1
|
Tong HH, Creutzfeldt CJ, Hicks KG, Kross EK, Sharma RK, Jennerich AL. Questions From Family Members During the Dying Process And Moral Distress Experienced by ICU Nurses. J Pain Symptom Manage 2024; 67:402-410.e1. [PMID: 38342474 DOI: 10.1016/j.jpainsymman.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND For a hospitalized patient, transitioning to comfort measures only (CMO) involves discontinuation of life-prolonging interventions with a goal of allowing natural death. Nurses play a pivotal role during the provision of CMO, caring for both the dying patient and their family. OBJECTIVE To examine the experiences of ICU nurses caring for patients receiving CMO. METHODS Between October 2020 and June 2021, nurses in the neuro- and medical-cardiac intensive care units at Harborview Medical Center in Seattle, WA, completed surveys about their experiences providing CMO. Surveys addressed involvement in discussions about CMO and questions asked by family members of dying patients. We also assessed nurses' moral distress related to CMO and used ordinal logistic regression to examine predictors of moral distress. RESULTS Surveys were completed by 82 nurses (response rate 44%), with 79 (96%) reporting experience providing CMO in the previous year. Most preferred to be present for discussions between physicians or advanced practice providers and family members about transitioning to CMO (89% most of the time or always); however, only 31% were present most of the time or always. Questions from family about time to death, changes in breathing, and medications to relieve symptoms were common. Most nurses reported moral distress at least some of the time when providing CMO (62%). Feeling well-prepared to answer specific questions from family was associated with less moral distress. CONCLUSION There is discordance between nurses' preferences for inclusion in discussions about the transition to CMO and their actual presence. Moral distress is common for nurses when providing CMO and feeling prepared to answer questions from family members may attenuate distress.
Collapse
Affiliation(s)
- Hao H Tong
- University of Pennsylvania, Division of Pulmonary, Allergy and Critical Care (H.H.T.), Philadelphia, Pennsylvania, USA
| | - Claire J Creutzfeldt
- Harborview Medical Center, Department of Neurology (C.J.C.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA
| | - Katherine G Hicks
- Baylor College of Medicine, Section of Geriatrics and Palliative Medicine (K.G.H.), Houston, Texas, USA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA; Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington (E.K.K., A.L.J.), Seattle, Washington, USA
| | - Rashmi K Sharma
- Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA; University of Washington, Division of General Internal Medicine (R.K.S.), Seattle, Washington, USA
| | - Ann L Jennerich
- Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA; Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington (E.K.K., A.L.J.), Seattle, Washington, USA.
| |
Collapse
|
2
|
Wibisono S, Mavandadi P, Wilkinson S, Amiot C, Forbat L, Thomas EF, Allen F, Decety J, Noonan K, Minto K, Breen LJ, Kho M, Crane M, Lizzio-Wilson M, Molenberghs P, Louis W. "More support, less distress?": Examining the role of social norms in alleviating practitioners' psychological distress in the context of assisted dying services. DEATH STUDIES 2024:1-12. [PMID: 38597737 DOI: 10.1080/07481187.2024.2337189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
This study explores how providing assisted dying services affects the psychological distress of practitioners. It investigates the influence of professional norms that endorse such services within their field. Study 1 included veterinarians (N = 137, 75.2% female, Mage = 43.1 years, SDage = 12.7 years), and Study 2 health practitioner students (N = 386, 71.0% female, Mage = 21.0 years, SDage = 14.4 years). In both studies, participants indicated their degree of psychological distress following exposure to scenarios depicting assisted dying services that were relevant to their respective situations. In Study 1, we found that higher willingness to perform animal euthanasia was associated with lower distress, as were supportive norms. In Study 2, a negative association between a greater willingness to perform euthanasia and lower psychological distress occurred only when the provision of such services was supported by professional norms. In conclusion, psychological distress is buffered by supportive professional norms.
Collapse
Affiliation(s)
- Susilo Wibisono
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Payam Mavandadi
- Institute for Social Neuroscience, ISN Psychology, Ivanhoe, Australia
| | - Stuart Wilkinson
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Catherine Amiot
- Department of Psychology, The Université du Quebec à Montreal, Montreal, Canada
| | - Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia
| | - Felicity Allen
- Department of Psychology, Charles Darwin University, Darwin, Australia
| | - Jean Decety
- Department of Psychology, and Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Kerrie Noonan
- School of Psychology, Western Sydney University, Penrith, Australia
- Western NSW Local Health District, Dubbo, Australia
| | - Kiara Minto
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Lauren J Breen
- Curtin School of Population Health and Enable Institute, Curtin University, Perth, Australia
| | - Madison Kho
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | | | | | - Winnifred Louis
- School of Psychology, University of Queensland, Brisbane, Australia
| |
Collapse
|
3
|
Malik G, Penman J, Rogerson K, Murphy J, Zhong Y, Johnson CE. Educational content and strategies to support nurses from culturally and linguistically diverse backgrounds caring for patients considering voluntary assisted dying: The Australian experience. Appl Nurs Res 2024; 76:151765. [PMID: 38641377 DOI: 10.1016/j.apnr.2024.151765] [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] [Received: 01/03/2023] [Revised: 08/22/2023] [Accepted: 02/18/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES Drawing on findings from a qualitative study that aimed to explore the knowledge and attitudes of nurses from culturally and linguistically diverse (CALD) backgrounds about voluntary assisted dying (VAD). The study also aimed to identify the strategies that assist nurses in their readiness and preparation for exposure to VAD. This paper reports on the educational content and strategies that could assist nurses from CALD backgrounds to be better prepared when they encounter VAD requests. BACKGROUND Around the world, healthcare professionals have roles to play in caring for patients requesting voluntary assisted dying. Nurses, particularly those from diverse geographic and clinical settings, have voiced inadequate knowledge and understanding about voluntary assisted dying. DESIGN A qualitative descriptive approach was undertaken. METHODS Data collection involved one focus group and 16 in-depth interviews. A total of 21 nurses from CALD backgrounds were recruited from one Australian state. Thematic analysis was conducted to interpret the data. FINDINGS Nurses identified their knowledge gaps and specified the need for education and workplace training on VAD, its legal and ethical aspects, clarity on their role, communication techniques and how VAD intersects with their practice. They suggested various teaching strategies that could prepare nurses to work safely and confidently in a clinical environment where voluntary assisted dying is an option for patients. CONCLUSION Given the high number of nurses from diverse backgrounds working in the Australian health sector, these nurses need to be fully prepared to care for patients requesting VAD.
