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Zakaria M, Martins RS, Khan MU, Fatimi AS, Maqbool B, Fatimi SH. Operating Ethically: A Review of Surgical Ethics in Pakistan and Recommendations for the Way Forward. Cureus 2023; 15:e46789. [PMID: 37954730 PMCID: PMC10632743 DOI: 10.7759/cureus.46789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Medical ethics underpin the moral framework that delineates the professional relationship between physicians and their patients and thereby is an integral part of making patient-centric healthcare decisions. The concept of ethics is deeply embedded in the field of surgery as surgeons confront a myriad of dilemmas as a part of their routine, whether it be in a preoperative or postoperative environment. The current review aims to describe the state of surgical ethics in Pakistan, with the intent of encouraging dialogues about the ethical considerations relevant to the field surgery that will identify actionable areas for improvement. While most surgeons are aware of the traditional principles of ethics and their practice, their surgical and clinical decisions may fall short of these standards because of time constraints and prevailing cultural and religious beliefs and taboos. The rigorous application of ethical principles in areas of patient-related communication, such as consenting, trainee education, palliative and end-of-life care, and surgical innovation and research, will have significant implications for patients, surgeons, and society. Our review has identified the lack of formal bioethics education and insufficient oversight and ethical regulations to be at the core of inadequate ethical practices in Pakistan and has highlighted actionable areas to be addressed in the future.
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Affiliation(s)
- Maheen Zakaria
- Medical College, Aga Khan University Medical College, Karachi, PAK
| | | | | | | | - Baila Maqbool
- Department of Acute Care Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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Rao SR, Salins N, Joshi U, Patel J, Remawi BN, Simha S, Preston N, Walshe C. Palliative and end-of-life care in intensive care units in low- and middle-income countries: A systematically constructed scoping review. J Crit Care 2022; 71:154115. [PMID: 35907272 DOI: 10.1016/j.jcrc.2022.154115] [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: 05/27/2022] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Death is common in intensive care units, and integrating palliative care enhances outcomes. Most research has been conducted in high-income countries. The aim is to understand what is known about the type and topics of research on the provision of palliative care within intensive care units in low- and middle-income countries MATERIALS AND METHODS: Scoping review with nine databases systematically searched for literature published in English on palliative care in intensive care units in low- and middle- income settings (01/01/1990 to 31/05/2021). Two reviewers independently checked search results and extracted textual data, which were analyzed and represented as themes. RESULTS Thirty papers reported 19 empirical studies, two clinical case reports and six discussion papers. Papers originated from Asia and Africa, primarily using observational designs and qualitative approaches, with no trials or other robust evaluative or comparative studies. No studies directly sought data from patients or families. Five areas of research focus were identified: withholding and withdrawing treatment; professional knowledge and skills; patient and family views; culture and context; and costs of care. CONCLUSIONS Palliative care in intensive care units in low-and middle-income countries is understudied. Research focused on the specific needs of intensive care in low- and middle-income countries is required to ensure optimal patient outcomes.
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Affiliation(s)
- Seema Rajesh Rao
- Karunashraya Institute for Palliative Care Education and Research, Bangalore Hospice Trust, Karunashraya, Bangalore, India.
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, India.
| | - Udita Joshi
- Karunashraya Institute for Palliative Care Education and Research, Bangalore Hospice Trust, Karunashraya, Bangalore, India
| | - Jatin Patel
- Karunashraya Institute for Palliative Care Education and Research, Bangalore Hospice Trust, Karunashraya, Bangalore, India
| | - Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, UK.
| | - Srinagesh Simha
- Karunashraya Institute for Palliative Care Education and Research, Bangalore Hospice Trust, Karunashraya, Bangalore, India
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, UK.
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, UK.
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YazdiMoghaddam H, Manzari ZS, Mohammadi E. Nurses' Challenges in Caring for an Organ Donor Brain Dead Patient and their solution strategies: A Systematic Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:265-272. [PMID: 33014736 PMCID: PMC7494161 DOI: 10.4103/ijnmr.ijnmr_226_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 11/05/2022]
Abstract
Background: Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges. Materials and Methods: In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000–2018 on the keywords “brain dead OR brain death” and “nurses OR nursing.” After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation. Results: According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care. Conclusions: Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be thefirst step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.
