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Bouchez T, Cagnon C, Hamouche G, Majdoub M, Charlet J, Schuers M. Interprofessional clinical decision-making process in health: A scoping review. J Adv Nurs 2024; 80:884-907. [PMID: 37705486 DOI: 10.1111/jan.15865] [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: 12/27/2021] [Revised: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
AIMS To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN Scoping review of the literature. DATA SOURCES MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
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Affiliation(s)
- Tiphanie Bouchez
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
| | - Clémence Cagnon
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Gouraya Hamouche
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Marouan Majdoub
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Jean Charlet
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Assistance Publique-Hôpitaux de Paris/DRCI, Paris, France
| | - Matthieu Schuers
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Department of General Practice, University of Rouen, Rouen, France
- Department of Medical Informatic, Academic Hospital of Rouen, Rouen, France
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Heck LO, Carrara BS, Mendes IAC, Arena Ventura CA. Nursing and advocacy in health: An integrative review. Nurs Ethics 2022; 29:1014-1034. [PMID: 35172646 DOI: 10.1177/09697330211062981] [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: 11/17/2022]
Abstract
BACKGROUND The practice of health advocacy in nursing has been defined as a process aimed at promoting the independence and autonomy of users of health services, in addition to providing information on healthcare decision-making and offering support for decisions taken. ETHICAL CONSIDERATIONS Ethics approval was not required to conduct this review. AIM This integrative review aims to synthesize evidence in the literature on health advocacy in professional nursing practice. METHODS An integrative review methodology guided by Whittemore and Knalf was used. Studies were identified by conducting searches on PubMed, Scopus, Web of Science, CINAHL, and LILACS databases. Of 2179 records, 34 studies matched the inclusion criteria. RESULTS The main aspects involved in the practice of health advocacy by professional nurses are related to the ethical principles of the nursing profession, such as protecting patients seeking autonomy and care. Furthermore, the practice of health advocacy by nurses requires an empathetic attitude, responsibility, and assertive communication. CONCLUSION The diverse possibilities for the practice of advocacy synthesized in this study allow nurses to approach and become familiarized with the topic, being able to acquire and complement knowledge that will reflect on their professional practice in different work environments such as the educational field, in hospital practice, or basic health care.
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Albanesi B, Marchetti A, D'Angelo D, Capuzzo MT, Mastroianni C, Artico M, Lusignani M, Piredda M, De Marinis MG. Exploring Nurses’ Involvement in Artificial Nutrition and Hydration at the End of Life: A Scoping Review. JPEN J Parenter Enteral Nutr 2020; 44:1220-1233. [DOI: 10.1002/jpen.1772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/10/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Beatrice Albanesi
- Department of Biomedicine and Prevention University of Rome “Tor Vergata Rome Italy
| | - Anna Marchetti
- Department of Biomedicine and Prevention University of Rome “Tor Vergata Rome Italy
| | - Daniela D'Angelo
- CNEC Center for Clinical Excellence and Quality of Care Istituto Superiore di Sanità Rome Italy
| | | | | | - Marco Artico
- Palliative Care and Pain Therapy Unit Azienda ULSS 4 Veneto Orientale San Donà di Piave Italy
| | - Maura Lusignani
- Biomedical Sciences for Health University of Milan Milan Italy
| | - Michela Piredda
- Research Unit Nursing Science Campus Bio‐Medico di Roma University Rome Italy
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Schildmann J, Nadolny S, Haltaufderheide J, Gysels M, Vollmann J, Bausewein C. Do we understand the intervention? What complex intervention research can teach us for the evaluation of clinical ethics support services (CESS). BMC Med Ethics 2019; 20:48. [PMID: 31307458 PMCID: PMC6633613 DOI: 10.1186/s12910-019-0381-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluating clinical ethics support services (CESS) has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. MAIN BODY In this paper, we argue that a first necessary step for progress is to better understand the intervention(s) in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, we introduce principles of "complex intervention research" and show how CESS fulfil the criteria of "complex interventions". In a second step, we develop a generic "conceptual framework" for "ethics consultation on request" as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of "bioethics mediation" to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: "proactive ethics consultation" and "moral case deliberation" and discuss implications for evaluating both types of CESS. CONCLUSION To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer "good" CESS.
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Affiliation(s)
- Jan Schildmann
- Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany.
