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Hanifi N, Gholami Z, Moqaddam M. Nurses' attitude toward futile treatment and its relationship with missed care at the end of life. Int J Palliat Nurs 2024; 30:486-494. [PMID: 39302911 DOI: 10.12968/ijpn.2024.30.9.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Avoiding futile treatment for patients at the end of life is among one of the care challenges of nurses in intensive care units (ICUs). AIMS This study aimed to determine the attitude of intensive care unit nurses toward futile treatment and its relationship with missed care for patients at the end of life. METHOD This cross-sectional study was conducted on 307 ICU nurses. Eleven teaching hospitals were selected from three Iranian provinces, Zanjan Province, East Azerbaijan and West Azerbaijan, in 2021. The data were collected using The Attitudes Toward Futile Treatment Scale (ATFTS) and The Missed Nursing Care Survey (MISSCARE Survey) as self-reports. RESULTS According to the obtained results, 94.8% of the nurses agreed that futile treatment should not be performed. However, 97.7% of the nurses reported that missed care occurs less for patients at the end of life. The correlation between the MISSCARE Survey's total scale and the ATFTS's total scale was positive and statistically significant (r =.11). CONCLUSION This research contributes to understanding nurses' attitudes toward futile treatment. Nurses oppose futile treatment, so obstacles to avoiding it should be eliminated. This attitude does not have a significant impact on nursing care quality or missed care for patients at the end of life, but it can lead to enduring distress for nurses. It is recommended to study the reasons for futile treatment, and its link to nurses' mental and physical health.
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Martins CS, Nunes R. Portuguese Advance Directives-a twist against futility? A cross sectional study. SAO PAULO MED J 2024; 142:e2022537. [PMID: 38536997 PMCID: PMC10962926 DOI: 10.1590/1516-3180.2022.0537.r2.201023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 05/04/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility. OBJECTIVES To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions. DESIGN AND SETTING This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool. METHODS Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments. RESULTS In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts. CONCLUSION The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase "Health Care to Receive / Not to Receive" with the sentence "Health Care to Accept / Refuse" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans. TRIAL REGISTRATION ClinicalTrials.gov ID NCT05090072. URL https://clinicaltrials.gov/ct2/show/NCT05090072.
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Affiliation(s)
- Catarina Sampaio Martins
- MD, MSc. Physician, Serviço de Medicina Paliativa do Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal; PhD student, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Nunes
- PhD. Cathedratic Professor, Departamento de Medicina da Comunidade, Informação e Decisão em Saúde Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Alexander D, Quirke M, Doyle C, Hill K, Masterson K, Brenner M. Technology solutionism in paediatric intensive care: clinicians' perspectives of bioethical considerations. BMC Med Ethics 2023; 24:55. [PMID: 37507700 PMCID: PMC10386660 DOI: 10.1186/s12910-023-00937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/24/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The use of long-term life-sustaining technology for children improves survival rates in paediatric intensive care units (PICUs), but it may also increase long-term morbidity. One example of this is children who are dependent on invasive long-term ventilation. Clinicians caring for these children navigate an increasing array of ethical complexities. This study looks at the meaning clinicians give to the bioethical considerations associated with the availability of increasingly sophisticated technology. METHODS A hermeneutic phenomenological exploration of the experiences of clinicians in deciding whether to initiate invasive long-term ventilation in children took place, via unstructured interviews. Data were analysed to gain insight into the lived experiences of clinicians. Participants were from PICUs, or closely allied to the care of children in PICUs, in four countries. RESULTS Three themes developed from the data that portray the experiences of the clinicians: forming and managing relationships with parents and other clinicians considering, or using, life sustaining technology; the responsibility for moral and professional integrity in the use of technology; and keeping up with technological developments, and the resulting ethical and moral considerations. DISCUSSION There are many benefits of the availability of long-term life-sustaining technology for a child, however, clinicians must also consider increasingly complex ethical dilemmas. Bioethical norms are adapting to aid clinicians, but challenges remain. CONCLUSION During a time of technological solutionism, more needs to be understood about the influences on the initiation of invasive long-term ventilation for a child. Further research to better understand how clinicians, and bioethics services, support care delivery may positively impact this arena of health care.
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Affiliation(s)
- Denise Alexander
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Mary Quirke
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Carmel Doyle
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Masterson
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
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4
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Micco A, Carpentieri E, Di Sorbo A, Chetta A, Del Donno M. Palliative care and end of life management in patients with idiopathic pulmonary fibrosis. Multidiscip Respir Med 2023; 18:896. [PMID: 36909932 PMCID: PMC9994447 DOI: 10.4081/mrm.2023.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic disease with an unknown etiology that causes deterioration of the structure of the lung parenchyma, resulting in a severe and progressive decline in respiratory function and early mortality. IPF is essentially an incurable disease, with a mean overall survival of 5 years in approximately 20% of patients without treatment. The combination of a poor prognosis, uncertainty about the disease's progression, and the severity of symptoms has a significant impact on the quality of life of patients and their families. New antifibrotic drugs have been shown to slow disease progression, but their impact on health-related quality of life (HRQoL) has to be proven yet. To date, studies have shown that palliative care can improve symptom management, HRQoL, and end-of-life care (EoL) in patients with IPF, reducing critical events, hospitalization, and health costs. As a result, it is essential for proper health planning and patient management to establish palliative care early and in conjunction with other therapies, beginning with the initial diagnosis of the disease.