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Affiliation(s)
- Hamideh YazdiMoghaddam
- Iranian Research Center on Healthy Aging, Operating Room Department, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra-Sadat Manzari
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Ali MM, Khokhar MA. Issues Regarding End-of-Life Care in Pakistan. J Palliat Care 2019; 35:174-175. [PMID: 31271103 DOI: 10.1177/0825859719855953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ganz FD, Sapir B. Nurses' perceptions of intensive care unit palliative care at end of life. Nurs Crit Care 2018; 24:141-148. [PMID: 30426607 DOI: 10.1111/nicc.12395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/06/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Significant barriers can block the provision of palliative care at the end of life in the intensive care unit (ICU). However, the relationship between perceptions of ICU quality palliative care and barriers to palliative care at the end of life is not well documented. AIMS AND OBJECTIVES To describe ICU nurses' perceptions of quality palliative end-of-life care, barrier intensity and frequency to palliative care and their association with one another. DESIGN This was a descriptive, correlational, cross-sectional design. METHODS A convenience sample of 126 ICU nurses from two hospitals in Israel was recruited for the study. Participants completed three pencil-and-paper questionnaires (a personal characteristics questionnaire, the Quality of Palliative Care in the ICU and a revised Survey of Oncology Nurses' Perceptions of End-of-Life Care). Respondents were recruited during staff meetings or while on duty in the ICU. Ethical approval was obtained for the study from participating hospitals. RESULTS The item mean score of the quality of palliative end-of-life care was 7·5/10 (SD = 1·23). The item mean barrier intensity and frequency scores were 3·05/5 (SD = 0·76) and 3·30/5 (SD = 0·61), respectively. A correlation of r = 0·46, p < 0·001 was found between barrier frequency and intensity and r = -0·19, p = 0·04 between barrier frequency and quality palliative end-of-life care. CONCLUSIONS ICU nurses perceived the quality of palliative care at the end of life as moderate despite reports of moderate barrier levels. The frequency of barriers was weakly associated with quality palliative end-of-life care. However, barrier intensity did not correlate with quality palliative end-of-life care at a statistically significant level. Further research that investigates other factors associated with quality ICU palliative care is recommended. RELEVANCE TO CLINICAL PRACTICE Barriers to palliative care are still common in the ICU. Increased training and education are recommended to decrease barriers and improve the quality of ICU palliative care.
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Affiliation(s)
- Freda DeKeyser Ganz
- Research and Development, Hadassah Hebrew University School of Nursing, Jerusalem, Israel
| | - Batel Sapir
- Hadassah Hebrew University School of Nursing and Hadassah Medical Center, Jerusalem, Israel
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Moghaddam HY, Manzari ZS, Heydari A, Mohammadi E. Explaining nurses' experiences of caring for brain dead patients: a content analysis. Electron Physician 2018; 10:7205-7216. [PMID: 30214703 PMCID: PMC6122867 DOI: 10.19082/7205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 01/17/2023] Open
Abstract
Background Caring for patients with brain death diagnosis is the heaviest of duties for nurses, and, due to the complexities and stressors, it is the biggest challenge of nursing in an intensive care unit. Objective This qualitative research aimed to disclose the nurses' experience of caring for brain-dead patients. Methods The present study was a qualitative research using a content analysis, where the data collection process included 21 semi-structured and in-depth interviews with intensive care nurses, physicians, head nurses, a transplantation committee coordinator, and the authority of the organ procurement unit. Adequate data were collected from March 2014 until the saturation point was reached in June 2016. Data were analyzed simultaneously with data collection using qualitative content analysis with a conventional approach. Results Qualitative content analysis of data resulted in two themes and eight subthemes, reflecting the analysis of nurses' experiences of caring for brain-dead patients. The themes included "Challenges of right and duty requirement," and "turbulent confrontation with successive chains of tension". Finally, the main themes of "resonance of stress and internal conflict in care" were abstracted. Conclusion The findings deepened our understanding and knowledge of the issue. Despite all the stress, nurses care for potential organ donors, and this results in preserving the organs' viability for donation. Nurses' problems and challenges in this caring process should be considered by policymakers of health and treatment systems and a supportive model be designed for nurses in the intensive care unit.
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Affiliation(s)
- Hamideh Yazdi Moghaddam
- Ph.D. of Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.,Assistant Professor, Anesthesiology and Operating Room Department, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra Sadat Manzari
- Ph.D. of Nursing, Assistant Professor, Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Ph.D. of Nursing, Professor, Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Ph.D. of Nursing, Professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Moghaddam HY, Pouresmaeili A, Manzari ZS. Analysis of the reasons for nurses' confusion in relation to the concept of brain death from clinical and legal points of view. Electron Physician 2018; 10:6868-6876. [PMID: 29997774 PMCID: PMC6033127 DOI: 10.19082/6868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/26/2017] [Indexed: 11/20/2022] Open
Abstract
Background Nurses in intensive care units (ICU) play a key role in taking care of brain dead patients and they are often in contact with such patients given the high rate of brain deaths. Consequently, they are in a challenging and stressful condition, which may be aggravated due to the need for increased organ donation, and this may also affect the quality of care provided for these patients. Objective This review analyzes the different studies on the concept of brain death from both medical and legal points of view. The aim of this study was to identify the challenges the nurses face with the perception of the concept of brain death and its effects on the care provided for the patients suffering from brain death, as well as organ donation. Methods This Narrative review study summarizes the information obtained from relevant literature through a targeted search of library texts and electronic resources including Science Direct, PubMed, Google Scholar, Scientific Information Database (SID), IranMedex, and Magiran databases during 2000–2017 in English and Persian, on the subject of interest by keywords such as brain death, organ donation, care, legal, regulations and nursing. Finally, a total of 44 relevant articles were reviewed. Results Nurses play an important role in taking care of brain dead patients; therefore, recognizing challenges can be the first step in taking accurate care of these patients and subsequently maintaining the organs’ health for transplants. Although there are clinical and legal uncertainties regarding the concept of brain death, nurses have an important effect on taking care of brain dead patients as well as the rate of organ donation. Conclusion Nurses in intensive care units should have a clear understanding of the concept of brain death in order to be able to take care of brain dead patients by avoiding psychological effects. In this regard, it is recommended that a comprehensive educational program be designed on the dimensions of brain death. Therefore, the nurses’ awareness of brain death and their ability to clarify this concept to the patients’ relatives would have a great effect on the decrease in the challenges and the stress imposed on the nurses. Also, there would be an increase in the quality of the care given to brain dead patients and even the rate of organ donation.
