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Azimi H, Rezapour-Nasrabad R, Borhani F, Sadat-Hoseini AS, Momeni M. The model of solving ethical challenges with nursing based on faith in God: a new model for nurses to care during epidemics. BMC Nurs 2024; 23:538. [PMID: 39112997 PMCID: PMC11304786 DOI: 10.1186/s12912-024-02207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/26/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND The existence of various ethical challenges, the inability to resolve ethical conflicts, and, as a result, the low quality of care and the occurrence of dissatisfaction in patients and nurses have been discussed for years. By creating new ethical challenges, the Covid-19pandemic has played an important role in making the process of care for these patients more difficult and complicated. This study was conducted with the aim of designing a prescriptive model to help provide ethical-care and resolve ethical conflicts during the Covid-19pandemic. METHODS In this two-stage qualitative study, a grounded theory research method was used in the first stage, and data were collected through semi-structured interviews. Sampling started purposefully and continued theoretically. In the second step, the appropriate model was designed using the three-step method proposed by Walker and Avant. RESULTS The core concept was "behavior based on faith in God", based on which the grounded theory of "faithful nursing" and then "model of solving ethical challenges with nursing based on faith in God" were presented. The strategies of the model in three parts are strengthening the beliefs of nurse, strengthening environmental facilitators to help nurse, and strengthening situational analysis in duty diagnosis in nurse were presented. CONCLUSIONS According to this model, nurses' beliefs play a key role, and the strengthening of environmental factors play a secondary role in ethical-care.
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Affiliation(s)
- Hamideh Azimi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rafat Rezapour-Nasrabad
- Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fariba Borhani
- Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Sadat Sadat-Hoseini
- Pediatric and NICU Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Momeni
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Tosam MJ. Autonomy-based bioethics and vulnerability during the COVID-19 pandemic: towards an African relational approach. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:183-197. [PMID: 38789700 DOI: 10.1007/s11017-024-09671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
The COVID-19 pandemic has provoked new interest in the notion of vulnerability and in identifying alternative approaches for responding to vulnerable patients and populations during health emergencies. In this paper, I argue that the autonomy-based approach (the most dominant approach in bioethics) to responding to vulnerability during health emergencies is deficient because it focuses only on the interests, values, and decisions of the individual patient. It overly emphasizes respect for autonomy and not respect for the patient as it does not consider the patient as a social and relational agent. Indeed, relational approaches to autonomy like the feminist and indigenous sub-Saharan African ethical approaches are promising alternatives. In this essay, I use the indigenous African relational approach to autonomy as an example of an alternative method which can be used to respond to vulnerability during a global health emergency like COVID-19.
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Affiliation(s)
- Mbih Jerome Tosam
- Department of Philosophy, The University of Bamenda, Bamenda, Cameroon.
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Smith EM, Rakestraw C, Farroni JS. Scientific priorities and relational dynamics during the COVID-19 pandemic: A qualitative study. Account Res 2024; 31:356-376. [PMID: 36168913 PMCID: PMC10076447 DOI: 10.1080/08989621.2022.2130058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
To rapidly respond to the COVID-19 public health crisis, researchers have been called upon to prioritize pandemic research, while simultaneously modifying their existing research to maintain the safety of all stakeholders. This study aims to explore the experiences of health science researchers in their scientific practices, research priorities, and professional relational dynamics due to COVID-19. Specifically, we interviewed 31 researchers from diverse fields at the University of Texas Medical Branch. Participants worked on COVID-19, non-COVID-19 related research, or both. We integrated inductive and deductive coding using a thematic coding method. The following four themes were explored: 1) impact of research, 2) research priorities, 3) professional relationships and 4) contextual influences on science. Participants were drawn to COVID-19 work for a diversity of reasons including social need, scientific interest, professional duty, and increased access to funding opportunities. While collaborations have increased for COVID-19 researchers, interpersonal relationships have been challenging for participants. Additionally, political, familial, and personal stresses due to the pandemic have taken a toll on researchers in very different and often inequitable ways. To ensure team cohesion, there is a need to develop research practices, policies and systems that value empathy, flexibility, and interdependence.
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Affiliation(s)
- Elise M Smith
- Department of Bioethics and Health Humanities, School of Public and Population Health, Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Corisa Rakestraw
- Department of Bioethics and Health Humanities, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Jeffrey S Farroni
- Department of Bioethics and Health Humanities, School of Public and Population Health, Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas
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da Silva Neto PK, de Souza MT, de Gouvêa AR, da Mata LRF, Luchesi BM, Pessalacia JDR. Health professionals' knowledge about ethical criteria in the allocation of resources in the COVID-19 pandemic. Monash Bioeth Rev 2023; 41:181-197. [PMID: 37156990 PMCID: PMC10166454 DOI: 10.1007/s40592-023-00174-y] [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] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
Due to the rapid advance of the pandemic caused by COVID-19, several countries perceived that human and material resources would be insufficient to meet the demand of infected patients. The aim of this study is to analyze the knowledge of health professionals working in the pandemic about the application of ethical criteria in decision-making in situations of resource scarcity. This is a cross-sectional, descriptive, and quantitative survey study, conducted from June to December 2020, with health professionals working in the COVID-19 pandemic in Brazil. We applied a questionnaire to assess the professionals' knowledge about ethical criteria in decision-making in the allocation of scarce resources during the pandemic, containing 14 questions and possible score from 0 to 70, which was developed by researchers from documents and protocols validated by organizations from various countries, available in the first months of the pandemic, a sociodemographic characterization questionnaire and a self-assessment questionnaire regarding knowledge about bioethics. A total of 197 health professionals participated in the study, 37.6% of whom were nurses and 22.8% of whom were physicians, working in the Family Health Unit (28.4%) with a degree at the level of specialization (46.2%). Moreover, (9.5%) of nurses, (18.2%) of dental surgeons and (24.4%) of physicians reported that they have no prior knowledge about bioethics. Physicians and hospital workers scored higher on the knowledge assessment questionnaire. The mean score of the participants was 45.4 (SD = 7.2). Investments in training and professional education in the field of health focused on Bioethics are necessary, considering models and ethical theories that help professionals, managers and society to better position themselves in the face of pandemic contexts.