Collapse
Affiliation(s)
- Gulzar Malik
- School of Nursing and Midwifery, La Trobe University, Australia.
| | - Joy Penman
- School of Nursing and Midwifery, Monash University, Australia
| | | | | | - Yaping Zhong
- School of Nursing and Midwifery, Monash University, Australia
| | - Claire E Johnson
- Palliative and Supportive Care, Eastern Health, Melbourne, Australia; Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.
| |
Collapse
|
4
|
Jonker LA, Heijltjes MT, Rietjens JAC, van der Heide A, Hendriksen G, van Delden JJM, van Thiel GJMW. Experiences and perceptions of continuous deep sedation: An interview study among Dutch patients and relatives. Health Expect 2023; 27:e13869. [PMID: 37822095 PMCID: PMC10726059 DOI: 10.1111/hex.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The incidence of continuous deep sedation (CDS) has more than doubled over the last decade in The Netherlands, while reasons for this increase are not fully understood. Patients and relatives have an essential role in deciding on CDS. We hypothesize that the increase in CDS practice is related to the changing role of patients and relatives in deciding on CDS. OBJECTIVE To describe perceptions and experiences of patients and relatives with regard to CDS. This insight may help professionals and policymakers to better understand and respond to the evolving practice of CDS. METHODS Qualitative interviews were held with patients and relatives who had either personal experience with CDS as a relative or had contemplated CDS for themselves. RESULTS The vast majority of respondents appreciated CDS as a palliative care option, and none of the respondents reported (moral) objections to CDS. The majority of respondents prioritized avoiding suffering at the end of life. The patients and families generally considered CDS a palliative care option for which they can choose. Likewise, according to our respondents, the decision to start CDS was made by them, instead of the physician. Negative experiences with CDS care were mostly related to loss of sense of agency, due to insufficient communication or information provision by healthcare professionals. Lack of continuity of care was also a source of distress. We observed a variety in the respondents' understanding of the distinction between CDS and other end-of-life care decisions, including euthanasia. Some perceived CDS as hastening death. CONCLUSION The traditional view of CDS as a last resort option for a physician to relieve a patient's suffering at the end of life is not explicit among patients and relatives. Instead, our results show that they perceive CDS as a regular palliative care option. Along with this normalization of CDS, patients and relatives claim a substantial say in the decision-making and are mainly motivated by a wish to avoid suffering and exercise control at the end of life. These distinct views on CDS of patients, their relatives and healthcare providers should be reconciled in guidelines and protocols for CDS. PATIENT OR PUBLIC CONTRIBUTION One of the authors in our team (G. H.) has experience with CDS as a relative and ensured that the patient/relative viewpoint was adequately reflected in the design and conduct of our study. In the preliminary phase of our study, G. H. adjusted the topic list so it was better adapted to the current practice of CDS. During the data analysis, G. H. read several interviews and took part in the open and critical discussion on central themes and core concepts as an important member of the author team, thereby guaranteeing the central position of the patient/relative perspective in our final research outcome.
Collapse
Affiliation(s)
- Louise Annemoon Jonker
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of PediatricsDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Madelon T. Heijltjes
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus Medical CenterErasmus UniversityRotterdamThe Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus Medical CenterErasmus UniversityRotterdamThe Netherlands
| | - Geeske Hendriksen
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Johannes J. M. van Delden
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Ghislaine J. M. W. van Thiel
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| |
Collapse
|
5
|
Rezaei Z, Nematollahi M, Asadi N. The relationship between moral distress, ethical climate, and attitudes towards care of a dying neonate among NICU nurses. BMC Nurs 2023; 22:303. [PMID: 37670308 PMCID: PMC10478422 DOI: 10.1186/s12912-023-01459-7] [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: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Nurses working in neonatal intensive care units play a crucial role in providing care to critically ill or premature neonates. However, is not without its challenges, particularly when it comes to making difficult ethical decisions about end-of-life care. In some cases, neonates do not survive despite the best efforts of medical professionals. The present study aimed to investigate the relationship between moral distress, ethical climate, and attitudes towards end-of-life care among nurses working in neonatal intensive care units. METHODS This is a descriptive-analytical cross-sectional study (May 21, 2021).The research population included 126 nurses working in neonatal intensive care units in Kerman province (Kerman, Jiroft, Bam, and Rafsanjan). Data collection tools included four questionnaires: demographic information, the Frommelt Attitudes towards Care of the Dying (FATCOD), the Hospital Ethical Climate Survey, and the Moral Distress Scale. SPSS22 was used to analyze the data. RESULTS The results revealed that the mean frequency and intensity of moral distress were 44.42 ± 17.67 and 49.45 ± 17.11, respectively. The mean ethical climate was 92.21 ± 17.52 and the FATCOD was 89.75 ± 9.08, indicating NICU nurses' positive perceptions of ethical climate and their favorable attitudes towards EOL care, respectively. The results showed a direct and significant relationship between ethical climate and the FATCOD (P = 0.003, r = 0.26). DISCUSSION We suggest policymakers and managers design strategies for better ethical climate in hospitals and reduction of moral distress among nurses.
