Interprofessional clinical decision-making process in health: A scoping review

Nursing ethical dimensions of euthanasia and medically assisted suicide for older people in need of long-term care

Euthanasia and medically assisted suicide (E/MAS) are (healthcare-)practices intended to cause a patient's death according to their wish and will. This article addresses the specific ethical questions that arise in the context of E/MAS regarding older adults in need of long-term care (LTC) from a nursing ethics perspective. Older people in need of LTC are particularly vulnerable due to a combination of health-related, social, and economic factors. Multiple chronic diseases, age-related frailty and the subsequent need for LTC, for example, may contribute to an increased risk of social isolation, loneliness and hopelessness. The boundaries between "normal" age-related changes and changes that are deemed to be pathological also become blurred. The complex interplay of these factors results in the particular needs of older adults who rely on nursing care. Consequently, specific ethical issues arise that are unique in terms of their quality and quantity - also regarding E/MAS. We present a common scenario: a fall with a subsequent fracture, as a turning point in the LTC arrangement. The consequences of such an adverse event (limited mobility, risk of further falls) compromise the security of care at home, raising the (potential) need for transfer to a LTC facility. This (potential) move represents a major disruption, is experienced as a crisis, and marks a transition for the older adult in need of LTC. We highlight the complex interplay between aging, health-care dependency, personal values and the resulting wish/request for E/MAS. We discuss how the professional self-perception and ethical values of the nursing profession in the home care setting determine the treatment pathway for older peoples' request for E/MAS.

Measuring the relationship between reciprocity behaviour and technology readiness of nursing staff working in residential care and community nursing: A cross-sectional study

AIM

The aim of this study is to measure how collaborative factors are associated with the technology readiness of nursing staff working in residential care and community nursing. The Reciprocity Instrument and Technology Readiness Index 2.0 were applied to measure this association.

DESIGN

A cross-sectional survey was conducted between October 2020 and January 2021.

METHODS

The Technology Readiness Index 2.0 was translated into Dutch, administered together with the Reciprocity Instrument and linguistically validated. And 1660 Registered Nurses and Nursing Assistants received an invitation to the online survey. Descriptive statistics and regression analyses were used to analyse the data.

RESULTS

A total of 475 nursing staff responded, a response rate of 28.6%. The following factors have a statistically significant association with technology readiness: age, education level, years of working experience, type of organization, reciprocity behaviour and conditions of reciprocity behaviour: digital communication usage to reach one another, multilayeredness and future perspective.

CONCLUSION

This study shows that reciprocity behaviour is positively associated with technology readiness. The influencing factor reciprocity remains intact after the correction of the other factors that were measured. This confirms the relevance of collaborative factors that influence the technology adoption process of nursing staff working in residential care and community nursing.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study offers insights into how collaboration based on reciprocity behaviour positively impacts the technology readiness of nursing staff engaged in residential care and community nursing and could be used in the education of nursing staff and healthcare teams.

IMPACT

Being aware of the impact that collaborative factors have on the adoption process of ICT among nursing staff could be used to support the desired preparatory activities as part of ICT implementation for healthcare managers, innovators, and nursing work groups charged with implementing technology in the healthcare process.

REPORTING METHOD

The study has adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

The experiences of hospital staff with decision-making concerning patient enrolment in hospital at home services: A complex and dynamic process

BACKGROUND

Hospital at home care services offer a potential solution to the problem of strain on hospital beds while simultaneously enhancing patient outcomes. Nevertheless, implementation of the hospital at home care model is associated with several challenges. One such barrier involves patient enrolment, particularly during the initial stage of service operation. Due to their frontline experience, healthcare professionals possess valuable insights that can help us understand and address this challenge. This study aimed to explore the experiences of hospital staff in the decision-making process concerning patient enrolment in hospital at home.

METHODS

In total, 22 semi-structured individual interviews were conducted with hospital staff members between January and May 2022 at the participants' workplace or in a public office depending on their preferences. Data were analysed using reflexive thematic analysis.

RESULTS

We identified four themes pertaining to the experiences of hospital staff with the decision-making process concerning patient enrolment in hospital at home: "beneficial for the patients; an important motivating factor", "patient eligibility; prioritizing safety", "contextual factors within hospital ward units; opportunities and limitations", and "collaboration with municipalities; crucial but challenging".

CONCLUSIONS

Hospital staff described a complex and dynamic decision-making process when considering patient eligibility for enrolment to hospital at home services. The findings highlight both barriers and enablers pertaining to this process and emphasize the need to provide support to hospital staff as they navigate this complex situation. A key finding pertains to the critical importance of high-quality decision-making in ensuring positive outcomes and the overall effectiveness of hospital at home care services. Additionally, this study proposes a deeper exploration of the ethical considerations associated with balancing the goal of patient safety with that of equitable access to high-quality, person-centred care within the context of hospital at home.