personal narratives are a valuable starting point for discovering sources of resilience. This paper explores such a shift by considering two areas of ethical concern suggested by patient narratives: informed consent and the physician-patient relationship. Both areas contain pitfalls and opportunities. The powerful emotions these patients bring with them argue for caution in medical decision making. Attention to the individual's psychosocial adjustment should always supplement surgical evaluations. Because of the inequality of the physician-patient relationship, care should be taken to use this power in positive ways. The relationship between patient and surgeon is particularly charged and may be an important source of support, information, hope, and advice for patients. The changing health care system threatens the physician-patient relationship, but the rise of alternative medicine suggests patients continue to value relationships. Relationships are critical for individuals with CFC, who experience social rejection because of the fundamental importance of face in human interactions. Future research directions should include long-term outcome studies on patients receiving modern craniofacial team care, qualitative research on resilience in patients with positive life adjustment, and development of a conceptual framework and research methodology for understanding quality of life of individuals with CFC. An emphasis upon strengths rather than defects will have implications for the structure of craniofacial teams, the care that is provided, and allocation of resources.
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Grüber, Katrin, and Elena Loevskaya. "Supporting Ethical Decision Making – A Tool for Ethical Reflection on Care Technologies." Studia Universitatis Babeş-Bolyai Bioethica 66, Special Issue (September 9, 2021): 84–85. http://dx.doi.org/10.24193/subbbioethica.2021.spiss.51.
Full textAbstract:
"The tool FreTiP (Fragen zur ethischen Reflexion von digitalen Technologien in der Pflegepraxis – questions on ethical reflection of digital technologies in nursing practice) was developed in 2020 by the Institute Mensch, Ethik und Wissenschaft (IMEW) as part of ELSI research in the PPZ-Berlin project. Our aim was to develop an instrument that stimulates and supports ethical reflection processes in the application of digital care innovation technologies in practice. Ethical considerations are part of everyday (nursing) life, are closely interwoven with other aspects and are therefore difficult to recognise as such. The starting thesis of our work was that actors in care act on the basis of value concepts that they are more or less aware of. An ethics that is consciously integrated into everyday care takes into account all aspects that are relevant for an action or decision. In this respect, it is important to look at ethics in context and not to understand “ethics” as something isolated, coming from outside. Based on this, the development of the instrument should not consist of “breaking down” ethical concepts and theories to practice, but of ethically locating, structuring and making applicable the experiences, questions and needs of the actors working in nursing practice. Thus, FreTiP is not only to be considered practice-oriented, but also to a certain extent practice-based. The instrument was designed to be suitable for everyday care in clinics, care facilities and in the home context. FreTiP was developed as a low-threshold instrument that can be used flexibly and that takes into account the perspective of patients as well as carers. The development of the instrument was preceded by a triangulated study that included a literature review, interviews and (non-)participatory observations. In the paper, experiences with the ethical reflection tool FreTiP will be presented. "
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Mannelli, Chiara. "Whose life to save? Scarce resources allocation in the COVID-19 outbreak." Journal of Medical Ethics 46, no. 6 (April 9, 2020): 364–66. http://dx.doi.org/10.1136/medethics-2020-106227.
Full textAbstract:
After initially emerging in China, the coronavirus (COVID-19) outbreak has advanced rapidly. The World Health Organization (WHO) has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians.
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Crippen, Dan, and Amber E. Barnato. "The Ethical Implications of Health Spending: Death and other Expensive Conditions." Journal of Law, Medicine & Ethics 39, no. 2 (2011): 121–29. http://dx.doi.org/10.1111/j.1748-720x.2011.00582.x.
Full textAbstract:
In this essay I ask the reader to consider the “end of life” as a life stage, rather than as a health state. At one end of the life course is childhood and at the other end is elderhood. The basic inter-generational social compact in most societies is that working adults take care of their children and their parents, and count on their children to do the same for them. In developed countries, these obligations are met in part through government programs, with taxpayers funding significant portions of education, health care, and income support.