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Seidlein AH, Salloch S. Ethische Fragen im Gesundheitswesen als Gegenstand interprofessionellen Lernens: Überblick zur Situation in Deutschland und Projektbericht. Ethik Med 2022. [DOI: 10.1007/s00481-022-00703-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ZusammenfassungInterprofessionelles Lernen von Auszubildenden der Pflegeberufe sowie Medizinstudierenden bietet vielfältige Chancen für die zukünftige Zusammenarbeit mit dem Ziel einer qualitativ hochwertigen Versorgung von Patient*innen. Expert*innengremien fordern daher eine frühzeitige Integration von interprofessionellen Lehr- und Lernformaten, um effektive und nachhaltige Verbesserungen in der Praxis erreichen zu können. In Deutschland wird interprofessionelle Lehre in der grundständigen Ausbildung der zwei Professionen in wachsendem Umfang in ausgewählten Fächern – obligat oder fakultativ – eingesetzt. Der Bereich der Ethik im Gesundheitswesen wird dabei bislang jedoch kaum berücksichtigt. Der Beitrag untersucht die Situation interprofessioneller Ethiklehre in Deutschland und beleuchtet deren Möglichkeiten und Grenzen vor dem Hintergrund eines Pilotprojektes.
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Nowak A, Schildmann J, Nadolny S, Heirich N, Linoh KP, Rosenau H, Dutzmann J, Sedding D, Noutsias M. Clinical ethics case consultation in a university department of cardiology and intensive care: a descriptive evaluation of consultation protocols. BMC Med Ethics 2021; 22:99. [PMID: 34301238 PMCID: PMC8305900 DOI: 10.1186/s12910-021-00668-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital. METHODS Semi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. All documents were analysed by two researchers independently. RESULTS Twenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43-96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1-65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases. CONCLUSIONS To the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes.
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Affiliation(s)
- Andre Nowak
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty , Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty , Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty , Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,Nursing Science Staff Unit, Franziskus-Hospital Harderberg, Niels-Stensen-Klinken, Alte Rothenfelder Str. 23, 49124, Georgsmarienhütte, Germany
| | - Nicolas Heirich
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty , Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
| | - Kim P Linoh
- Chair of Criminal Law, Criminal Procedure and Medical Law, Law School, Faculty of Law and Economics, Martin Luther University Halle-Wittenberg, Universitätsplatz 6, 06108, Halle (Saale), Germany
| | - Henning Rosenau
- Chair of Criminal Law, Criminal Procedure and Medical Law, Law School, Faculty of Law and Economics, Martin Luther University Halle-Wittenberg, Universitätsplatz 6, 06108, Halle (Saale), Germany
| | - Jochen Dutzmann
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.,Department of Internal Medicine A, Division of Cardiology, Angiology, Nephrology and Intensive Medical Care , Ruppiner Kliniken, Medical School of Brandenburg Theodor Fontane (MHB) , Fehrbelliner Strasse 38 , 16816 , Neuruppin , Germany
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Ranisch R, Riedel A, Bresch F, Mayer H, Pape KD, Weise G, Renz P. [The Tübingen Model "Ethics Consultants on the Ward": a pilot project to establish decentralized structures of clinical ethics consultation at a university hospital]. Ethik Med 2021; 33:257-274. [PMID: 34155423 PMCID: PMC8210507 DOI: 10.1007/s00481-021-00635-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/28/2021] [Indexed: 01/20/2023]
Abstract
DEFINITION OF THE PROBLEM Clinical ethics committees form an integral part of ethics management and organizational ethics in clinical healthcare facilities. However, working mostly reactive and not being anchored in the corresponding organizational levels, such instruments are limited in terms of effectiveness. ARGUMENTS Based on these shortcomings of clinical ethics consultation the multiprofessional working group "Ethics" at the University Hospital Tübingen, Germany has endeavored to design and implement new structures for sustainable ethical decision-making processes on its hospital wards. The Tübingen Model "Ethics Consultants on the Ward" is a pilot project intended to appoint specifically trained nursing staff on all wards as contact partners for ethical issues. Thus, the Tübingen Model represents an extension to established structures of clinical ethics consultation and complements existing top-down strategies. CONCLUSIONS This article presents the objectives of the Tübingen Model and describes initial experiences in its implementation. After explaining their role within the existing structures of ethics consultation at the hospital, the tasks of the ethics consultants within and across the hospital's wards are presented. Furthermore, the qualification program for ethics consultants (basic and advanced training) as well as a train-the-trainer concept are presented, which support an in-depth development of competencies in nursing as well as medical ethics and provide confidence in the reflection and decision-making processes on the ward.