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Bibler TM, Zainab A. Withdrawing extra corporeal membrane oxygenation (ECMO) against a family's wishes: Three permissible scenarios. J Heart Lung Transplant 2023; 42:849-852. [PMID: 36972748 DOI: 10.1016/j.healun.2023.03.014] [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: 12/01/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
The ethical permissibility of unilaterally withdrawing life-sustaining technologies has been a perennial topic in transplant and critical care medicine, often focusing on CPR and mechanical ventilation. The permissibility of unilateral withdrawal of extracorporeal membrane oxygenation (ECMO) has been discussed sparingly. When addressed, authors have appealed to professional authority rather than substantive ethical analysis. In this Perspective, we argue that there are at least three (3) scenarios wherein healthcare teams would be justified in unilaterally withdrawing ECMO, despite the objections of the patient's legal representative. The ethical considerations that provide the groundwork for these scenarios are, primarily: equity, integrity, and the moral equivalence between withholding and withdrawing medical technologies. First, we place equity in the context of crisis standards of medicine. After this, we discuss professional integrity as it relates to the innovative usage of medical technologies. Finally, we discuss the ethical consensus known at the "equivalence thesis." Each of these considerations include a scenario and justification for unilateral withdrawal. We also provide three (3) recommendations that aim at preventing these challenges at their outset. Our conclusions and recommendations are not meant to be blunt arguments that ECMO teams wield whenever disagreement about the propriety of continued ECMO support arises. Instead, the onus will be on individual ECMO programs to evaluate these arguments and decide if they represent sensible, correct, and implementable starting points for clinical practice guidelines or policies.
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Affiliation(s)
- Trevor M Bibler
- Center for Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
| | - Asma Zainab
- Department of Cardiovascular Anesthesia, Weill Cornell Medical College, New York, New York; Intensivist Cardiovascular Surgical ICU, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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Skelton E, Smith A, Harrison G, Rutherford M, Ayers S, Malamateniou C. The effect of the COVID-19 pandemic on UK parent experiences of pregnancy ultrasound scans and parent-fetal bonding: A mixed methods analysis. PLoS One 2023; 18:e0286578. [PMID: 37267279 DOI: 10.1371/journal.pone.0286578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Companionship in antenatal care is important for facilitating positive parental experiences. During the COVID-19 pandemic, restrictions on partner attendance at fetal ultrasound scans were introduced nationally to minimise transmission of the virus. This study aimed to explore the effect of these restrictions on maternal and paternal experiences of pregnancy scans and evaluate their potential effect on parent-fetal bonding. METHODS A UK-wide, anonymous cross-sectional survey was completed by new and expectant parents (n = 714) who had, or were awaiting a pregnancy scan during the COVID-19 pandemic. The CORE-10 and an adapted version of the Prenatal Attachment Inventory were used to evaluate psychological distress and prenatal bonding. Additional survey questions captured parental experiences of scans. Separate statistical and thematic analyses of the data were undertaken. A joint display matrix was used to facilitate integration of quantitative and qualitative claims to generate a comprehensive interpretation of study findings. FINDINGS When fathers did not attend the scan, feelings of excitement and satisfaction were significantly reduced (p<0.001) and feelings of anxiety increased (p<0.001) in both parents. Mothers were concerned about receiving unexpected news alone and fathers felt excluded from the scan. Mean paternal bonding (38.22, SD 10.73) was significantly lower compared to mothers (47.01, SD 7.67) although no difference was demonstrated between those who had attended the scan and those who had not. CORE-10 scores suggested low-to-mild levels of psychological distress, although the mean difference between mothers and fathers was not significant. Key themes described both parents' sense of loss for their desired pregnancy scan experience and reflected on sonographers' central role in providing parent-centred care during scans. CONCLUSION Restrictions on partner attendance at scans during the COVID-19 pandemic had a negative effect on parental experiences of antenatal imaging. Provision of parent-centred care, which is inclusive of partners, is essential for improved parental experiences.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alison Smith
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gill Harrison
- Society and College of Radiographers, London, United Kingdom
| | - Mary Rutherford
- Perinatal Imaging and Health, King's College London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Christina Malamateniou
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Abstract
BACKGROUND Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. AIMS To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. RESEARCH DESIGN A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. PARTICIPANTS AND RESEARCH CONTEXT Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. ETHICAL CONSIDERATIONS The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. FINDINGS The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. CONCLUSIONS Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.
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Affiliation(s)
- Enrico De Luca
- Faculty of Health and Life Science, Academy of
Nursing, Exeter, Exeter University, Exeter, UK
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Rochwulaningsih Y, Sulistiyono ST, Utama MP, Masruroh NN, Sholihah F, Yudha FGP. Integrating socio-cultural value system into health services in response to Covid-19 patients' self-isolation in Indonesia. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:162. [PMID: 37073272 PMCID: PMC10089823 DOI: 10.1057/s41599-023-01629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/16/2023] [Indexed: 05/03/2023]
Abstract
This article studies the synergistic sociocultural value system to handle COVID-19 patients in self-isolation in Indonesia, to find an effective formula in COVID-19 spread control. The problems studied here is the response carried out and the constraints faced by the Indonesian government related to the self-isolation policy. Why and how does the Indonesians' sociocultural value system contribute to COVID-19 patient response? Through the survey conducted via Google Forms, in-depth interviews, focus group discussions and literature study, it is found that the Indonesian government issued the self-isolation regulation for COVID-19 patients to mitigate the rapid and massive COVID-19 transmission. However, many constraints are found in the policy implementation, including; people's insufficient knowledge and understanding of COVID-19, leading to negative implications for the COVID-19 survivors or patients' perception, causing social stigmatisation for COVID-19 survivors or patients; COVID-19 task force's limited access to medicine, medical instrument and hospital facilities. Meanwhile, the Indonesians' strong socio-cultural values like tolerance, mutual aid, and communal work, including among the educated people in urban society, may be potentially integrated into the health service to respond to COVID-19 patients with their self-isolation. Therefore, their integration and empowerment can be a solution to mitigating COVID-19 transmission in Indonesia.
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Affiliation(s)
- Yety Rochwulaningsih
- Departement of History, Faculty of Humanities, Universitas Diponegoro, Semarang, Indonesia
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Singgih Tri Sulistiyono
- Departement of History, Faculty of Humanities, Universitas Diponegoro, Semarang, Indonesia
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Mahendra Puji Utama
- Departement of History, Faculty of Humanities, Universitas Diponegoro, Semarang, Indonesia
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Noor Naelil Masruroh
- Departement of History, Faculty of Humanities, Universitas Diponegoro, Semarang, Indonesia
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Fanada Sholihah
- Departement of History, Faculty of Humanities, Universitas Diponegoro, Semarang, Indonesia
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Fajar Gemilang Purna Yudha
- Departement of History, Faculty of Humanities, Universitas Diponegoro, Semarang, Indonesia
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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Paradoxes of pandemic infection control: Proximity, pace and care within and beyond SARS-CoV-2. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100110. [PMID: 35693450 PMCID: PMC9170590 DOI: 10.1016/j.ssmqr.2022.100110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/17/2022] [Accepted: 05/27/2022] [Indexed: 01/12/2023]
Abstract
From the adoption of mask-wearing in public settings to the omnipresence of hand-sanitising, the SARS-CoV-2 pandemic has brought unprecedented cultural attention to infection prevention and control (IPC) in everyday life. At the same time, the pandemic threat has enlivened and unsettled hospital IPC processes, fracturing confidence, demanding new forms of evidence, and ultimately involving a rapid reassembling of what constitutes safe care. Here, drawing on semi-structured interviews with 63 frontline healthcare workers from two states in Australia, interviewed between September 2020 and March 2021, we illuminate some of the affective dimensions of IPC at a time of rapid change and evolving uncertainty. We track how a collective sense of risk and safety is relationally produced, redefining attitudes and practices around infective risk, and transforming accepted paradigms of care and self-protection. Drawing on Puig de la Bellacasa's formulation, we propose the notion of IPC as a multidimensional matter of care. Highlighting the complex negotiation of space and time in relation to infection control and care illustrates a series of paradoxes, the understanding of which helps illuminate not only how IPC works, in practice, but also what it means to those working on the frontline of the pandemic.
