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Egger-Rainer A, Sahinoglu F, Schreier MM, Brandl C, Brandstötter-Gugg C, Bublitz SK, Lorenzl S, Mayr-Pirker B, Weck C, Paal P. Workshop on hastened death as "space for an appreciative discussion": A qualitative study. Nurse Educ Pract 2024; 79:104081. [PMID: 39053151 DOI: 10.1016/j.nepr.2024.104081] [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: 12/12/2023] [Revised: 07/07/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
AIM To evaluate the suitability of a drama-based workshop as a method for ethical deliberation. BACKGROUND Nurses worldwide are inadequately prepared to care for people who desire hastened death, which can lead to ethical and moral dilemmas. To address this problem, we developed a drama-based ethical deliberation workshop to assist nurses in these situations. Senghor and Racine's three moments of ethical deliberation and their quality criteria served as basis for evaluation. DESIGN Qualitative descriptive study design. METHODS Non-participant observations and a survey with incomplete sentences to be completed by nursing students were used. Data analysis followed Mayring's deductive content analysis approach. RESULTS All three moments of ethical deliberation according to Senghor and Racine were identified. Participants recognised hastened death as morally problematic, shared their experiences and gained a deeper understanding of the problem. They reported feeling better prepared for encounters with persons seeking assisted suicide. In terms of its quality, the drama-based workshop achieved good and partial ethical deliberation. CONCLUSIONS The workshop has demonstrated its suitability as a method for ethical deliberation. The workshop should be complemented by specific modules, such as communication skills and be tailored to other professional groups. A validated instrument is needed to ensure a more comprehensive assessment of the quality.
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Affiliation(s)
- Andrea Egger-Rainer
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria.
| | - Fulya Sahinoglu
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria; Paracelsus Medical University, Master Programme Public Health, Center for Public Health and Healthcare Research, Strubergasse 21, Salzburg 5020, Austria
| | - Maria Magdalena Schreier
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria
| | - Clemens Brandl
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria
| | | | - Sarah Kristina Bublitz
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria
| | - Stefan Lorenzl
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria; Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University, Munich 81377, Germany
| | - Brigitte Mayr-Pirker
- Paracelsus Medical University, Department of Geriatric Medicine, Christian Doppler University Hospital, Ignaz-Harrer-Straße 79, Salzburg 5020, Austria
| | - Christiane Weck
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria
| | - Piret Paal
- Paracelsus Medical University, Institute of Palliative Care, Strubergasse 21, Salzburg 5020, Austria; University of Tartu, Institute of Cultural Studies, Department of Ethnology, Ülikooli 16, Tartu 51003, Estonia
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Understanding Moral Distress among Eldercare Workers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159303. [PMID: 35954662 PMCID: PMC9368675 DOI: 10.3390/ijerph19159303] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing moral distress, which is associated with poor work ability. The causes and consequences of moral distress among eldercare workers remain undiscovered. This scoping review investigates the existing studies of causes and consequences of moral distress among eldercare workers. Additionally, it seeks evidence of interventions designed to mitigate moral distress in eldercare workers. Fourteen studies were included in the final review. Most of the included studies were qualitative, aiming to increase understanding of morally challenging situations in eldercare. We also found quantitative studies with cross-sectional designs and small sample sizes. Thus, no reliable evidence of causal effects between moral distress and worker wellbeing in eldercare was found. We found no interventions undertaken to resolve moral distress among eldercare workers, either. More research is needed on the causes and consequences of moral distress and on interventions to mitigate moral distress among eldercare workers. This is of utmost importance to increase the attractiveness of eldercare as a workplace and to improve eldercare workers’ ability to work and sustain long working careers.
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Kwon S, Kim M, Choi S. Ethical dilemmas and care actions in nurses providing palliative sedation. Nurs Ethics 2022; 29:1220-1230. [PMID: 35728273 DOI: 10.1177/09697330221105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. OBJECTIVE To explore the meaning of nurses' experiences in dealing with ethical dilemmas in relation to palliative sedation. RESEARCH DESIGN A qualitative research design was employed with a thematic analysis approach. PARTICIPANTS AND RESEARCH CONTEXT Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. ETHICAL CONSIDERATIONS Ethical approval was obtained from the authors' institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. RESULTS Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague's disrespectful attitudes toward patients; dilemmas from patients' families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. CONCLUSION Nurses' ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation.