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Affiliation(s)
| | | | | | - Alfredo Chetta
- Pneumology Clinic, Department of Medicine and Surgery, University of Parma, Italy
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5
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Alexander D, Quirke MB, Berry J, Eustace-Cook J, Leroy P, Masterson K, Healy M, Brenner M. Initiating technology dependence to sustain a child's life: a systematic review of reasons. JOURNAL OF MEDICAL ETHICS 2022; 48:1068-1075. [PMID: 34282042 PMCID: PMC9726963 DOI: 10.1136/medethics-2020-107099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Decision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the range of influences on these decisions. METHODS Medline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence. RESULTS 53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care. CONCLUSIONS There is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside 'end-of-life' care. This review provides a sound basis for empirical research into the important influences on a child's potential technology dependence.
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Affiliation(s)
- Denise Alexander
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary Brigid Quirke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jay Berry
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | | | - Piet Leroy
- Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC+, Maastricht, The Netherlands
| | - Kate Masterson
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Martina Healy
- Paediatric Intensive Care, Our Lady's Hospital Crumlin, Crumlin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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6
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Khankeh HR, Ebadi A, Norouzi Tabrizi K, Moradian ST. Home health care for mechanical ventilation-dependent patients: A grounded theory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2157-e2168. [PMID: 34791719 DOI: 10.1111/hsc.13654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 10/16/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.
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Affiliation(s)
- Hamid Raza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kian Norouzi Tabrizi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Alexander D, Eustace-Cook J, Brenner M. Approaches to the initiation of life-sustaining technology in children: A scoping review of changes over time. J Child Health Care 2021; 25:509-522. [PMID: 32966106 DOI: 10.1177/1367493520961884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is understood about the dynamic circumstances within which the initiation of technology dependence takes place in children. The aim of this scoping review was to identify the influences on the initiation of technology dependence and the issues that require further exploration and consideration. Scientific literature that directly or indirectly discussed the initiation of technology dependence in children was identified. A three-stage screening process of title and abstract scrutiny, full-text scanning and in-depth full-text reading resulted in 63 relevant articles from 1133 initially reviewed. These were then subjected to descriptive and thematic analysis. Articles ranged from the 1970s to the present, reflecting the evolution of ethical debates around the approaches to clinical practice and changes in cultural and societal attitudes. Three themes emerged: how technology alters the meaning of futile care, dissonance in the perspectives of decision makers and increasing support for joint decision-making. Only articles in English and predominantly from the clinician's rather than the patient's perspective were included. Societal and cultural factors as well as the structural, financial and cultural environment influence the initiation of technology dependence in children. However, to what extent these overt and implicit influences guide decision-makers in this field remains largely unknown.
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Affiliation(s)
- Denise Alexander
- School of Nursing and Midwifery, 8809Trinity College Dublin, Ireland
| | | | - Maria Brenner
- School of Nursing and Midwifery, 8809Trinity College Dublin, Ireland
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8
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Becker C, Manzelli A, Marti A, Cam H, Beck K, Vincent A, Keller A, Bassetti S, Rikli D, Schaefert R, Tisljar K, Sutter R, Hunziker S. Association of medical futility with do-not-resuscitate (DNR) code status in hospitalised patients. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106977. [PMID: 33514639 DOI: 10.1136/medethics-2020-106977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
Guidelines recommend a 'do-not-resuscitate' (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Good Outcome Following Attempted Resuscitation score and the Clinical Frailty Scale in patients hospitalised in the Divisions of Internal Medicine and Traumatology/Orthopedics at the University Hospital of Basel between September 2018 and June 2019. The definition of presumed CPR futility was met in 467 (16.2%) of 2889 patients. 866 (30.0%) patients had a DNR code status. In a regression model adjusted for age, gender, main diagnosis, nationality, language and religion, presumed CPR futility was associated with a higher likelihood of a DNR code status (37.3% vs 7.1%, adjusted OR 2.99, 95% CI 2.31 to 3.88, p<0.001). In the subgroup of patients with presumed futile CPR, 144 of 467 (30.8%) had a full code status, which was independently associated with younger age, male gender, non-Christian religion and non-Swiss citizenship. We found a significant proportion of hospitalised patients to have a full code status despite the fact that CPR had to be considered futile according to an established definition. Whether these decisions were based on patient preferences or whether there was a lack of patient involvement in decision-making needs further investigation.