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Preparing for the Worst-Case Scenario in a Pandemic: Intensivists Simulate Prioritization and Triage of Scarce ICU Resources. Crit Care Med 2022; 50:1714-1724. [PMID: 36222541 PMCID: PMC9668365 DOI: 10.1097/ccm.0000000000005684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Simulation and evaluation of a prioritization protocol at a German university hospital using a convergent parallel mixed methods design. DESIGN Prospective single-center cohort study with a quantitative analysis of ICU patients and qualitative content analysis of two focus groups with intensivists. SETTING Five ICUs of internal medicine and anesthesiology at a German university hospital. PATIENTS Adult critically ill ICU patients ( n = 53). INTERVENTIONS After training the attending senior ICU physicians ( n = 13) in rationing, an impending ICU congestion was simulated. All ICU patients were rated according to their likelihood to survive their acute illness (good-moderate-unfavorable). From each ICU, the two patients with the most unfavorable prognosis ( n = 10) were evaluated by five prioritization teams for triage. MEASUREMENTS AND MAIN RESULTS Patients nominated for prioritization visit ( n = 10) had higher Sequential Organ Failure Assessment scores and already a longer stay at the hospital and on the ICU compared with the other patients. The order within this worst prognosis group was not congruent between the five teams. However, an in-hospital mortality of 80% confirmed the reasonable match with the lowest predicted probability of survival. Qualitative data highlighted the tremendous burden of triage and the need for a team-based consensus-oriented decision-making approach to ensure best possible care and to support professionals. Transparent communication within the teams, the hospital, and to the public was seen as essential for prioritization implementation. CONCLUSIONS To mitigate potential bias and to reduce the emotional burden of triage, a consensus-oriented, interdisciplinary, and collaborative approach should be implemented. Prognostic comparative assessment by intensivists is feasible. The combination of long-term ICU stay and consistently high Sequential Organ Failure Assessment scores resulted in a greater risk for triage in patients. It remains challenging to reliably differentiate between patients with very low chances to survive and requires further conceptual and empirical research.
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González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, Bouza E. Lessons from COVID-19 for future disasters: an opinion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:444-454. [PMID: 35754203 PMCID: PMC9548069 DOI: 10.37201/req/058.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022]
Abstract
A "Pandemic/Disaster Law" is needed to condense and organize the current dispersed and multiple legislation. The State must exercise a single power and command appropriate to each situation, with national validity. The production of plans for the use of land and real estate as potential centers for health care, shelter or refuge is recommended. There should be specific disaster plans at least for Primary Health Care, Hospitals and Socio-sanitary Centers. The guarantee of the maintenance of communication and supply routes is essential, as well as the guarantee of the autochthonous production of basic goods. The pandemic has highlighted the need to redefine the training plans for physicians who, in their different specialties, have to undertake reforms that allow a more versatile and transversal training. National research must have plans to be able to respond quickly to questions posed by the various crises, using all the nation's resources and in particular, all the data and capabilities of the health sector. Contingency plans must consider ethical aspects, and meet the needs of patients and families with a humanized approach. In circumstances of catastrophe, conflicts increase and require a bioethical response that allows the best decisions to be made, with the utmost respect for people's values. Rapid, efficient and truthful communication systems must be contained in a special project for this sector in critic circumstances. Finally, we believe that the creation of National Coordination Centers for major disasters and Public Health can contribute to better face the crises of the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Mestres‐Soler O, Leyva‐Moral JM, Aguayo‐González M, Zuriguel‐Pérez E, Rosales M, Gómez‐Ibáñez R. Autonomy and isolation experienced by patients and primary caregivers during COVID-19 hospitalization in Barcelona (Spain). Nurs Health Sci 2022; 24:853-861. [PMID: 36117318 PMCID: PMC9537796 DOI: 10.1111/nhs.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/27/2022]
Abstract
This study aims to describe patients' and family caregivers' hospitalization experiences during the COVID-19 pandemic. Using qualitative exploratory descriptive methods, 13 patients admitted to the largest hospital in Barcelona (Spain) due to COVID-19 were interviewed by telephone once discharged, as were eight primary caregivers. Data were analyzed using the content analysis method proposed by Krippendorff. Two main themes were identified: (i) Acceptance of mandatory isolation for patients and family caregivers, which refers to the verbalization of a feeling that justifies the imposed isolation and the need for the use of personal protective equipment by the health team for everyone's safety; and (ii) Limited autonomy during hospitalization for patients and family caregivers, which describes participants' perceptions of autonomy during hospitalization. Patients and caregivers experienced feelings of loneliness, which negatively affected their emotional health. In addition, they experienced reduced autonomy due to new habits and routines intended to control the pandemic for the benefit of public and global health.