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany
- Institute for educational and health-care research in the health sector (InBVG), Bielefeld University of Applied Sciences, Interaktion 1, 33619, Bielefeld, Germany
- University of Applied Sciences for Diakonia, Bethelweg 8, 33617, Bielefeld, Germany
| | - Joschka Haltaufderheide
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44779, Bochum, Germany
| | - Marjolein Gysels
- Centre for Social Science and Global Health, University of Amsterdam, AHTC, Tower C4, Paasheuvelweg 25, 1105, BP Amsterdam, Netherlands
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44779, Bochum, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Asman O, Melnikov S, Barnoy S, Tabak N. Experiences, behaviors, and perceptions of registered nurses regarding research ethics and misconduct. Nurs Ethics 2017; 26:859-869. [PMID: 28901204 DOI: 10.1177/0969733017727152] [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: 11/15/2022]
Abstract
BACKGROUND Nurses engaging in research are held to research ethics standards. RESEARCH AIM Examine experiences, behaviors, and perceptions of nurses in Israel regarding research ethics and explore possible related factors. RESEARCH DESIGN An original investigator-designed self-administered questionnaire measured five variables: (a) ethics in research, (b) encountered research misconduct during the course of one's studies, (c) the inclination to fabricate data, (d) the inclination to select or omit data, and (e) knowledge of research misconduct in the workplace. Additionally, demographic data were collected. PARTICIPANTS AND RESEARCH CONTEXT The questionnaire was completed by 151 Israeli registered nurses. 10.2% hold a PhD, 34 % hold an MA, 42.2% hold a BA, and 13.6% with no academic degree. ETHICAL CONSIDERATIONS The study was approved by the University's ethics committee; anonymity and consent of the respondents were respected. FINDINGS Registered nurses' level of studies achieved was significantly associated with a lower inclination to fabricate data, with one exception-PhD nurses were more inclined to fabricate data than nurses with a Master's degree. A trend was found in which a higher level of studies is associated with higher knowledge of research misconduct in the workplace. DISCUSSION Results indicate that nurses' perceptions of research ethics change throughout their academic studies, indicating a positive influence of level of studies, research experience, and work experience on ethics perceptions. Nevertheless, PhD nurses showed a greater inclination to actually select, omit, or even fabricate data than MA nurses. This may be related to pressure to publish. CONCLUSION PhD nursing programs should include ethics training. Academic faculty members should serve as role models regarding research integrity. Research ethics deserves further emphasis on all levels of nurse education in Israel, as well as in the nurses' code of ethics and related documents. This may positively impact ethical research practices.
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Pavlish C, Brown-Saltzman K, Jakel P, Fine A. The Nature of Ethical Conflicts and the Meaning of Moral Community in Oncology Practice. Oncol Nurs Forum 2014; 41:130-40. [DOI: 10.1188/14.onf.130-140] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Park M, Jeon SH, Hong HJ, Cho SH. A comparison of ethical issues in nursing practice across nursing units. Nurs Ethics 2014; 21:594-607. [PMID: 24449700 DOI: 10.1177/0969733013513212] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice. RESEARCH OBJECTIVES The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments. RESEARCH DESIGN The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale. PARTICIPANTS The study sample included 993 staff nurses working in a university hospital in South Korea. ETHICAL CONSIDERATIONS This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent. FINDINGS The most frequently and disturbingly encountered issues across nursing units were "conflicts in the nurse-physician relationship," "providing care with a possible risk to your health," and "staffing patterns that limit patient access to nursing care." The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues. DISCUSSION Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit. CONCLUSION This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses' reflection on their experiences.
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Affiliation(s)
- Mihyun Park
- Seoul National University, Republic of Korea
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Abstract
The aim of this study is to examine the current profile of bioethics education in the nursing curriculum as perceived by nursing students and faculty in Korea. A convenience sampling method was used for recruiting 1223 undergraduate nursing students and 140 nursing faculty in Korea. Experience of Bioethics Education, Quality of Bioethics Education, and Demand for Bioethics Education Scales were developed. The Experience of Bioethics Education Scale showed that the nursing curriculum in Korea does not provide adequate bioethics education. The Quality of Bioethics Education Scale revealed that the topics of human nature and human rights were relatively well taught compared to other topics. The Demand for Bioethics Education Scale determined that the majority of the participants believed that bioethics education should be a major requirement in the nursing curriculum. The findings of this study suggest that bioethics should be systemically incorporated into nursing courses, clinical practice during the program, and during continuing education.