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Affiliation(s)
- Sinyoung Kwon
- Department of Nursing, 250458Gangdong University, Eumseong-gun, Chungcheongbuk-do, Korea
| | | | - Sujin Choi
- 35031Woosuk University, Wanju, Jeollabuk-do, Korea
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Torabizadeh C, Jafari S, Momennasab M. Patient's Dignity: Viewpoints of Patients and Nurses in Hospitals. Hosp Top 2021; 99:187-197. [PMID: 33792508 DOI: 10.1080/00185868.2021.1897487] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Much of the available research on perceptions of patient dignity either is qualitative in type or explores them in specific patient groups, such as elderly patients, cancer patients, terminally-ill patients, and adolescent patients. The present study addresses nurses' and adult patients' views on patient dignity. A total of 400 individuals (200 nurses and 200 patients) from 39 internal and surgical units from four hospitals affiliated to Shiraz University of Medical Sciences participated in the study. The collected data were analyzed using descriptive, t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS v. 23.0. A significant difference between nurses' and patients' points of view was identified in relation to four domains: the importance of privacy (p < 0.001); attention to patient autonomy (p < 0.001); respect for patients (p < 0.001); and communication between nurses and patients (p < 0.001). In order to maintain patients' dignity in practice, nurses must become better acquainted with patients' expectations. The questionnaire assessing respect for patient's dignity developed in the present study is a reliable and valid instrument for this purpose.
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Affiliation(s)
- Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Jafari
- Master of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Momennasab
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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5
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Schmidt J, Trappenburg M, Tonkens E. Social dignity for marginalized people in public healthcare: an interpretive review and building blocks for a non-ideal theory. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:85-97. [PMID: 33111158 PMCID: PMC7910373 DOI: 10.1007/s11019-020-09987-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Jacobson (Social Science & Medicine 64:292-302, 2007) finds two distinct meanings of "dignity" in the literature on dignity and health: (1) intrinsic human dignity and (2) social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns (Social Theory and Practice 34:341-362, 2008) and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: (1) avoid violations of dignity rather than seeking to promote it; (2) dignity is not a goal to be reached; it requires ongoing effort; (3) promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and (4) dignity can be undermined by organizational and discursive constraints.
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Affiliation(s)
- Jante Schmidt
- Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands.
| | - Margo Trappenburg
- Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands
| | - Evelien Tonkens
- Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands
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Duprez V, Beeckman D, Van Hecke A, Verhaeghe S. Nurses' perceptions of success in self‐management support: An exploratory qualitative study. Res Nurs Health 2020; 43:274-283. [DOI: 10.1002/nur.22018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Veerle Duprez
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
- School of Health SciencesÖrebro University Örebro Sweden
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
- Nursing departmentGhent University Hospital Ghent Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
- Department Health CareVIVES University College Roeselare Belgium
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van Het Bolscher-Niehuis MJT, Uitdehaag MJ, Francke AL. Community nurses' self-management support in older adults: A qualitative study on views, dilemmas and strategies. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:195-203. [PMID: 31518040 DOI: 10.1111/hsc.12853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/22/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Providing self-management support is an appropriate task for community nurses. However, the support of self-management sometimes triggers tensions in practice. The aim of this study was to explore community nurses' views of self-management, the dilemmas community nurses face when providing support of self-management by older adults and the strategies they use to solve these challenges. A qualitative study was performed to collect data. Twenty-one community nurses from the eastern part of the Netherlands were recruited through purposive sampling. The interviews were audiotaped, transcribed verbatim and a thematic analysis was carried out. The results show that community nurses find it difficult to give a clear, definitive description of the concept of self-management. They relate self-management to 'taking control of your own life', 'making your own choices and decisions' and 'being self-reliant'. Situations in which older adults exhibit considerable or little self-direction or self-reliance can lead to conflicts in self-management support, namely: 1) 'striving for optimal health and well-being versus respecting older adults' choices' and 2) 'stimulating self-reliance and self-direction versus accepting a dependent attitude'. Different strategies are applied to resolve these scenarios. In the first case, strategies of 'adapting', 'persuading' and 'taking control' are used, and for the second case 'empowering', challenging' and 'tolerating' are used. Creating a clear and shared understanding of 'self-management' and facilitating community nurses to reflect on their dilemmas and strategies might help them in supporting self-management by older adults.
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Affiliation(s)
| | - Madeleen J Uitdehaag
- Research Group Nursing, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Anneke L Francke
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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8
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Abstract
BACKGROUND Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today's hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual's dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses' options to act on the basis of ethical and moral grounds in the individual care situation. AIM The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. METHOD The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. ETHICAL CONSIDERATION We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. RESULTS The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse-patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. CONCLUSION Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses' professional decision-making and forcing them to compromise basic nursing values.