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Affiliation(s)
- Olga Mestres‐Soler
- Nursing Department. Faculty of Medicine. Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS)Universitat Autónoma de Barcelona, Avda. Can Domènech s/n, 08193BellaterraBarcelonaSpain
| | - Juan M. Leyva‐Moral
- Universitat Autònoma de Barcelona, Department of Nursing. Faculty of Medicine.Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Mariela Aguayo‐González
- Nursing Department. Faculty of Medicine. Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS)Universitat Autónoma de Barcelona, Avda. Can Domènech s/n, 08193BellaterraBarcelonaSpain
| | - Esperanza Zuriguel‐Pérez
- Department of Knowledge Management and EvaluationVall d'Hebron University Hospital. Barcelona, Spain. Head of Multidisciplinary Nursing Research Group. Vall d’Hebron Research Institute (VHIR)BarcelonaSpain
| | - Marta Rosales
- Hospitalization nurse at the Vall d’Hebron General HospitalBarcelonaSpain
| | - Rebeca Gómez‐Ibáñez
- Nursing Department. Faculty of Medicine. Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS)Universitat Autónoma de Barcelona, Avda. Can Domènech s/n, 08193BellaterraBarcelonaSpain
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[Prioritization of health resources in contexts of scarcity. SESPAS Report 2022]. GACETA SANITARIA 2022; 36 Suppl 1:S51-S55. [PMID: 35781149 PMCID: PMC9244785 DOI: 10.1016/j.gaceta.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 12/26/2022]
Abstract
La pandemia de COVID-19 ha supuesto un desafío tanto clínico como jurídico y bioético. Se desarrollan estos tres pilares fundamentales en el abordaje de la priorización de recursos sanitarios en pandemia: criterios clínicos, marco legal correspondiente y principios éticos aplicables. Inicialmente se aplicaron criterios clínicos para identificar a los pacientes con mejor pronóstico de supervivencia, combinando una evaluación clínica y el uso de variables de pronóstico a corto y largo plazo. Sin embargo, la decisión de priorizar la atención de un paciente sobre otro tiene una carga jurídico-política, que presenta el riesgo de caer en la discriminación ya que están en juego derechos fundamentales. Los criterios de priorización deben basarse en principios que reflejen como filosofía vehicular la que hemos asumido constitucionalmente como Estado social y democrático de Derecho, que no responde al utilitarismo, sino al personalismo. Cualquier filosofía de distribución de recursos tiene que tener presente la perspectiva científica, constitucional y, con ellas, las de los derechos fundamentales y los principios bioéticos. En la priorización de los recursos deberían consolidarse principios éticos como el respeto a la dignidad de las personas, el principio de necesidad (igual necesidad, igual acceso al recurso), el principio de equidad (que aconseja priorizar a los grupos de población más vulnerables), la transparencia (fundamental en la confianza de la sociedad) y el principio de reciprocidad (que exige proteger a los sectores de la población que asumen más riesgos), entre otros.
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Thirsk LM, Stahlke S, Perry B, Gordon B. #Morethanavisitor: Experiences of COVID-19 visitor restrictions in Canadian long-term care facilities. FAMILY RELATIONS 2022; 71:FARE12712. [PMID: 35936016 PMCID: PMC9347746 DOI: 10.1111/fare.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/09/2021] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
Objective The purpose of this study was to understand the experiences of families, residents, and staff around visitor restriction policies in long-term care during the COVID-19 pandemic in Canada. Background Beginning in March 2020, public health orders across Canada restricted visitors to long-term care facilities to curb the spread of the infection. This included family caregivers who provide significant support to residents to meet their physical, psychological, social, and safety needs. Method We collected data from publicly available news and social media. News articles, blogs, and tweets from Canada were collected from March 2020 to April 2021. In total, 40 news articles, eight blogs, and 23 tweets were analyzed using generic qualitative description. Results Reports from family members indicate that some residents may have died from malnutrition, dehydration, and isolation, rather than from COVID-19, because of the sudden and prolonged absence of family caregivers. There are long-term impacts on family suffering and long-term care worker burnout. Policy and structural issues were identified. Conclusion Experiences in long-term care reflected not only impacts of pandemic-related visitor restrictions, but also long-standing funding and workforce issues. Implications Involvement of family, and specifically family caregivers, is crucial in policy decisions, even in unusual circumstances, such as the pandemic.
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Affiliation(s)
| | - Sarah Stahlke
- Department of SociologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Beth Perry
- Faculty of Health DisciplinesAthabasca UniversityAthabascaAlbertaCanada
| | - Brogan Gordon
- Faculty of Health DisciplinesAthabasca UniversityAthabascaAlbertaCanada
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15
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Daly A, Teeling SP, Garvey S, Ward M, McNamara M. Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052754. [PMID: 35270447 PMCID: PMC8910100 DOI: 10.3390/ijerph19052754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.
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Affiliation(s)
- Ailish Daly
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
- Correspondence:
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research, Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh EH21 6UU, UK
| | - Suzanne Garvey
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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16
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Sullivan WF, Björne P, Heng J, Northway R. Ethics framework and recommendations to support capabilities of people with intellectual and developmental disabilities during pandemics. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022; 19:116-124. [PMID: 35601010 PMCID: PMC9115164 DOI: 10.1111/jppi.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- William F. Sullivan
- Department of Family and Community Medicine and Academic Family Health Team St. Michael's Hospital Toronto Ontario Canada
| | - Petra Björne
- Department for Disability Support Malmö Sweden
- University of Lund Lund Sweden
| | - John Heng
- Departments of Philosophy, Thanatology, Disability Studies King's University College at Western University London Ontario Canada
| | - Ruth Northway
- Faculty of Life Sciences and Education University of South Wales Wales UK
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17
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Yip JYC. Ethical considerations for clinicians faced with patients lacking the capacity to form reasoned judgments regarding COVID-19 tests and isolation. J Med Ethics Hist Med 2022; 14:13. [PMID: 35082993 PMCID: PMC8754172 DOI: 10.18502/jmehm.v14i13.7668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeffrey Yuk-Chiu Yip
- Lecturer, School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
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18
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Vaccine Hesitancy and Anti-Vaccination Attitudes during the Start of COVID-19 Vaccination Program: A Content Analysis on Twitter Data. Vaccines (Basel) 2022; 10:vaccines10020161. [PMID: 35214620 PMCID: PMC8876163 DOI: 10.3390/vaccines10020161] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Twitter is a useful source for detecting anti-vaccine content due to the increasing prevalence of these arguments on social media. We aimed to identify the prominent themes about vaccine hesitancy and refusal on social media posts in Turkish during the COVID-19 pandemic. In this qualitative study, we collected public tweets (n = 551,245) that contained a vaccine-related keyword and had been published between 9 December 2020 and 8 January 2021 through the Twitter API. A random sample of tweets (n = 1041) was selected and analyzed by four researchers with the content analysis method. We found that 90.5% of the tweets were about vaccines, 22.6% (n = 213) of the tweets mentioned at least one COVID-19 vaccine by name, and the most frequently mentioned COVID-19 vaccine was CoronaVac (51.2%). We found that 22.0% (n = 207) of the tweets included at least one anti-vaccination theme. Poor scientific processes (21.7%), conspiracy theories (16.4%), and suspicions towards manufacturers (15.5%) were the most frequently mentioned themes. The most co-occurring themes were “poor scientific process” with “suspicion towards manufacturers” (n = 9), and “suspicion towards health authorities” (n = 5). This study may be helpful for health managers, assisting them to identify the major concerns of the population and organize preventive measures through the significant role of social media in early spread of information about vaccine hesitancy and anti-vaccination attitudes.