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Affiliation(s)
- Robert Ranisch
- Klinisches Ethik-Komitee, Universitätsklinikum Tübingen, Gartenstraße 47, 72074 Tübingen, Deutschland
- Professur für Medizinische Ethik mit Schwerpunkt auf Digitalisierung, Fakultät für Gesundheitswissenschaften Brandenburg, Universität Potsdam, Potsdam, Deutschland
- Institut für Ethik und Geschichte der Medizin, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Annette Riedel
- Fakultät Soziale Arbeit, Bildung und Pflege, Hochschule Esslingen, Esslingen, Deutschland
| | - Friedemann Bresch
- Klinisches Ethik-Komitee, Universitätsklinikum Tübingen, Gartenstraße 47, 72074 Tübingen, Deutschland
| | - Hiltrud Mayer
- Klinisches Ethik-Komitee, Universitätsklinikum Tübingen, Gartenstraße 47, 72074 Tübingen, Deutschland
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Klaus-Dieter Pape
- Klinisches Ethik-Komitee, Universitätsklinikum Tübingen, Gartenstraße 47, 72074 Tübingen, Deutschland
- Katholische Klinikseelsorge in der Psychiatrie und Neurologie, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - Gerda Weise
- Klinisches Ethik-Komitee, Universitätsklinikum Tübingen, Gartenstraße 47, 72074 Tübingen, Deutschland
- Stroke Unit und neurologische Intensivüberwachung, Neurologische Klinik, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Petra Renz
- Stabsstelle Vorstand KV 4 – Pflegeorganisation Qualitätsentwicklung und Pflegeberatung, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Cederquist L, LaBuzetta JN, Cachay E, Friedman L, Yi C, Dibsie L, Zhang Y. Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center. BMC Med Ethics 2021; 22:44. [PMID: 33849509 PMCID: PMC8045298 DOI: 10.1186/s12910-021-00613-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization. Methods This was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR). Results From January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations. Conclusions Based on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs. Supplementary information The online version contains supplementary material available at 10.1186/s12910-021-00613-7.
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Affiliation(s)
- Lynette Cederquist
- Department of Medicine, Division of General Internal Medicine, University of California San Diego, 9500 Gilman Drive #0945, La Jolla, CA, 92093-0945, USA.
| | - Jamie Nicole LaBuzetta
- Department of Neurosciences, University of California San Diego, 9300 Campus Point Drive #7740, La Jolla, CA, 92037-7740, USA
| | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, 200 W. Arbor Drive #8681, San Diego, CA, 92103-8681, USA
| | - Lawrence Friedman
- Department of Medicine, Division of General Internal Medicine, University of California San Diego, 200 W. Arbor Drive #8985, San Diego, CA, 92103-8985, USA
| | - Cassia Yi
- Department of Nursing, University of California San Diego, 200 W. Arbor Drive #8929, San Diego, CA, 92103-8929, USA
| | - Laura Dibsie
- Department of Nursing, University of California San Diego, 200 W. Arbor Drive #8929, San Diego, CA, 92103-8929, USA
| | - Yiran Zhang
- Department of Family Medicine and Public Health, Division of Biostatistics and Bioinformatics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Abstract
This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a (business) case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals.
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Yoon NYS, Ong YT, Yap HW, Tay KT, Lim EG, Cheong CWS, Lim WQ, Chin AMC, Toh YP, Chiam M, Mason S, Krishna LKR. Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019. BMC Med Ethics 2020; 21:51. [PMID: 32611436 PMCID: PMC7329412 DOI: 10.1186/s12910-020-00492-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Amidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality of CECons. METHODS Guided by Levac et al's (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings. RESULTS Nine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified - the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations. CONCLUSION This review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy. To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards.
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Affiliation(s)
- Nicholas Yue Shuen Yoon
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Yun Ting Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Hong Wei Yap
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Dr, Experimental Medicine Building, Singapore, 636921, Singapore
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Elijah Gin Lim
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Clarissa Wei Shuen Cheong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Wei Qiang Lim
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Ethics Committees: Team Perspectives and Organizational Responses. J Christ Nurs 2020; 36:180-184. [PMID: 30585882 DOI: 10.1097/cnj.0000000000000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Healthcare ethics committees can be valuable resources but are largely underutilized by nurses. The purpose of this project was to review ethics concerns and educational needs of nurses in a large, integrated healthcare delivery system. Seven themes were identified: organizational issues, nonbeneficial care, withdrawing life-sustaining therapies, discharge disposition, challenging patients and families, communication with physicians, and capacity versus competence. A process was then developed to better engage nurses in ethical discussions.