Collapse
Affiliation(s)
- Zeinab Rezaei
- Department of Pediatric and Neonatal Intensive Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Neda Asadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
6
|
Lucchi E, Milder M, Dardenne A, Bouleuc C. Could palliative sedation be seen as unnamed euthanasia?: a survey among healthcare professionals in oncology. BMC Palliat Care 2023; 22:97. [PMID: 37468913 DOI: 10.1186/s12904-023-01219-z] [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: 09/19/2022] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND In 2016 a French law created a new right for end-of-life patients: deep and continuous sedation maintained until death, with discontinuation of all treatments sustaining life such as artificial nutrition and hydration. It was totally unprecedented that nutrition and hydration were explicitly defined in France as sustaining life treatments, and remains a specificity of this law. End- of-life practices raise ethical and practical issues, especially in Europe actually. We aimed to know how oncology professionals deal with the law, their opinion and experience and their perception. METHODS Online mono-centric survey with closed-ended and open-ended questions in a Cancer Comprehensive Centre was elaborated. It was built during workshops of the ethics committee of the Institute, whose president is an oncologist with a doctoral degree in medical ethics. 58 oncologists and 121 nurses-all professionals of oncological departments -, received it, three times, as mail, with an information letter. RESULTS 63/ 179 professionals answered the questionnaire (35%). Conducting end-of-life discussions and advanced care planning were reported by 46/63 professionals. In the last three months, 18 doctors and 7 nurses faced a request for a deep and continuous sedation maintained until death, in response to physical or existential refractory suffering. Artificial nutrition and even more hydration were not uniformly considered as treatment. Evaluation of the prognosis, crucial to decide a deep and continuous sedation maintained until death, appears to be very difficult and various, between hours and few weeks. Half of respondents were concerned that this practice could lead to or hide euthanasia practices, whereas for the other half, this new law formalised practices necessary for the quality of palliative care at the end-of-life. CONCLUSION Most respondents support the implementation of deep and continuous sedation maintained until death in routine end-of-life care. Nevertheless, difficulty to stop hydration, confusion with euthanasia practices, ethical debates it provokes and the risk of misunderstanding within teams and with families are significant. This is certainly shared by other teams. This could lead to a multi-centric survey and if confirmed might be reported to the legislator.
Collapse
Affiliation(s)
- E Lucchi
- Department of Supportive and Palliative Care, Institut Curie, Saint-Cloud, France.
| | - M Milder
- Department of Clinical Research, Institut Curie, Paris, France
| | - A Dardenne
- Department of Supportive and Palliative Care, Institut Curie, Saint-Cloud, France
| | - C Bouleuc
- Department of Supportive and Palliative Care, Institut Curie, Paris, France
| |
Collapse
|
7
|
Gandossi C, De Brasi EL, Rosa D, Maffioli S, Zappa S, Villa G, Manara DF. How Do Nursing Students Perceive Moral Distress? An Interpretative Phenomenological Study. NURSING REPORTS 2023; 13:539-548. [PMID: 36976701 PMCID: PMC10056563 DOI: 10.3390/nursrep13010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Background: Research shows that the longer nurses care for terminally ill patients, the greater they experience moral distress. The same applies to nursing students. This study aims to analyze episodes of moral distress experienced by nursing students during end-of-life care of onco-hematologic patients in hospital settings. Methods: This study was conducted in the interpretative paradigm using a hermeneutic phenomenological approach and data were analyzed following the principles of the Interpretative Phenomenological Analysis. Results: Seventeen participants were included in the study. The research team identified eight themes: causes of moral distress; factors that worsen or influence the experience of moral distress; feelings and emotions in morally distressing events; morally distressing events and consultation; strategies to cope with moral distress; recovering from morally distressing events; end-of-life accompaniment; internship clinical training, and nursing curriculum. Conclusions: Moral distress is often related to poor communication or lack of communication between health care professionals and patients or relatives and to the inability to satisfy patients’ last needs and wants. Further studies are necessary to examine the quantitative dimension of moral distress in nursing students. Students frequently experience moral distress in the onco-hematological setting.
Collapse
Affiliation(s)
| | | | - Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence:
| | | | - Sara Zappa
- San Raffaele Institute (IRCCS), 20132 Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
8
|
Lizzio-Wilson M, Thomas EF, Louis WR, Crane MF, Kho M, Molenberghs P, Wibisono S, Minto K, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Allen F. Using Latent Profile Analysis to Understand Health Practitioners' Attitudes Toward Voluntary Assisted Dying. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149453. [PMID: 36826344 DOI: 10.1177/00302228221149453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others' emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners' attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD.
Collapse
Affiliation(s)
- Morgana Lizzio-Wilson
- Department of Psychology, The University of Exeter, Exeter, UK
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Winnifred R Louis
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Monique F Crane
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Madison Kho
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Susilo Wibisono
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Catherine E Amiot
- Département de Psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- Death Literacy Institute, University of Western Sydney, Penrith South, NSW, Australia
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | |
Collapse
|
9
|
Garcia ACM, Isidoro GM, Paiva EMDC, Silva AE, Costa ICP, Bornemann-Cimenti H. Palliative Sedation at Home: A Scoping Review. Am J Hosp Palliat Care 2023; 40:173-182. [PMID: 35466700 DOI: 10.1177/10499091221096412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Palliative Sedation (PS) is an effective measure for the relief of refractory symptoms in end-of-life patients. This intervention can be performed at home, respecting the patients' and their families' decisions. A scoping review was performed to map the available evidence in the literature on the performance of PS at home. This review included 23 studies. Most were conducted in European countries with adult cancer patients. Patients, family members and healthcare providers participated in the decision making regarding the use of PS at home. PS was used primarily to manage refractory symptoms (pain, delirium, dyspnea, and others), and in 1 of the studies PS was mentioned as a possible intervention for shortening life. The most commonly used medication was midazolam and the average duration ranged from 4 h to 7 days. There are few reports on adverse events related to PS. This intervention seems to be a feasible possibility for the management of refractory symptoms in patients at the end of life, despite the fact that it can represent specific challenges for healthcare providers, patients and families. However, the literature is limited regarding PS in children and in people with diseases other than cancer, as well as on the evaluation of possible adverse effects related to this intervention. Furthermore, it is essential to have a broad ethical, clinical and legal debate on whether to consider the use of PS for the purpose of shortening life in specific cases.