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Affiliation(s)
| | | | | | - Pia Dreyer
- Aarhus University, Denmark.,Aarhus University Hospital, Denmark
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9
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Abstract
BACKGROUND Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. AIM To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. RESEARCH DESIGN AND CONTEXT A case study was conducted in a professional development course ('learning circle') for home care nurses, including participant observations and focus groups. The theoretical notion of 'relational agency' and the moral concept of 'practices of responsibility' were used to conduct a narrative analysis on the nurses' stories about autonomy. PARTICIPANTS Eight nurses, two coaches and two university lecturers who participated in the learning circle. ETHICAL CONSIDERATIONS Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. FINDINGS Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients' strengths and collaboration with patients and informal caregivers. DISCUSSION On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. CONCLUSION The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.
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Affiliation(s)
- Gaby Jacobs
- Fontys University of Applied Sciences, The Netherlands
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10
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Ammerlaan JW, van Os-Medendorp H, de Boer-Nijhof NC, Prakken B, Bijlsma JWJ, Kruize AA. The most important needs and preferences of patients for support from health care professionals: A reflective practice on (transitional) care for young adults with Juvenile Idiopathic Arthritis. PATIENT EDUCATION AND COUNSELING 2017; 100:1961-1964. [PMID: 28363359 DOI: 10.1016/j.pec.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
In this manuscript, presented as a Reflective Practice, the learning experiences and reflections of a healthcare team on redeveloping the transitional care for young adults with a juvenile rheumatic disease are described. In this process of redeveloping care, the healthcare team experienced that small step, driven by patient stories and involvement of patients in all phases from development to evaluation, led to meaningful results. The eHealth interventions, developed to support the transition and to increase self-management were found to be feasible and evaluated positively by the young adult group. But the healthcare team also experienced that the focus on the patient alone, is not enough to implement self-management interventions and sustain patient centered care in daily practice. How healthcare professionals personally think and feel about patient centered care is essential and needs to be discussed in daily care.It determines the way of being present with attention and commitment in daily health care. It affects the hands, head and heart. A daily reflection on shared answers of the patient and the health care professional to the question 'what is the most important to you?'may help to implement patient centered care in health practice.
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Affiliation(s)
- Judy W Ammerlaan
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Harmieke van Os-Medendorp
- University Medical Center Utrecht, Department Dermatology/Allergology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Nienke C de Boer-Nijhof
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Berent Prakken
- University Medical Center Utrecht, Department Pediatric Rheumatology, HPN KC.02.085.0, P.O. Box 85090, Utrecht 3508 AB, the Netherlands.
| | - Johannes W J Bijlsma
- University Medical Center Utrecht, Department Rheumatology & Clinical Immunology, HPN F02.127, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Aike A Kruize
- University Medical Center Utrecht, Department Rheumatology & Clinical Immunology, HPN F02.127, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
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van de Bovenkamp HM, Dwarswaard J. The complexity of shaping self-management in daily practice. Health Expect 2017; 20:952-960. [PMID: 28152248 PMCID: PMC5600231 DOI: 10.1111/hex.12536] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/26/2022] Open
Abstract
Background and context Many countries are giving patients a more active role in health care, on both the individual and collective level. This study focuses on one aspect of the participation agenda on the individual level: self‐management. The study explores self‐management in practice, including the implications of the difficulties encountered. Objective To gain insight into the complexity of self‐management practice. This is crucial for developing both self‐management interventions and the participation policy agenda. Methods Qualitative semi‐structured interviews with experts (n=6) and patients with a chronic condition (n=20). Results In terms of level of involvement and type of activity, shaping self‐management in practice depends on personal and social dynamics, patients’ ideas of the good life and their interactions with care professionals. Clashes can arise when patients and professionals hold differing ideas, based on different values, about the level and type of patient involvement. Discussion The discussion on self‐management should account for the fact that how we define self‐management is very much a normative issue. It depends on the norms and values of patients, professionals and underlying health‐care policies. Differing ideas present professionals with ethical dilemmas which they should reflect on. However, professional reflection alone is not enough to deal with these dilemmas. The participation agenda needs far wider ranging reflection on how participation relates to other values in health care.