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Kohlen H. Ethische Fragen der Pflegepraxis im Krankenhaus und Möglichkeiten der Thematisierung. Ethik Med 2019. [DOI: 10.1007/s00481-019-00547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Außerklinische Ethikberatung: Eine Evaluation des Angebots in den Landkreisen Traunstein und Berchtesgadener Land mittels Dokumentenanalyse und Befragung von Hausärzten. Ethik Med 2018. [DOI: 10.1007/s00481-018-0510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Famuyide M, Compretta C, Ellis M. Neonatal nurse practitioner ethics knowledge and attitudes. Nurs Ethics 2018; 26:2247-2258. [PMID: 30319013 DOI: 10.1177/0969733018800772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. RESEARCH AIM To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. RESEARCH DESIGN This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. PARTICIPANTS AND RESEARCH CONTEXT All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. ETHICAL CONSIDERATIONS The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). FINDINGS Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital's legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. DISCUSSION Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. CONCLUSION In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.
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Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values. Behav Sci (Basel) 2018; 8:bs8050042. [PMID: 29701637 PMCID: PMC5981236 DOI: 10.3390/bs8050042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.
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de Brito GMG, de Oliveira Santa Rosa D. Nurses performance in clinical ethics committees and commissions: An integrative review. Nurs Ethics 2017; 26:688-699. [PMID: 28933257 DOI: 10.1177/0969733017724611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The research on nursing professionals in Clinical Ethics Committees and Nursing Ethics Commissions occurs in different parts of the world; however, little information on this subject is found in the literature. OBJECTIVE This study analyzed national and international publications in relation to the participation of nursing professionals in Clinical Ethics Committees. RESEARCH DESIGN This was an integrative review of articles published in national and international journals between 1994 and 2016 which described the participation of nursing professionals in ethics commissions. PARTICIPANTS AND RESEARCH CONTEXT A total of 35 articles were selected. DISCUSSION AND CONCLUSION FOR THIS ARTICLE The thematic categories were the need for time to discuss ethical issues; ethics committee to reduce the moral suffering of professionals; competencies required for participation; and barriers/difficulties and facilitators for implementation/ performance. It was concluded that professionals recognize the need for ethics committees to foster discussions. However, barriers hamper operation and fundamental competencies for participation. Communication of committee activities to professionals and educational activities may be major allies to improve the functioning of these committees.
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Doran E, Fleming J, Jordens C, Stewart CL, Letts J, Kerridge IH. Managing ethical issues in patient care and the need for clinical ethics support. AUST HEALTH REV 2016; 39:44-50. [PMID: 25514126 DOI: 10.1071/ah14034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/22/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. METHODS A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. RESULTS Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. CONCLUSION Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia.
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Affiliation(s)
- Evan Doran
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| | - Jennifer Fleming
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| | - Christopher Jordens
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| | - Cameron L Stewart
- Centre for Health Governance, Law and Ethics, University of Sydney, New Law Building, Camperdown, NSW 2006, Australia. Email
| | - Julie Letts
- Office of the Chief Health Officer, NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia. Email
| | - Ian H Kerridge
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
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14
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Crigger N, Fox M, Rosell T, Rojjanasrirat W. Moving It Along: A study of healthcare professionals' experience with ethics consultations. Nurs Ethics 2015; 24:279-291. [PMID: 26338282 DOI: 10.1177/0969733015597571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them. OBJECTIVES The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals. DESIGN AND METHOD The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States. RESULTS The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.
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Affiliation(s)
| | - Maria Fox
- University of Kansas Medical Center, USA
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15
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Abstract
This article discusses all aspects of the hospital ethics committee. The nurse's use of the committee and participation on the committee are delineated. Neonatal examples are given.
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16
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Carnevale FA. Confronting moral distress in Nursing: recognizing nurses as moral agents. Rev Bras Enferm 2013; 66 Spec:33-8. [DOI: 10.1590/s0034-71672013000700004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 11/21/2022] Open
Abstract
The concept of moral distress has brought forth a substantively different way of understanding some of the difficulties confronted by nurses in their practice. This concept highlights that nurses' distress can be an indication of nurses' conscientious moral engagement with their professional practice that has confronted practices or an environment that impedes them from acting according to their own ethical standards. Moral distress can be an indicator of problems in nurses' practice environments. This concept is described and related to moral agency in nursing practice. Selected research on moral distress is reviewed, followed by a discussion of recommendations for addressing this problem.
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