Collapse
Affiliation(s)
| | | | | | - Alexandre E Silva
- Nursing Department - Campus Centro-Oeste Dona Lindu, 74383Federal University of São João del-Rei, Divinópolis, Brazil
| | | | - Helmar Bornemann-Cimenti
- Departement of Anesthesiology and Intensive Care Medicine, 31475Medical University of Graz, Graz, Austria
| |
Collapse
|
10
|
Wibisono S, Minto K, Lizzio-Wilson M, Thomas EF, Crane M, Molenberghs P, Kho M, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Louis W. Attitudes Toward and Experience With Assisted-Death Services and Psychological Implications for Health Practitioners: A Narrative Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221138997. [PMID: 36357863 DOI: 10.1177/00302228221138997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
A narrative systematic review was conducted to review studies that examine mental health implications of involvement in assisted-death services among health practitioners. Qualitative and quantitative studies were included to understand health practitioners' attitudes and experiences with assisted dying services, as well as to identify the mental health consequences. We identified 18 articles from 1591 articles drawn from seven major scientific databases (i.e., PubMed, MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Scopus). Two raters independently evaluated the exclusion and inclusion decisions of the articles and examined methodological flaws in the selected articles. We found that engagement in assisted death services were not reliably associated with mental health outcomes such as anxiety and moral distress. Both positive and negative outcomes were reported, and psychological outcomes for practitioners were shown to vary based on factors including social support for health practitioners' views; their perceived capacity to care for the patients; and legislation.
Collapse
Affiliation(s)
- Susilo Wibisono
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Department of Psychology, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Morgana Lizzio-Wilson
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Madison Kho
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Catherine E Amiot
- Department of Psychology, The Universite du Quebec a Montreal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin School of Population Health and Enable Institute, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- School of Social Sciences, Western Sydney University, Kingswood, Australia
| | - Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Winnifred Louis
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
11
|
Byrnes E, Ross AI, Murphy M. A Systematic Review of Barriers and Facilitators to Implementing Assisted Dying: A Qualitative Evidence Synthesis of Professionals' Perspectives. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221116697. [PMID: 35929771 DOI: 10.1177/00302228221116697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. This systematic review and qualitative evidence synthesis aims to identify the factors that healthcare professionals experience when working within assisted dying frameworks. PRISMA guidelines for systematic reviews were followed. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. Remaining papers were subjected to critical appraisal and a thematic synthesis. Eight themes fell under the domain of 'barrier' and represented different personal and professional factors that hinder professionals from delivering assisted dying healthcare. Five themes came under the domain of 'facilitators' and represent factors that contribute to the smooth implementation and delivery of assisted dying services. Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks.
Collapse
Affiliation(s)
- Eric Byrnes
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
- Cork Mental Health Services, Cork/Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Alasdair Iain Ross
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
- Cork Mental Health Services, Cork/Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Mike Murphy
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
| |
Collapse
|
12
|
Kwon S, Kim M, Choi S. Ethical dilemmas and care actions in nurses providing palliative sedation. Nurs Ethics 2022; 29:1220-1230. [PMID: 35728273 DOI: 10.1177/09697330221105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. OBJECTIVE To explore the meaning of nurses' experiences in dealing with ethical dilemmas in relation to palliative sedation. RESEARCH DESIGN A qualitative research design was employed with a thematic analysis approach. PARTICIPANTS AND RESEARCH CONTEXT Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. ETHICAL CONSIDERATIONS Ethical approval was obtained from the authors' institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. RESULTS Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague's disrespectful attitudes toward patients; dilemmas from patients' families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. CONCLUSION Nurses' ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation.
Collapse
Affiliation(s)
- Sinyoung Kwon
- Department of Nursing, 250458Gangdong University, Eumseong-gun, Chungcheongbuk-do, Korea
| | | | - Sujin Choi
- 35031Woosuk University, Wanju, Jeollabuk-do, Korea
| |
Collapse
|
13
|
Kovanci MS, Akyar I. Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review. Nurs Ethics 2022; 29:1476-1490. [PMID: 35724332 DOI: 10.1177/09697330221105638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Moral distress is a phenomenon that all nurses experience at different levels and contexts. The level of moral distress can be affected by individual values and the local culture. The sources of the values shape the level of moral distress experienced and the nurses' decisions. AIM The present scoping review was conducted to examine the situations that cause moral distress in ICU nurses in different countries. RESULTS A scoping review methodology was adopted for the study, in line with the approach of Arksey, and O'Malley Literature was searched within PubMed/Medline, Scopus, Web of Science, and PsycINFO indexed keywords such as "moral distress", "Critical Care Nurse", and "Moral Distress Scale-Revised". Of the 617 identified citations, 12 articles matched the inclusion criteria. CONCLUSION The moral distress experienced in countries and regions with similar cultures and geographies was parallel. The situations that cause the most moral distress are futile-care to prolong death, unnecessary tests and treatments, and working with incompetent healthcare personnel.
Collapse
Affiliation(s)
- Mustafa Sabri Kovanci
- Psychiatric Nursing Department, Faculty of Nursing, 37515Hacettepe University, Ankara, Turkey
| | - Imatullah Akyar
- Internal Medicine Nursing Department, Faculty of Nursing, 37515Hacettepe University, Ankara, Turkey
| |
Collapse
|
14
|
Cocker A, Singy P, Jox RJ. How should health care providers inform about palliative sedation? A qualitative study with palliative care professionals. Eur J Cancer Care (Engl) 2022; 31:e13602. [PMID: 35488398 PMCID: PMC9541839 DOI: 10.1111/ecc.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/24/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Objective In Switzerland, palliative sedation consists of using sedatives to relieve terminally ill patients. It is divided into several steps, with one of them consisting of informing patients and relatives about the procedure. In the current recommendations, there is a lack of orientation about how and when this discussion should take place. Hence, we aim to explore perceptions and experiences of palliative care professionals regarding these questions. Methods Qualitative semi‐structured interviews with five physicians and five nurses working in specialised palliative care were conducted. They were then analysed with thematic analysis. Results Results showed a uniformity around definition, goals and indications of palliative sedation. However, there was a lack of consistency regarding the process of delivering this information to patients and relatives. Finally, some participants strongly opposed the idea of systematically informing patients in specialised palliative care, while others were more divided on this question. Conclusion Despite a common understanding of the concept of palliative sedation, there is no standard practice when informing patients on palliative sedation among palliative care professionals. Therefore, this study demonstrates the need for further guidelines on this question and calls for a better understanding and knowledge of palliative sedation among health professionals outside palliative care.