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19
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Thomson G, Balaam MC, Nowland Harris R, Crossland N, Moncrieff G, Heys S, Sarian A, Cull J, Topalidou A, Downe S. Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives. BMJ Open 2022; 12:e051965. [PMID: 35017241 PMCID: PMC8753093 DOI: 10.1136/bmjopen-2021-051965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore stakeholders' and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study. SETTING Maternity care provision in England. PARTICIPANTS Interviews were held with 26 national governmental, professional and service-user organisation leads (July-December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February-December 2020). RESULTS Six themes emerged: 'Postcode lottery of care' highlights variations in companionship and visiting practices between trusts/locations, 'Confusion and stress around 'rules'' relates to a lack of and variable information concerning companionship/visiting, 'Unintended consequences' concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, 'Need for flexibility' highlights concerns about applying companionship and visiting policies irrespective of need, ''Acceptable' time for support' highlights variations in when and if companionship was 'allowed' antenatally and intrapartum and 'Loss of human rights for gain in infection control' emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights. CONCLUSIONS Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Marie-Claire Balaam
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Rebecca Nowland Harris
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Gill Moncrieff
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | | | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Joanne Cull
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Anastasia Topalidou
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Soo Downe
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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20
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Lajeunesse A. Prise de décision, répartition des ressources médicales et personnes âgées en contexte de COVID-19 : une anthropologie de et pour la bioéthique. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1094692ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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21
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Montanari Vergallo G, Varone MC, Del Rio A. Should vaccinated people be prioritized for COVID-19 care? Reply to Ramphul. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022098. [PMID: 35546006 PMCID: PMC9171855 DOI: 10.23750/abm.v93i2.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022]
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22
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De Donno A, Acella A, Angrisani C, Gubinelli G, Musci G, Gravili G, Ciritella C, Santamato A. Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study. Front Med (Lausanne) 2021; 8:754456. [PMID: 34917632 PMCID: PMC8669589 DOI: 10.3389/fmed.2021.754456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic has revolutionized the habits of entire communities, having even more profound negative effects on assistance for the chronically ill. The sudden demand for extraordinary resources caught all worldwide countries unprepared, highlighting shortages in provision of care services. This applies to all patients, affected by COVID-19 or not, as many need continuing access to chronic diseases treatments. Almost all of the energy available has been directed toward care of COVID-19 patients, and almost nothing has been done to continue therapy for patients with spasticity. This study builds on a recent article and discusses its results as a basis for highlighting the ethical dilemmas and unintended consequences of health systems changing their priorities during the pandemic. The above mentioned study has shown increased patient-perceived spasticity during lockdown (72.2%) with reductions in perceived quality of life (70.9%). Telemedicine tools have proved insufficient, with access by only 7.3% of these patients. Despite the health emergency, it cannot be denied that this situation is a violation of these patients' rights and dignity. The healthcare system will also have to bear increased costs in the future to recover the loss of previous therapies benefits, because of their interruption. The real challenge will be to exploit the critical issues emerged during the pandemic, and to resolve the measures needed to take the care to the patient, and not vice versa. This applies particularly to fragile patients, to respect their dignity and right to care.
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Affiliation(s)
- Antonio De Donno
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Adriano Acella
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Carmelinda Angrisani
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Giulia Gubinelli
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Gianluca Musci
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Gianluca Gravili
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Chiara Ciritella
- University of Foggia-Spasticity and Movement Disorders Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, Foggia, Italy
| | - Andrea Santamato
- University of Foggia-Spasticity and Movement Disorders Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, Foggia, Italy
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23
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Gómez-Vírseda C, Usanos RA. Relational autonomy: lessons from COVID-19 and twentieth-century philosophy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:493-505. [PMID: 34173944 PMCID: PMC8233626 DOI: 10.1007/s11019-021-10035-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 05/04/2023]
Abstract
COVID-19 has turned many ethical principles and presuppositions upside down. More precisely, the principle of respect for autonomy has been shown to be ill suited to face the ethical challenges posed by the current health crisis. Individual wishes and choices have been subordinated to public interests. Patients have received trial therapies under extraordinary procedures of informed consent. The principle of respect for autonomy, at least in its mainstream interpretation, has been particularly questioned during this pandemic. Further reflection on the nature and value of autonomy is urgently needed. Relational autonomy has been proposed as an alternative account of autonomy that can more adequately respond to contemporary ethical issues in general and to a pandemic such as the one we are currently facing in particular. As relational autonomy is an emerging notion in current bioethics, it requires further consideration and development to be properly operationalized. This paper aims to show how six different philosophical branches--namely, philosophy of nature, philosophical anthropology, existential phenomenology, discourse ethics, hermeneutics, and cultural anthropology--have incorporated the category of relation throughout the twentieth century. We first delve into primary philosophical sources and then apply their insights to the specific field of medical ethics. Learning from the historical developments of other philosophical fields may provide illumination that will enable bioethics to experience a successful "relational turn", which has been partially initiated in contemporary bioethics but not yet achieved.
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Affiliation(s)
- Carlos Gómez-Vírseda
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35/3, 3000 Louvain, Belgium
| | - Rafael Amo Usanos
- Bioethics Chair at the Universidad Pontificia Comillas, C/Universidad Comillas, 3, 28049 Madrid, Spain
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24
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Joo-Castro L, Emerson A. "No Man Is an Island": Perspectives of CHamorus in Guam on COVID-19. Public Health Nurs 2021; 39:89-95. [PMID: 34820889 DOI: 10.1111/phn.13018] [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] [Received: 07/13/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Guam is a United States territory situated in the western Pacific Ocean with a multiethnic population numbering approximately 168,000. The CHamorus, who are the Indigenous people of Guam, make up 37%. In this study, we sought to explore CHamorus' perspectives on and experiences of COVID-19. DESIGN Interviews were conducted with 10 CHamoru adults in June-July 2020 via telephone for a larger study on understanding how the collective history of the CHamoru people is perceived relative to contemporary health beliefs and practices. This study is a secondary data analysis of questions that focused on COVID-19. We used thematic analysis techniques to analyze the data. RESULTS Three themes were identified: self and other, or "no man is an island"; trust in government; and focusing on the positives. A cross-cutting theme was commitment to the common welfare of the community through interconnectedness and inafa'maolek (doing good for others). CONCLUSION Results indicated that CHamorus recognized a balance between community and individual, the need to protect the vulnerable while also considering personal choice, and the implications of enforced social distancing on community and economic stability.
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Affiliation(s)
- Lucy Joo-Castro
- School of Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
| | - Amanda Emerson
- School of Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
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25
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Borhany H, Golbabaei S, Jameie M, Borhani K. Moral Decision-Making in Healthcare and Medical Professions During the COVID-19 Pandemic. TRENDS IN PSYCHOLOGY 2021. [PMCID: PMC8598100 DOI: 10.1007/s43076-021-00118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With the coronavirus disease 2019 (COVID-19) outbreak, healthcare and medical professions face challenging situations. The high number of COVID-19 infected patients, scarce resources, and being vulnerable to the infection are among the reasons that may influence clinicians’ moral decision-making. Furthermore, healthcare workers may be carriers of coronavirus, resulting in their social interactions to involve moral decision-making. This study aimed to investigate the effect of working in the frontline on psychological and cognitive factors and how these factors influence moral decision-making in clinicians during the pandemic. Further, we evaluated the impact of these factors on compliance with social distancing. Clinicians who worked in hospitals allocated to coronavirus disease patients participated in our study. We designed an online survey containing eight dilemmas to test moral decision-making in clinicians. Information on clinicians’ behavior and psychological state during the COVID-19 pandemic including the degree of respect to social distancing, sources of stress, and dead cases of COVID-19 they confronted with were collected. First, the relation between these measures and moral decision-making was assessed. Next, we used multiple regression analysis to evaluate the degree to which these factors can predict variances in morality. Based on our results, clinicians’ most important source of stress was the infection of their families. Stress, estimated chance of self-infection, job satisfaction, and age predicted utilitarian behavior among them. Moreover, age, number of death cases of COVID-19 they confronted, perceived risk of infection, and stress were positively correlated to compliance with social distancing. Our results have critical implications in implementing policies for healthcare principals.