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Affiliation(s)
- Christoph Becker
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
- Emergency Department, Universitatsspital Basel, Basel, Switzerland
| | - Alessandra Manzelli
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
| | - Alexander Marti
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
| | - Hasret Cam
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
| | - Alessia Vincent
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
| | - Annalena Keller
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Daniel Rikli
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Traumatology & Orthopedics, University Hospital Basel, Basel, Switzerland
| | - Rainer Schaefert
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kai Tisljar
- Division of Critical Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Critical Care Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Dos Santos MJ, Martins MS, Santana FLP, Furtado MCSPC, Miname FCBR, Pimentel RRDS, Brito ÁN, Schneider P, Dos Santos ES, da Silva LH. COVID-19: instruments for the allocation of mechanical ventilators-a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:582. [PMID: 32993736 PMCID: PMC7522926 DOI: 10.1186/s13054-020-03298-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/17/2020] [Indexed: 01/11/2023]
Abstract
After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.
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Affiliation(s)
- Marcelo José Dos Santos
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil. .,Departamento de Orientação Profissional, Escola de Enfermagem da Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 419, CEP - 05403-000 Cerqueira Cesar, São Paulo, SP, Brazil.
| | - Maristela Santini Martins
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Fabiana Lopes Pereira Santana
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Rafael Rodrigo da Silva Pimentel
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Ágata Nunes Brito
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Patrick Schneider
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Edson Silva Dos Santos
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Luciane Hupalo da Silva
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
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Gaspar RB, Silva MMD, Zepeda KGM, Silva ÍR. Conditioning factors for nurses to defend the autonomy of the elderly on the terminality of life. Rev Bras Enferm 2020; 73 Suppl 3:e20180857. [PMID: 32696897 DOI: 10.1590/0034-7167-2018-0857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand the meanings attributed by nurses about conditions that interfere in defending of the elderly's autonomy on the terminality of life in the context of hospitalization. METHOD qualitative and exploratory study, which applied the Grounded Theory. Data were collected between November 2016 and May 2017, in the internal medicine wards of a hospital in Rio de Janeiro, Brazil, through non-participant observation and semi-structured interviews. Three sample groups composed of ten nurses, eight doctors, and 15 nursing technicians were investigated. RESULTS the conditions are related to the medical power, subordination of nurses, family influences; the functional decline of the elderly; and biomedical model. Final considerations: the elderly's autonomy is veiled and violated since their abilities are subjugated, and the family's will and professional paternalism may prevail. However, this right must guide contemporary care models and integrate palliative care.
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11
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Seidlein AH, Hannich A, Nowak A, Gründling M, Salloch S. Ethical aspects of time in intensive care decision making. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105752. [PMID: 32332151 DOI: 10.1136/medethics-2019-105752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
The decision-making environment in intensive care units (ICUs) is influenced by the transformation of intensive care medicine, the staffing situation and the increasing importance of patient autonomy. Normative implications of time in intensive care, which affect all three areas, have so far barely been considered. The study explores patterns of decision making concerning the continuation, withdrawal and withholding of therapies in intensive care. A triangulation of qualitative data collection methods was chosen. Data were collected through non-participant observation on a surgical ICU at an academic medical centre followed by semi-structured interviews with nurses and physicians. The transcribed interviews and observation notes were coded and analysed using qualitative content analysis according to Mayring. Three themes related to time emerged regarding the escalation or de-escalation of therapies: influence of time on prognosis, time as a scarce resource and timing in regards to decision making. The study also reveals the ambivalence of time as a norm for decision making. The challenge of dealing with time-related efforts in ICU care results from the tension between the need to wait to optimise patient care, which must be balanced against the significant time pressure which is characteristic of the ICU setting.
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Affiliation(s)
- Anna-Henrikje Seidlein
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Arne Hannich
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andre Nowak
- Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Halle(Saale), Germany
| | - Matthias Gründling
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Sabine Salloch
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
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12
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On Evolutions and Revolutions in Emergency Care: Commemorating the Emergency Nurses Association’s 50th Anniversary. J Emerg Nurs 2020; 46:2-7. [DOI: 10.1016/j.jen.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
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13
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Okenyi E, Donaldson TM, Collins A, Morton B, Obasi A. Assessing ethical climates in critical care and their impact on patient outcomes. Breathe (Sheff) 2019; 15:84-87. [PMID: 30838066 PMCID: PMC6395987 DOI: 10.1183/20734735.0335-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Intensive care units with a "good" ethical environment are more likely to identify perceived excessive patient care. Patients with perceived excessive care were more likely to die and time to death was shorter in units with a "good" ethical environment. http://ow.ly/vnFP30neAZN.
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Affiliation(s)
- Emmanuel Okenyi
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Andrea Collins
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.,Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Both authors contributed equally
| | - Angela Obasi
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,Both authors contributed equally
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14
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Müller R, Kaiser S. Perceptions of medical futility in clinical practice – A qualitative systematic review. J Crit Care 2018; 48:78-84. [DOI: 10.1016/j.jcrc.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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