Collapse
Affiliation(s)
- Allan Cocker
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Ralf J Jox
- Geriatric Palliative Care, CHUV, University of Lausanne, Lausanne, Switzerland.,Institute of Humanities in Medicine, CHUV, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
15
|
Grüne B, Meesters S, Bausewein C, Schildmann E. Challenges and Strategies Regarding Sedation at the End of Life in Hospitals and Nursing Homes. J Pain Symptom Manage 2022; 63:530-538. [PMID: 34921935 DOI: 10.1016/j.jpainsymman.2021.12.012] [Citation(s) in RCA: 2] [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: 07/16/2021] [Revised: 11/26/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Sedation is an accepted, but controversially discussed and challenging measure to treat suffering at the end of life. Although most people die in hospitals or nursing homes, little is known how professionals in these settings deal with sedatives and sedation at the end of life. OBJECTIVES To explore 1) challenges regarding use of sedatives and sedation at the end of life in hospitals and nursing homes, and 2) strategies, and supportive measures to meet these challenges, as perceived by nurses and physicians. METHODS Multicenter qualitative interview study. Forty-nine participants: 12 general practitioners and 12 nurses from five nursing homes, 12 physicians, and 13 nurses from five hospital departments (hematology/oncology (n = 2), neurology, geriatrics, gynecology). Semi-structured qualitative interviews. Data analysis guided by framework approach. RESULTS Perceived challenges relate to three levels of the care situation: individual, interaction with others, and work environment. The main challenge was defining the adequate timing and/or dose. Other challenges, e.g., disagreements regarding indication or legal uncertainties, were highly interrelated, and strongly associated with this major challenge. Reported strategies and supportive measures to address challenges also corresponded to the three interrelated levels. Major named strategies were education and training, joint decision-making within the team and regular discussion with the patient and family. On the level work environment, no implemented strategies, but wishes for change were identified. CONCLUSION To meet the identified challenges in a sustainable way and enable continuous improvement of quality of care, best practice recommendations, and other supportive measures have to address all identified levels of challenges.
Collapse
Affiliation(s)
- Bettina Grüne
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany; German Youth Institute (DJI), Department of Youth and Youth Services (B.G.), Munich, Germany.
| | - Sophie Meesters
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany
| |
Collapse
|
16
|
Kalender Smajlović S. Odnos medicinskih sester do evtanazije. OBZORNIK ZDRAVSTVENE NEGE 2022. [DOI: 10.14528/snr.2022.56.1.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Evtanazija je pojem, o katerem se mora razpravljati z vidika medicinskih, zdravstvenih in družboslovnih strok. Medicinske sestre so sestavni del zdravstvenih timov, zato je potrebno njihovo vključevanje v etične razprave o evtanaziji. Namen pregleda literature je predstaviti vidik evtanazije v povezavi z zdravstveno nego.Metode: Uporabljen je bil pregled literature, izveden v podatkovnih bazah COBIB.SI, CIHAHL in PubMed od 1. 11. 2020 do 1. 12. 2020. Iskanje je potekalo z uporabo ključnih besed: »evtanazija«, »zdravstvena nega«, v angleškem jeziku s kombinacijo ključnih besed: »attitudes«, »euthanasia« in »nursing«. Potek pregleda literature je prikazan z diagramom PRISMA. Kakovost virov, vključenih v končno analizo, je bila ocenjena s pomočjo hierarhije dokazov. Rezultati so bili sintetizirani z uporabo tematske analize.Rezultati: Izmed 138 virov je bilo v končno analizo vključenih enaindvajsetih člankov. Medicinske sestre so navajale naklonjen, kot tudi nenaklonjen odnos ter prisotnost etičnih dilem v povezavi z evtanazijo. Naklonjen odnos medicinskih sester do evtanazije se kaže v primerih neobvladljivih bolečin, neznosnega trpljenja in neozdravljivih bolezni, nenaklonjen pa v povezavi z nekaterimi demografskimi in kulturnimi značilnostmi medicinskih sester, upoštevanjem načel sočutne oskrbe in spoštovanjem vrednosti človekovega življenja.Diskusija in zaključek: Ugotovitve raziskave prispevajo prepoznati odnos medicinskih sester do evtanazije ter nekatere etične dileme v povezavi z evtanazijo. Potrebno bi bilo izvesti podrobne preglede etičnih dilem in moralnih stisk, ki se pojavljajo v povezavi z evtanazijo in zdravstveno nego.
Collapse
|
17
|
Gerber K, Willmott L, White B, Yates P, Mitchell G, Currow DC, Piper D. Barriers to adequate pain and symptom relief at the end of life: A qualitative study capturing nurses’ perspectives. Collegian 2022. [DOI: 10.1016/j.colegn.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Fonseca LDS, Carvalho BC, Santos HO, Silva JMD, Santos JCDO, Ferreira LLDL, Kameo SY. Atuação do Enfermeiro em Cuidados Paliativos na Atenção Primária à Saúde: Revisão Integrativa. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n1.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introdução: A atuação da enfermagem ao indivíduo em cuidados paliativos (CP) na Atenção Primária à Saúde (APS) visa a promover a qualidade de vida dos indivíduos e da sua família como garantia da assistência integral, para um cuidado humanizado e digno, melhorando a maneira de enfrentar a doença e minimizando o sofrimento. Objetivo: Analisar e sintetizar a produção científica relacionada à assistência do enfermeiro ao indivíduo em CP nas APS. Método: Revisão integrativa da literatura realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Base de Dados de Enfermagem (BDENF) e Scientific Electronic Library Online (SciELO), utilizando os descritores: Palliative Care, Nursing e Primary Health Care. Resultados: Foram analisados 17 artigos após seleção sistemática, sintetizados em um quadro com seus principais resultados e agrupados em três categorias: capacitação em CP: uma barreira para atuação do enfermeiro na APS; percepções, experiências e práticas dos enfermeiros nos CP; o papel do enfermeiro na equipe multiprofissional de CP. Conclusão: Notou-se que os enfermeiros possuíam conhecimento superficial acerca dos CP na APS, evidenciando a necessidade de educação continuada para promover a sua atuação em CP. Ademais, estudos com maior rigor metodológico com o foco no enfermeiro como agente disseminador da prática são necessários.