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Affiliation(s)
- Hamed Borhany
- Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroosh Golbabaei
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Mana Jameie
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khatereh Borhani
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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26
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Valente CO, Silva FRD, Mussi FC, Lacerda MR, Freitas KS, Rosa DDOS. Decision making by health professionals during COVID-19: an integrative review. Rev Bras Enferm 2021; 75:e20210067. [PMID: 34669787 DOI: 10.1590/0034-7167-2021-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the scientific production on the decision making of health workers during the COVID-19 pandemic. METHODS Integrative review in the databases CINAHL, MEDLINE, Scopus, ScienceDirect, WoS, and BVS. Inclusion criteria: original articles available in full, in any language, related to the object investigated. RESULTS During this pandemic, health workers have been making decisions based on ethical/bioethical principles (utility, beneficence, non-maleficence, autonomy, justice, proportionality, flexibility, clinical prognosis, duration of the need, and fair health attention), values (solidarity, equality, equity, utilitarianism, relational autonomy, reliability, reciprocity, maximization of the benefits and resources, and prioritization of those in worse conditions), beliefs and personal motivation, protocols, directives, tools, algorithms, recommendations, and criteria. FINAL CONSIDERATIONS Decision making has never been so necessary as in this pandemic. This article is not a recipe for the professionals, since decision making is based on numerous factors. However, it provides them with a foundation that can be helpful in this difficult process.
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27
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Saleh BM, Aly EM, Hafiz M, Abdel Gawad RM, El Kheir-Mataria WA, Salama M. Ethical Dimensions of Public Health Actions and Policies With Special Focus on COVID-19. Front Public Health 2021; 9:649918. [PMID: 34409003 PMCID: PMC8365183 DOI: 10.3389/fpubh.2021.649918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023] Open
Abstract
During pandemics, the ethicists, public health professionals, and human rights advocates raise a red flag about different public health actions that should, at best, be addressed through integrated, global policies. How to rationalize the healthcare resources and prioritize the cases is not a recent challenge but the serious concern about that is how to achieve this while not increasing the vulnerability of the disadvantaged population. Healthcare professionals use different scoring systems as a part of their decision-making so the medical teams and triage committees can allocate resources for predictable health outcomes and prognosis as well as to appropriately triage the patients accordingly. However, the value of the existing scoring systems to manage COVID-19 cases is not well-established yet. Part of this problem includes managing non-COVID patients with chronic medical conditions like non-communicable diseases and addressing their medical needs during the pandemic complex context in a way to avoid worsening their conditions and, on the other hand, avoid hindering the establishment of comprehensive standards for dealing with COVID-19. In this article, we discuss this dilemma as well as how preexisting ethical standards were challenged by COVID-19. We also discuss how monitoring the consistent application of ethical standards during the medical trials of new medications, vaccines, or unproven medical interventions is also a critical issue.
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Affiliation(s)
- Basma M. Saleh
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Eman Mohamed Aly
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Marwa Hafiz
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Rana M. Abdel Gawad
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Wafa Abu El Kheir-Mataria
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Mohamed Salama
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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28
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Ness MM, Saylor J, DiFusco LA, Evans K. Leadership, professional quality of life and moral distress during COVID-19: A mixed-methods approach. J Nurs Manag 2021; 29:2412-2422. [PMID: 34254387 PMCID: PMC8420482 DOI: 10.1111/jonm.13421] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
AIM To understand the impact of professional stressors on nurses' and other health care providers' professional quality of life and moral distress as they cared for patients during the COVID-19 pandemic. BACKGROUND Health care providers caring for patients during the COVID-19 pandemic are at increased risk of decreased professional quality of life and increased moral distress. METHODS A convergent mixed-methods design and snowball sampling was used to collect survey data (n = 171) and semi-structured interviews (n = 23) among health care providers working in the inpatient setting. RESULTS Perceived lack of support from executive leadership, access to personal protective equipment and constantly changing guidelines led to decreased professional quality of life and increased moral distress among health care providers. CONCLUSION Findings from this study indicate that shared governance, disaster management training and enhanced communication may assist executive leadership to reduce the likelihood of decreased professional quality of life and increased moral distress in front line health care providers. IMPLICATIONS FOR NURSING MANAGEMENT Following the principles of shared governance may assist executive leadership to promote and acknowledge the significance of the role of health care providers at the bedside. Additionally, disaster management training and open communication are crucial to ensure that health care providers are adequately informed and supported at the bedside.
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Affiliation(s)
| | | | | | - Kristen Evans
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
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29
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Koh TJW, Ling AHZ, Chiang CLL, Lee GSJ, Tay HSE, Yi H. Attitudes towards COVID-19 precautionary measures and willingness to work during an outbreak among medical students in Singapore: a mixed-methods study. BMC MEDICAL EDUCATION 2021; 21:317. [PMID: 34088316 PMCID: PMC8176668 DOI: 10.1186/s12909-021-02762-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/24/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has revealed challenges that medical students face when healthcare systems are under intense pressure. There is a need to assess medical students' education needs in pandemic preparedness. The objective of this mixed-methods study was threefold: (1) to assess COVID-19 perceived efficacy, susceptibility, and anxiety in relation to health literacy; (2) to describe attitudes towards a policy of precautionary measures against COVID-19 and willingness to work during an outbreak; and (3) to examine multilevel factors associated with willingness to work. METHODS An online survey was conducted among 263 medical students in Singapore during the lockdown period in July 2020. Participants were surveyed on COVID-19 related literacy, perceptions, anxiety, attitudes towards a policy of precautionary measures, and willingness to work during an outbreak. Bivariate and multivariate analyses were used to determine the factors associated with the key outcome variable of willingness to work. In addition, open-ended questions were used to assess medical education needs, which were reported using thematic analysis. RESULTS Perceived adequacy of COVID-19 information was associated with higher perceived efficacy, lower perceived susceptibility, and lower anxiety levels among the students. Medical students were mostly supportive of COVID-19 precautionary measures except for relatively intrusive measures like in-home surveillance. The degree of willingness to work during an outbreak varied based on certain conditions, in particular family's health and safety, and was associated with self-efficacy, perceived susceptibility, and hospital capacity of outbreak management. CONCLUSIONS Medical students' attitudes towards a policy of precautionary measures varied depending on legality, financial and psychological support, and privacy concerns. Health literacy played an important role in increasing the efficacy of protection against COVID-19 and reducing pandemic-related anxiety among medical students. Their willingness to work during an outbreak was increased by an effective policy of precautionary measures, hospital capacity to manage a pandemic, and assurance of family safety. Medical education should include pandemic preparedness to better prepare students to aid in pandemics, with emphasis on public health policy and ethics coupled with clinical training targeted to managing outbreaks.