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Schlairet MC, Kiser K, Norris S. Clinical ethics support services: an evolving model. Nurs Outlook 2012; 60:309-15. [PMID: 22357314 DOI: 10.1016/j.outlook.2012.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/04/2012] [Accepted: 01/15/2012] [Indexed: 10/28/2022]
Abstract
Ethical issues arising in clinical practice are complex and clinicians must be able to manage the needs of ethically vulnerable patients and families. This paper describes a model for providing Clinical Ethics Support Services as a broad spectrum of care for management of conflict and ethically difficult situations in health care and describes how an ethics consultation process was transformed to a Holistic Care Continuum for managing the needs of ethically vulnerable patients. During a 4-year journey at a regional medical center, a Family Support Team played a central role in identification of ethically vulnerable patients/family, interdisciplinary connectivity, and iterative engagement in the clinical milieu. Concepts of professional advocacy and interdisciplinary perspectives resulted in a model for ethically sound patient care promoting communication among patients/family, staff, and professionals; clarification of interdisciplinary roles and responsibilities; establishment of mutually derived goals and shared solutions; and implementation of interventions maximizing institutional resources.
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Affiliation(s)
- Maura C Schlairet
- College of Nursing, Valdosta State University, 1500 N. Patterson St.,Valdosta, GA 31698, USA.
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Pavlish C, Brown-Saltzman K, Hersh M, Shirk M, Rounkle AM. Nursing priorities, actions, and regrets for ethical situations in clinical practice. J Nurs Scholarsh 2011; 43:385-95. [PMID: 22008185 DOI: 10.1111/j.1547-5069.2011.01422.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Nurses in all clinical settings encounter ethical issues that frequently lead to moral distress. This critical incident study explored nurses' descriptions of ethically difficult situations to identify priorities, action responses, and regrets. METHODS Employing the critical incident technique, researchers developed a questionnaire that collected information on ethically difficult situations, nurse actions, and situational outcomes. Data on nursing priorities and actions were analyzed and categorized using a constant comparison technique. FINDINGS Addressing patient autonomy and quality of life were ethical priorities in the majority of cases. In many cases, nurses analyzed ethics from a diffuse perspective and only considered one dimension of the ethics conflict. However, some nurses were specific in their ethical analysis and proactive in their action choices. Nurses also identified 12 ethics-specific nurse activities, five ways of being, three ways of knowing, and two ways of deliberating. In 21 cases, nurses chose not to pursue their concerns beyond providing standard care. Several nurses expressed significant regret in their narration; most regretted unnecessary pain and suffering, and some claimed they did not do enough for the patient. CONCLUSIONS Not enough specific, evidence-based ethics actions have been developed. Stronger and more proactive nursing voices with early ethics interventions would make valuable contributions to quality of care for patients, especially at the end of life. CLINICAL RELEVANCE Ever-expanding treatment options raise ethical issues and challenge nurses to be effective patient advocates. Evidence-based nursing interventions that promptly identify and address moral conflict will benefit patients, their families, and the entire healthcare team by mitigating potential moral distress and disengagement.
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Affiliation(s)
- Carol Pavlish
- UCLA School of Nursing, Los Angeles, CA 90095–6918, USA.
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Pavlish C, Brown-Saltzman K, Hersh M, Shirk M, Nudelman O. Early indicators and risk factors for ethical issues in clinical practice. J Nurs Scholarsh 2011; 43:13-21. [PMID: 21342420 DOI: 10.1111/j.1547-5069.2010.01380.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Nurses in all clinical settings encounter ethical issues that frequently lead to moral distress. This critical incident study explored nurses' descriptions of ethically difficult situations to identify risk factors and early indicators of ethical conflicts. METHODS Employing the critical incident technique, researchers developed a questionnaire that collected information on ethically difficult situations, their risk factors and early indicators, nurse actions, and situational outcomes. Two nurse researchers independently analyzed and categorized data using a constant comparison technique. FINDINGS Most of the ethically difficult situations pertained to end-of-life care for children and adults. Conflicts in interpersonal relationships were prevalent. Nurses were especially moved by patient and family suffering and concerned about patient vulnerability, harm-benefit ratio, and patient autonomy. Researchers discovered risk factor categories for patients, families, healthcare providers, and health systems. Additionally, researchers found subcategories in six major categories of early indicators: signs of conflict, patient suffering, nurse distress, ethics violation, unrealistic expectations, and poor communication. CONCLUSIONS Nurses are keenly aware of pertinent risk factors and early indicators of unfolding ethical conflicts. Many nurses reported feeling powerless in the face of ethical conflict. Research that develops interventions to strengthen nurses' voices in ethically difficult situation is warranted. CLINICAL RELEVANCE Nurses are in a key position to identify patient situations with a high risk for ethical conflict. Initiating early ethics consultation and interventions can alter the course of pending conflicts and diminish the potential for patient and family suffering and nurses' moral distress.
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Gallardo AI. Responsabilidad de la enfermera en situaciones de limitación de tratamiento. Medwave 2010. [DOI: 10.5867/medwave.2010.11.4802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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