Collapse
|
19
|
Atli Özbaş A, Kovanci MS, Köken AH. Moral distress in oncology nurses: A qualitative study. Eur J Oncol Nurs 2021; 54:102038. [PMID: 34601227 DOI: 10.1016/j.ejon.2021.102038] [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: 07/17/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Oncology nursing is a special field of practice containing many factors that cause moral distress. The purpose of this study was to explore the sources of moral distress in oncology nurses. METHODS This qualitative phenomenological study was conducted with 14 oncology nurses. The mean interview duration was 30 min. Data were analyzed using qualitative inductive content analysis according to the methods of Corbin and Strauss. RESULTS Four main themes were identified in the study. The first theme, related to the failure of quality of care, includes the failure to provide holistic care and competence problems (not feeling competent in oncology practice). The second theme includes biomedical ethical issues commonly observed in the field of oncology. The third theme includes treatment and care practices, consisting of futile treatments, lack of regulation for 'do not resuscitate' orders and decisions to limit life-prolonging treatment, limited informational authority of nurses, and problems related to educational practices on the patient. The final theme includes problems arising from the health care system and institution's management and the need for regulation to support ethical decisions. CONCLUSION Oncology nurses face ethical problems in providing the quality and continuity of care they desire. It is difficult to manage the problems, especially in the end-of-life period. In order to reduce and eliminate these difficulties, it is recommended to make administrative, institutional, legislative, and systemic arrangements.
Collapse
Affiliation(s)
- Azize Atli Özbaş
- Hacettepe University, Faculty of Nursing, Psychiatric Nursing Department, Ankara, Turkey.
| | - Mustafa Sabri Kovanci
- Hacettepe University, Faculty of Nursing, Psychiatric Nursing Department, Ankara, Turkey.
| | - Arif Hüdai Köken
- Kırşehir Ahi Evran University, Faculty of Medicine, History of Medicine and Ethics Department, Kırşehir, Turkey.
| |
Collapse
|
20
|
Meesters S, Grüne B, Bausewein C, Schildmann E. "We don't want to sedate him" - A qualitative interview study on intentions when administering sedative drugs at the end of life in nursing homes and hospitals. BMC Palliat Care 2021; 20:141. [PMID: 34517847 PMCID: PMC8439055 DOI: 10.1186/s12904-021-00832-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous data indicate major differences between countries and settings regarding the intention when administering sedative drugs at the end of life and the perception, which drugs are sedating. Therefore, we aimed to explore the concept of 'sedative drugs' and the intentions of German healthcare professionals in general palliative care when administering sedative drugs at the end of life. METHODS Semi-structured qualitative interviews with physicians and nurses (n = 49). Recruitment took place via contact persons in five hospital departments (haematology/oncology (n = 2), neurology, geriatrics, gynaecology) and five nursing homes. We thematically analysed the transcripts by the Framework approach, using MAXQDA version 2018.2. RESULTS Most interviewees referred to benzodiazepines, opioids, and antipsychotics. Some subsumed all into sedative drugs, others differentiated between sedative drugs, anxiolytics, and analgesics. In explaining their intention, interviewees particularly emphasized what they want to avoid when administering sedative drugs. We identified three main themes regarding (excluded) intentions: (1) use of sedative drugs to relieve the patient's suffering with reduction of consciousness as side effect, (2) use of sedative drugs to relieve the situation for the team and/or the family, (3) distinction between intention and expectation regarding hastening death. Interviewees often equated the term 'sedation' with inducing a state of unconsciousness, which should be avoided. CONCLUSION German healthcare professionals in general palliative care seem to negatively connote the term 'sedation'. Moreover, they see themselves in a more passive role by accepting a side effect rather than performing an intentional act. Critical reflection of indications and intentions in accordance with respective guidelines is needed.
Collapse
Affiliation(s)
- Sophie Meesters
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Bettina Grüne
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
21
|
Ewuoso C, Hall S, Dierickx K. How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies. Glob Bioeth 2021; 32:67-84. [PMID: 33897255 PMCID: PMC8023626 DOI: 10.1080/11287462.2021.1909820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim This study is a systematic review that aims to assess how healthcare professionals manage ethical challenges regarding information within the clinical context. Method and Materials We carried out searches in PubMed, Google Scholar and Embase, using two search strings; searches generated 665 hits. After screening, 47 articles relevant to the study aim were selected for review. Seven articles were identified through snowballing, and 18 others were included following a system update in PubMed, bringing the total number of articles reviewed to 72. We used a Q-sort technique for the analysis of identified articles. Findings This study reveals that healthcare professionals around the world generally employ (to varying degrees) four broad strategies to manage different types of challenges regarding information, which can be categorized as challenges related to confidentiality, communication, professional duty, and decision-making. The strategies employed for managing these challenges include resolution, consultation, stalling, and disclosure/concealment. Conclusion There are a variety of strategies which health professionals can adopt to address challenges regarding information management within the clinical context. This insight complements current efforts aimed at enhancing health professional-patient communication. Very few studies have researched the results of employing these various strategies. Future empirical studies are required to address this. Abbreviations CIOMS: Council of International Organization of Medical Sciences; WHO: World Health Organization; AMA: American Medical Association; WMA: World Medical Association; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; ISCO: International Standard Classification of Occupations; ILO: International Labour Office; SPSS: The Statistical Package for the Social Sciences
Collapse
Affiliation(s)
| | - Susan Hall
- Center for Applied Ethics, Stellenbosch University, Western-Cape, South Africa
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
22
|