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Affiliation(s)
- Tricia Jia Wen Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abel Ho Zhi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Gabriel Sheng Jie Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hannah Si En Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
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Ditwiler RE, Swisher LL, Hardwick DD. Professional and Ethical Issues in United States Acute Care Physical Therapists Treating Patients With COVID-19: Stress, Walls, and Uncertainty. Phys Ther 2021; 101:6267722. [PMID: 33956143 PMCID: PMC8136052 DOI: 10.1093/ptj/pzab122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To the authors' knowledge, no peer-reviewed research has explored professional and ethical issues encountered by physical therapists in treating patients with COVID-19. The purpose of this study was to explore the experiences of physical therapists regarding the professional and ethical issues they encountered during the COVID-19 pandemic. METHODS The current study used reflexive thematic analysis, a qualitative research design developed by Braun and Clarke, to analyze individual interviews. RESULTS Analysis of the coded interviews produced 6 primary themes (uncertainty, physical therapist's role, ethical dilemmas and moral distress, emotions, providing care and working conditions, and management and leadership influence) and associated subthemes. CONCLUSION Physical therapists reported numerous professional and ethical issues across the individual, organizational, and societal realms during the COVID-19 pandemic. This study highlights the need for education and resources to prepare physical therapists for professional and ethical issues encountered during pandemics. Specifically, there is a need to define the physical therapist's role in pandemics and prepare physical therapy personnel for dealing with ethical issues, stress, uncertainty, and organizational changes associated with pandemics. Ethical guidelines would support organizations in delineating fair processes for triage and allocation of scarce resources for acute care physical therapy during health care emergencies. IMPACT The COVID-19 pandemic has produced significant changes in health care and physical therapist practice. This study reports results of the first, to our knowledge, research study focusing on professional and ethical issues experienced by physical therapists in acute care during the COVID-19 pandemic. As the United States faces an unprecedented spike in COVID-19 cases and deaths, results of this study may contribute to physical therapists' preparation for and response to professional and ethical issues encountered in acute care during the pandemic.
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Affiliation(s)
- Rebecca E Ditwiler
- Address all correspondence to R. E. Ditwiler, PT, DPT, OCS, Associate Professor, School of Physical Therapy and Rehabilitation Sciences, USF Health Morsani College of Medicine, University of South Florida,
| | - Laura L Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Dustin D Hardwick
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Morsani College of Medicine, Tampa, FL
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Perin M, De Panfilis L. Among equity and dignity: an argument-based review of European ethical guidelines under COVID-19. BMC Med Ethics 2021; 22:36. [PMID: 33789633 PMCID: PMC8011067 DOI: 10.1186/s12910-021-00603-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Under COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient's care. METHOD According to the argument-based review framework, we started our research from the following two questions: what are the ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care? RESULTS Twenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient's dignity, and decision making and quality of care. CONCLUSION Further studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals' moral distress.
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Affiliation(s)
- Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Cash PA, Moffitt P. Relational and caring partnerships: (re)creating equity, genuineness, and growth in mentoring faculty relationships. Int J Nurs Educ Scholarsh 2021; 18:ijnes-2020-0089. [PMID: 33781012 DOI: 10.1515/ijnes-2020-0089] [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] [Received: 08/22/2020] [Accepted: 03/06/2021] [Indexed: 11/15/2022]
Abstract
Mentoring in academia has traditionally and currently been prescriptive and institutionally driven. The purpose of this paper is to deconstruct these current mentoring practices with a critical feminist stance. New understandings are shared and gained through dialogue, relevant literature, and performativity to (re)create and name a caring and relational partnership. This caring and relational partnership is grown through a process of mutuality and reciprocity, and based on relational ethics, authenticity, and solidarity. By embracing ideologies of caring and relational ethics, mentoring blurs the lines of mentor/mentee to a perpetual state of walking beside each other in equity to learn and strengthen each other's insights into our worlds. Material realities become illuminated through our shared journeys growing an appreciation and gift of the other. In turn, engaging in meaningful dialogue informs scholarship increasing our understandings of the human condition.
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Affiliation(s)
| | - Pertice Moffitt
- Health Research Programs, Aurora College, Yellowknife, Canada
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Ness MM, Saylor J, Di Fusco LA, Evans K. Healthcare providers' challenges during the coronavirus disease (COVID-19) pandemic: A qualitative approach. Nurs Health Sci 2021; 23:389-397. [PMID: 33580590 PMCID: PMC8012981 DOI: 10.1111/nhs.12820] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
The uncertain trajectory of COVID-19 has led to significant psychosocial impacts on nurses and other healthcare providers. Given the critical role of these providers in pandemic response, this study sought to gain a better understanding of the challenges faced by healthcare providers caring for adult patients during the COVID-19 pandemic. A descriptive, qualitative study was conducted via semi-structured interviews. A purposeful sample of healthcare providers (n = 23) caring for patients during the COVID-19 pandemic was recruited to participate in interviews via snowball sampling and an information systems-supported recruiting process (e-recruiting). Thematic analysis revealed four themes: (1) Managing isolation, fear, and increased anxiety; (2) adapting to changes in healthcare practice and policy; (3) addressing emotional and physical needs of patients and their families; and (4) navigating evolving workplace safety. New evidence was introduced about nurses practicing outside their usual role. Nurses and other healthcare providers consistently reported increased anxiety during the pandemic. Hospital administrations can proactively support healthcare providers during this and future pandemics by ensuring access to mental health programs, standardizing communication, and developing plans that address equipment and supply availability.