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Affiliation(s)
- Hamideh Yazdi Moghaddam
- Ph.D. in Nursing, Faculty of Paramedical, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Alireza Pouresmaeili
- Ph.D. in Private Law, Assistant Professor, Department of Law, Faculty of Theology and Islamic Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - Zahra Sadat Manzari
- Ph.D. of Nursing, Assistant Professor, Department of Medical-surgical nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Kumar A, Naqvi S, Giyanwani PR, Yousuf F, Masnoon A, Bai K, Kumar D. Euthanasia: A Controversial Entity Among Students of Karachi. Cureus 2017; 9:e1510. [PMID: 28948130 PMCID: PMC5608484 DOI: 10.7759/cureus.1510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background A serene death may be achieved through skilled and compassionate care, as well as by the dying person's own sense of having lived a righteous life. The purpose of this study is to acquire information about students' knowledge and understanding of euthanasia. Materials and Methods Four hundred and fifty-six students from four classes of two institutions with similar demographic characteristics were included in this cross-sectional study. A questionnaire adapted from a study of 'Gruber, et al.' was distributed among the respondents after obtaining a verbal informed consent. The questionnaire had two parts, first dealing with demographics of respondents, and in the second part students were given different situations and asked about their decision in that particular setting to understand their opinion about euthanasia. Results There were 31.7% medical students and 12.9% non-medical students in favor to provide complete medical information (p < 0.001) while 59.2% non-medical students thought that complete information should be given to a patient if any iatrogenic incident occurred. Same favored by 33.7% of medical students (p < 0.001). The majority of medical students (84.5%) felt that cardiopulmonary resuscitation (CPR) must always be provided (p < 0.001) and this was acceptable more among females (p = 0.001). Furthermore, medical students (57.6%) were more in favor of continuing maximum medical treatment including CPR than non-medical students (42.9%, p = 0.003). A total of 83% non-medical students and 46% medical students found euthanasia an acceptable practice. Conclusion Results show a significant difference in perception of medical and non-medical students regarding euthanasia. Non-medical students are more in favor of euthanasia than medical students. Also, it is observed that males seem to be more inclined towards euthanasia while females are more in favor to provide maximum medical treatment.
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Affiliation(s)
| | - Syeda Naqvi
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | | | | | - Aaliya Masnoon
- Internal Medicine, Credit Valley Hospital, Mississauga, Ontario
| | - Kiran Bai
- Medicine, Peoples University of Medical and health sciences for women
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Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions. Intensive Care Med 2016; 42:1118-27. [DOI: 10.1007/s00134-016-4347-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
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Piedrafita-Susín AB, Yoldi-Arzoz E, Sánchez-Fernández M, Zuazua-Ros E, Vázquez-Calatayud M. [Nurses' perception, experience and knowledge of palliative care in intensive care units]. ENFERMERIA INTENSIVA 2015; 26:153-65. [PMID: 26242205 DOI: 10.1016/j.enfi.2015.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. OBJECTIVE To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. METHODOLOGY A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. RESULTS Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. CONCLUSION This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making.
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Affiliation(s)
- A B Piedrafita-Susín
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España.
| | - E Yoldi-Arzoz
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - M Sánchez-Fernández
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - E Zuazua-Ros
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - M Vázquez-Calatayud
- Área de Investigación, Formación y Desarrollo en Enfermería, Clínica Universidad de Navarra, Pamplona, España
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Siddiqui OT, Nizami S, Raza E, Ali MU, Bikak M, Siddiqui S, Khan SH, Mustafa MA, Khan S, Fatmi Z. Deceased-Donor Organ Transplantation: Knowledge and Attitudes Among Health Care Professionals Managing Critically Ill Patients in Karachi. EXP CLIN TRANSPLANT 2012; 10:544-50. [DOI: 10.6002/ect.2012.0130] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Townsend SC, Hardy J. End-of-life decision-making in intensive care: the case for an international standard or a standard of care? Intern Med J 2008; 38:303-4. [PMID: 18402557 DOI: 10.1111/j.1445-5994.2008.01654.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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