Heino L, Stolt M, Haavisto E. The practices and attitudes of nurses regarding palliative sedation: A scoping review. Int J Nurs Stud 2020; 117:103859. [PMID: 33545642 DOI: 10.1016/j.ijnurstu.2020.103859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/12/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Palliative sedation is used as a last-resort option to treat refractory symptoms of dying patients. Nurses are important participants in the process of sedation. However, little is known about palliative sedation from a nursing perspective. OBJECTIVES To analyze the practices and attitudes of nurses concerning palliative sedation. DATA SOURCES AND REVIEW METHODS A scoping review guided by Arksey and O`Malley`s methodological framework was used to analyze existing peer-reviewed empirical research on the topic of the practices and attitudes of nurses related to the palliative sedation of patients aged 18 years and older. Of the 316 publications identified from the PubMed, CINAHL and Cochrane Library, 17 full-text articles were included in this review. The data of the included articles were charted (author(s), year of publication, country, objectives, study design, data collection, setting, respondents, definition of palliative sedation, focus of the study and key findings), and the results were summarized with inductive content analysis. The PRISMA-ScR checklist was used as a guideline for the reporting in this review. RESULTS During the decision-making concerning the start of palliative sedation, nurses usually have an advocatory and supportive role, although the role varies between different countries. This role then changes to a relatively independent performance of sedation; including administration of the medication, monitoring the effectiveness of sedation, and in some cases taking decisions concerning the medication and dosage policy. Further, nurses provide information and compassionate care to both the patient and the family during the process of palliative sedation. Most nurses view palliative sedation as a positive and sometimes necessary last resort therapy to relieve refractory suffering of dying patients. However, sedation poses ethical problems for many nurses. These problems especially concern the essential elements of deciding to use palliative sedation, the depth of sedation, the potential for shortening life, and the loss of social interaction. CONCLUSIONS Nurses play a key role in palliative sedation, as they often perform sedation independently and have important information about the needs and wishes of both patients and their families due to their unique position at the bedside of the patient. Although nurses generally see palliative sedation as a positive practice for selected patients, many of them feel it is ethically controversial. This scoping review reveals a great need for further research and discussion on the practices and attitudes of nurses regarding palliative sedation.
Collapse
Affiliation(s)
- Linda Heino
- Bachelor of Health Sciences, Department of Nursing Science, University of Turku, Turku, Finland.
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku and Turku University Hospital, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku and Satakunta Central Hospital, Pori, Finland
| |
Collapse
|
23
|
Heggestad AKT, Magelssen M, Pedersen R, Gjerberg E. Ethical challenges in home-based care: A systematic literature review. Nurs Ethics 2020; 28:628-644. [PMID: 33334250 DOI: 10.1177/0969733020968859] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of the transfer of responsibility from hospitals to community-based settings, providers in home-based care have more responsibilities and a wider range of tasks and responsibilities than before, often with limited resources. The increased responsibilities and the complexity of tasks and patient groups may lead to several ethical challenges. A systematic search in the databases MEDLINE, CINAHL, and SveMed+ was carried out in February 2019 and August 2020. The research question was translated into a modified PICO (Population, Intervention, Comparison, and Outcome) worksheet. A total of 40 articles were included. The review is conducted according to the Vancouver Protocol. The main findings from the systematic literature review show that ethical challenges experienced by healthcare and social care providers in home-based care are related to autonomy and balancing ethical principles, decisions regarding intensity of care, challenges related to priority settings, truth-telling, and balancing the professional role. Findings regarding ethical challenges within home-based care are in line with findings from institutional healthcare and social care settings. However, some significant differences from the institutional context are also highlighted.
Collapse
|
24
|
Corradi-Perini C, Beltrão JR, Ribeiro URVDCO. Circumstances Related to Moral Distress in Palliative Care: An Integrative Review. Am J Hosp Palliat Care 2020; 38:1391-1397. [PMID: 33280390 DOI: 10.1177/1049909120978826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The practice of palliative care is involved with ethical conflicts related to the life-death process and relief of suffering. The inability to act in the face of such dilemmas, due to internal or external barriers, can cause moral distress in the healthcare professionals. OBJECTIVE The purpose of this integrative review is to analyze which circumstances cause moral distress in healthcare professionals who work in palliative care. METHODS An integrative review of the literature was made in the SCIELO and PubMed databases, based on the descriptors "palliative care" and "moral distress." Articles published between 2015-2020, in Portuguese, Spanish and English were included, following the PRISMA criteria. RESULTS From a selection of 97 documents, 56 were completed reviewed and 23 studies were included in the review. Most articles refer to the nursing area, followed by multidisciplinary studies. The circumstances related to moral distress were identified involving: personal aspects; patients and caregivers; team; environment and organization. Communication problems, lack of resources and witnessing professionals giving false hope to patient and family members were the events related to moral distress most mentioned by the articles in the review. Recommendations for reducing and preventing moral distress include empowerment and educational programs in bioethics and palliative care. CONCLUSIONS Moral distress is an evident phenomenon in palliative care, involving different situations that can impact on quality-of-care provided as well as the well-being of the healthcare professionals.
Collapse
Affiliation(s)
- Carla Corradi-Perini
- Graduated Program in Bioethics, School of Life Sciences, 28100Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, Curitiba, Brazil
| | - Julianna Rodrigues Beltrão
- Graduated Program in Bioethics, School of Life Sciences, 28100Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, Curitiba, Brazil
| | | |
Collapse
|
25
|
De Brasi EL, Giannetta N, Ercolani S, Gandini ELM, Moranda D, Villa G, Manara DF. Nurses' moral distress in end-of-life care: A qualitative study. Nurs Ethics 2020; 28:614-627. [PMID: 33267730 DOI: 10.1177/0969733020964859] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff. RESEARCH QUESTION The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events. RESEARCH DESIGN A hermeneutic-phenomenological qualitative study was performed. PARTICIPANTS AND RESEARCH CONTEXT Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim. ETHICAL CONSIDERATIONS Ethical approval was obtained from the Institutional Review Hospital Board. FINDINGS Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured. DISCUSSION In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events. CONCLUSION Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.