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Affiliation(s)
- Michelle M Ness
- Department of Nursing, Towson University, Towson, Maryland, USA
| | - Jennifer Saylor
- School of Nursing, University of Delaware, Newark, Delaware, USA
| | | | - Kristen Evans
- Conway School of Nursing, The Catholic University of America, Washington, District of Columbia, USA
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Shaibu S, Kimani RW, Shumba C, Maina R, Ndirangu E, Kambo I. Duty versus distributive justice during the COVID-19 pandemic. Nurs Ethics 2021; 28:1073-1080. [PMID: 33719734 DOI: 10.1177/0969733021996038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic exposed vulnerabilities in inadequately prioritized healthcare systems in low- and middle-income countries such as Kenya. In this prolonged pandemic, nurses and midwives working at the frontline face multiple ethical problems, including their obligation to care for their patients and the risk for infection with severe acute respiratory syndrome coronavirus 2. Despite the frequency of emergencies in Africa, there is a paucity of literature on ethical issues during epidemics. Furthermore, nursing regulatory bodies in African countries such as Kenya have primarily adopted a Western code of ethics that may not reflect the realities of the healthcare systems and cultural context in which nurses and midwives care for patients. In this article, we discuss the tension between nurses' and midwives' duty of care and resource allocation in the context of the COVID-19 pandemic. There is an urgent need to clarify nurses' and midwives' rights and responsibilities, especially in the current political setting, limited resources, and ambiguous professional codes of ethics that guide their practice.
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Halberg N, Jensen PS, Larsen TS. We are not heroes-The flipside of the hero narrative amidst the COVID19-pandemic: A Danish hospital ethnography. J Adv Nurs 2021; 77:2429-2436. [PMID: 33616210 PMCID: PMC8014459 DOI: 10.1111/jan.14811] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/01/2022]
Abstract
Aim To explore how the media and socially established hero narrative, affected the nursing staff who worked in the frontline during the first round of the COVID19‐pandemic. Background During the COVID19‐pandemic, both media, politicians and the public have supported and cheered on the frontline healthcare workers around the world. We have found the hero narrative to be potentially problematic for both nurses and other healthcare workers. This paper presents an analysis and discussion of the consequences of being proclaimed a hero. Design Hospital ethnography including fieldwork and focus groups. Method Empirical data was collected in a newly opened COVID19‐ward in a university hospital in the urban site of Copenhagen, Denmark. Fieldwork was performed from April until the ward closed in the end of May 2020. Succeeding focus group interviews with nursing staff who worked in the COVID19‐ward were conducted in June 2020. The data were abductively analysed. Results The nursing staff rejected the hero narrative in ways that show how the hero narrative leads to predefined characteristics, ideas of being invincible and self‐sacrificing, knowingly and willingly working in risk, transcending duties and imbodying a boundless identity. Being proclaimed as a hero inhibits important discussions of rights and boundaries. Conclusion The hero narrative strips the responsibility of the politicians and imposes it onto the hospitals and the individual heroic health care worker. Impact It is our agenda to show how the hero narrative detaches the connection between the politicians, society and healthcare system despite being a political apparatus. When reassessing contingency plans, it is important to incorporate the experiences from the health care workers and include their rights and boundaries. Finally, we urge the media to cover a long‐lasting pandemic without having the hero narrative as the reigning filter.
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Affiliation(s)
- Nina Halberg
- The Research Unit of Orthopaedic Nursing, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Pia Søe Jensen
- The Research Unit of Orthopaedic Nursing, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Trine Schifter Larsen
- The Research Unit of Orthopaedic Nursing, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark.,Department of People and Technology, Roskilde University, Roskilde, Denmark
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Cheng FK. Ethical Dilemma: An Unprecedented Strike by Health care Workers in Early February 2020 in Hong Kong. Public Health Nurs 2021; 38:473-479. [PMID: 33538355 DOI: 10.1111/phn.12869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 11/28/2022]
Abstract
Urging the government to exercise a complete border closure to inhibit the spread of the novel coronavirus from Mainland China, about 8,000 health care workers participated in a 5-day strike in early February 2020 in Hong Kong. Despite gaining 61% support from the public, dissenters criticised that the participants violated professional ethics and abandoned their accountabilities, which led to moral distress. However, the participants were guided by the four fundamental medical principles (autonomy, beneficence, non-maleficence, and justice) for public interest and health equity. Their concerns for occupational safety should not be ignored to maintain an effective health care system. In short, the strike adopted a bottom-up initiative and adhered to a public-centered perspective and community-driven ethical behaviors, through which the participants deliberated over professionalism, humanism and the imminence of public health, and the balance between them. Strikers showed care and concern for the safety of the community, sustainability of the health care system, and well-being of all people in Hong Kong.
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Grignoli N, Petrocchi S, Bernardi S, Massari I, Traber R, Malacrida R, Gabutti L. Influence of Empathy Disposition and Risk Perception on the Psychological Impact of Lockdown During the Coronavirus Disease Pandemic Outbreak. Front Public Health 2021; 8:567337. [PMID: 33553084 PMCID: PMC7855966 DOI: 10.3389/fpubh.2020.567337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
During the current COVID-19 pandemic, and especially in the absence of availability of an effective treatment or a vaccine, the main health measure is neither chemical nor biological, but behavioral. To reduce the exponential growth of infections due to the new coronavirus (SARS-CoV-2) and the resulting overburdening of the healthcare system, many European Countries, parts of the US and Switzerland gradually implemented measures of quarantine and isolation defined as lockdown. This consideration leads to the need to understand how individuals are motivated to protect themselves and others. Recent research suggested that prosocial mental dispositions, such as empathy, might promote adherence to social norms of distancing. Other research conducted during the COVID-19 outbreak indicates, however, that empathy levels might fluctuate according to anxiety linked to the risk of death, and this negatively predicted prosocial willingness. The present protocol proposes a study on whether people's empathic dispositions, interacting with the levels of risk, influence the psychological impact of lockdown. The rationale is that emphatic dispositions, encouraging the acceptance of the lockdown, determine a better psychological adaptation and less distress. One retrospective study will be developed in Switzerland and, if the pandemic conditions force a new wave of lockdown on the population, one prospective study as well. A total of 120 participants will be involved, distinguished by their level of objective risk: (1) high objective risk (COVID-19 positive patients, hospitalized in isolation in post-acute phase); (2) moderate objective risk (COVID-19 positive patients, isolated at home); (3) minimum objective risk (non-positive adults, in lockdown). Measures of perceived risk of being contagious for third parties, empathic dispositions and acceptance of lockdown will be collected. The expected results provide important answers related to the immediate impact of empathic dispositions, effective risk and risk perception on the psychological impact of lockdown during a pandemic outbreak. Data gathered from this study could inform policy makers and public health managers about the best communication strategies that will take into account the various stages of health risk and, in particular, to modulate messages to the population aimed at inducing self-isolation behaviors.
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Affiliation(s)
- Nicola Grignoli
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland.,Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Serena Petrocchi
- Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sheila Bernardi
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Ilaria Massari
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
| | - Rafael Traber
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Boyd K. Explanatory frameworks and managing randomness. JOURNAL OF MEDICAL ETHICS 2020; 46:493-494. [PMID: 32723775 DOI: 10.1136/medethics-2020-106673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kenneth Boyd
- Biomedical Teaching Organisation, Edinburgh University, Edinburgh EH89AG, UK
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