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Affiliation(s)
| | - Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Dwarswaard J, van de Bovenkamp H. Self-management support: A qualitative study of ethical dilemmas experienced by nurses. PATIENT EDUCATION AND COUNSELING 2015; 98:1131-1136. [PMID: 26070469 DOI: 10.1016/j.pec.2015.05.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/11/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Policymakers increasingly focus their attention on stimulating patients' self-management. Critical reflection on this trend is often limited. A focus on self-management does not only change nurses' activities, but also the values underlying the nurse-patient relationship. The latter can result in ethical dilemmas. METHODS In order to identify possible dilemmas a qualitative study consisting of semi-structured interviews was conducted. Six experts on self-management and medical ethics and 15 nurses participated. RESULTS Nurses providing self-management support were at risk of facing three types of ethical dilemmas: respecting patient autonomy versus reaching optimal health outcomes, respecting patient autonomy versus stimulating patient involvement, and a holistic approach to self-management support versus safeguarding professional boundaries. CONCLUSION The ethical dilemmas experienced by nurses rest on different views about what constitutes good care provision and good self-management. Interviewed nurses had a tendency to steer patients in a certain direction. They put great effort into convincing patients to follow their suggestions, be it making the 'right choice' according to medical norms or becoming actively involved patients. PRACTICE IMPLICATIONS Because self-management support may result in clashing values, the development and implementation of self-management support requires deliberation about the values underlying the relationship between professionals and patients.
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Affiliation(s)
- Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, The Netherlands; Department of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
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Holm AL, Lyberg A, Berggren I, Åström S, Severinsson E. Going around in a Circle: A Norwegian Study of Suicidal Experiences in Old Age. Nurs Res Pract 2014; 2014:734635. [PMID: 25574387 PMCID: PMC4276303 DOI: 10.1155/2014/734635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/23/2014] [Indexed: 11/17/2022] Open
Abstract
Depression has repeatedly been found to be a risk factor for completed suicide, particularly when coupled with a pervasive sense of hopelessness. The aim of this study was to evaluate depressed older persons' suicidal experiences. Data were collected by means of individual in-depth interviews with nine informants living in two districts of Norway. A hermeneutic analysis was performed. One main theme: Going around in a circle and two themes: being alone without meaning in life and struggling to achieve reconciliation emerged from the analysis. An important implication for mental healthcare practice is the need to develop a person's ability to shape and take control of her/his life. The healthcare organisation must be committed to a plan that sets out strategies enabling suicidal individuals to avoid the negative experience of meaninglessness. It was concluded that suicidal depressed elderly persons need help to escape from their desperate situation. More research is urgently required in order to prevent suicide in depressed elderly persons whose emotional pain is unbearable.
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Affiliation(s)
- Anne Lise Holm
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, Kongsberg, Norway
| | - Anne Lyberg
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, Kongsberg, Norway
| | - Ingela Berggren
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, Kongsberg, Norway
- Department of Nursing, Health and Culture, University West, 461 86 Trollhättan, Sweden
| | - Sture Åström
- Department of Nursing, Health and Culture, University West, 461 86 Trollhättan, Sweden
| | - Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, Kongsberg, Norway
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Severinsson E, Holm AL. Chronic disease management: implementation and coordination of healthcare systems for depressed elderly persons. Issues Ment Health Nurs 2014; 35:934-9. [PMID: 25426749 DOI: 10.3109/01612840.2014.930215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the implementation of the research-based Chronic Care Model (CCM), discuss methods and summarise research recommendations for improving the care of depressed elderly persons. Interviews were conducted and state-of-the-art reviews employed. Three important areas emerged: (1) barriers to and facilitating factors in the implementation of the CCM; (2) the challenges involved in re-designing the delivery system and interdisciplinary team collaboration; and (3) empirical evidence pertaining to self-management support and how older persons manage to live with depressive ill-health. In conclusion, implementation research requires evidence-based knowledge, staff involvement and familiarity with the context in which development occurs.
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Affiliation(s)
- Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Buskerud and Vestfold University College , Kongsberg , Norway
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Interprofessional collaboration in the mental health services in norway. Nurs Res Pract 2014; 2014:849375. [PMID: 24724020 PMCID: PMC3958657 DOI: 10.1155/2014/849375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/30/2013] [Accepted: 01/13/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to describe and interpret interprofessional collaboration between healthcare professionals (HCPs) working at the district psychiatric centre (DPC) and employed in community mental health care (CMHC) using a dialogue-oriented co-operative approach. Data were collected by means of multistage focus groups and qualitative content analysis was performed. The main theme "development of interprofessional collaboration by means of organisational strategies and interactional styles" encompassed the following categories: "improved communication skills," "developing structures for coordination and responsibility" and " increased professional insight into the values and conditions necessary for decision-making." In conclusion, more attention should be paid to leadership in terms of coordination and feedback. The HCPs must be acknowledged, understood and strengthened in their work to improve the quality of CMHC. Finally, we recommend that a range of organisational and administrative models of care be used in order to support improvement work.
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