Collapse
Affiliation(s)
| | - Noemi Giannetta
- 18985Vita-Salute San Raffaele University, Italy; Tor Vergata University of Rome, Italy
| | - Sara Ercolani
- 9338ASST Grande Ospedale Metropolitano Niguarda, Italy
| | | | | | - Giulia Villa
- 9372IRCCS San Raffaele Scientific Institute, Italy
| | | |
Collapse
|
26
|
Tomczyk M, Schumacher BN. Nurses' experience with palliative sedation procedures in line with the 2005 Swiss guidelines: an exploratory study. Can Oncol Nurs J 2020; 30:261-268. [PMID: 33165398 DOI: 10.5737/23688076304261268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Many international studies have shown that the process of palliative sedation in an end-of-life context can be an adverse, even emotionally distressing experience for nurses. However, to the best of our knowledge, the experience of nurses working in palliative care in Switzerland has never been explored. The purpose of our study was, therefore, to understand and describe nurses' experience with the process of palliative sedation in line with the Swiss guidelines developed in 2005. We opted for an exploratory qualitative monocentric study using comprehensive individual interviews to achieve this objective. A total of 10 nurses were approached, and nine agreed to take part. After the interviews were transcribed, eight were ultimately included in the analysis. This analysis shows that nurses' attitudes toward the process of palliative sedation tended to be hesitant, resistant, or confident and that this was linked to the length of time they had worked in palliative care. These findings suggest that the 2005 Swiss guidelines do not protect nurses against the uncertainty related to process of palliative sedation. A national comprehensive multicentric study therefore needs to be developed to consolidate these results.
Collapse
Affiliation(s)
- Martyna Tomczyk
- Medical Ethics Researcher, PhD, Postdoctoral Fellow, Institute of Humanities in Medicine, Lausanne University Hospital (CHUV), Avenue de Provence 82, CH-1007 Lausanne, Switzerland, , +33 (0)6 95 11 86 45
| | - Bernard N Schumacher
- Philosopher, Professor, PhD-HDR, Coordinator, Interdisciplinary Institute of Ethics and Human Rights, University of Fribourg, Switzerland. Avenue de Beauregard 13, CH-1700 Fribourg, Switzerland,
| |
Collapse
|
27
|
Riedel A. Palliative Sedierung im stationären Hospiz – Konstruktion einer Ethik-Leitlinie mittels partizipativer Forschung. Pflege 2020; 33:107-109. [DOI: 10.1024/1012-5302/a000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Annette Riedel
- Fakultät Soziale Arbeit, Gesundheit und Pflege, Hochschule Esslingen
| |
Collapse
|
28
|
Jones-Bonofiglio K. Acute Care Contexts. HEALTH CARE ETHICS THROUGH THE LENS OF MORAL DISTRESS 2020. [DOI: 10.1007/978-3-030-56156-7_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
29
|
Wright DK, Gastmans C, Vandyk A, de Casterlé BD. Moral identity and palliative sedation: A systematic review of normative nursing literature. Nurs Ethics 2019; 27:868-886. [DOI: 10.1177/0969733019876312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In the last two decades, nursing authors have published ethical analyses of palliative sedation—an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care. Research aim: The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses’ moral identities are portrayed within this literature. Research design: We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher’s Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven), of the values, responsibilities, and relationships reflected in authors’ portrayal of the nursing role. Findings: Two different tones are apparent in the extant nursing ethics literature. One is educational, while the other is critically reflective. Irrespective of tone, all authors agree on the alleviation of suffering as a fundamental nursing responsibility. However, they differ in their analysis of this responsibility in relation to other values in end-of-life care, including those that depend on consciousness. Finally, authors emphasize the importance of subjective and experience-based understandings of palliative sedation, which they argue as depending on nurses’ proximity to patients and families in end-of-life care. Discussion and conclusion: Based on our findings, we develop three recommendations for future writing by nurses about palliative sedation. These relate to the responsibility of recognizing how consciousness might matter in (some) peoples’ moral experiences of death and dying, to the importance of moral reflectiveness in nursing practice, and to the value of a relational approach in conceptualizing the nursing ethics of palliative sedation.
Collapse
|
30
|
Maffoni M, Argentero P, Giorgi I, Hynes J, Giardini A. Healthcare professionals’ moral distress in adult palliative care: a systematic review. BMJ Support Palliat Care 2019; 9:245-254. [DOI: 10.1136/bmjspcare-2018-001674] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/01/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023]
Abstract
ObjectivesPalliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care.MethodsA literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms ‘moral distress’ AND ‘palliative care’. The review process has followed the international PRISMA statement guidelines.ResultsThe initial search identified 248 papers and 10 of them were considered eligible. Four main areas were identified: (1) personal factors, (2) patients and caregivers, (3) colleagues and superiors and (4) environment and organisation. Managing emotions of self and others, witnessing sufferance and disability, caring for highly demanding patients and caregivers, as well as poor communication were identified as distressing. Moreover, the relationship with colleagues and superiors, and organisational constraints often led to actions which contravened personal values invoking moral distress. The authors also summarised some supportive and preventive recommendations including self-empowerment, communication improvement, management of emotions and specific educational programmes for palliative care providers. A holistic model of moral distress in adult palliative care (integrating emotional, cognitive, behavioural and organisational factors) was also proposed.ConclusionsCognisance of risk and protective factors associated with the moral distress phenomenon may help reframe palliative healthcare systems, enabling effective and tailored actions that safeguard the well-being of providers, and consequently enhance patient care.
Collapse
|
31
|
Applying a Balm: Medicating the Patient to Treat the (Moral) Distress of Caregivers. J Hosp Palliat Nurs 2018; 20:433-439. [PMID: 30188434 DOI: 10.1097/njh.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Moral distress occurs when a nurse knows the right action but is impeded from taking that right action because of institutional constraints. Caring for patients who are dying might evoke distress, including moral distress. The distress from a difficult clinical situation is likely to permeate other areas of practice. In this article, 2 cases are used as a means to distinguish moral distress from other distress arising from clinical situations. Opportunities to alleviate distress include increasing knowledge, improved communication, enhanced collaboration, and development of institutional supports.
Collapse
|