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Rannikko S, Stolt M, Suhonen R, Leino-Kilpi H. Ethical issues in the care of patients with stroke: A scoping review. J Clin Nurs 2018; 28:20-31. [PMID: 30184289 DOI: 10.1111/jocn.14661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/25/2018] [Accepted: 08/30/2018] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES The aim was to identify and analyse the ethical issues in the care of patients with stroke (PwS). The goal was to understand the nature of the existing knowledge on the topic and to identify whether there are ethical issues specific to the care of PwS. BACKGROUND Stroke is a disease with possible multiple effects on the patient's overall condition and experienced ethical issues in the care. Additionally, stroke impacts the life of the significant other. For health professionals, the care of PwS is challenging at different stages of the care process. The care of stroke includes several ethically sensitive situations from the perspectives of all participants. DESIGN Scoping review. METHODS The review was conducted following the five-stage methodological framework of Arksey and O'Malley (2005). The literature search was conducted in several electronic databases and complemented with a manual search, resulting in 15 reviewed articles. The analysis was conducted by charting descriptive numerical data and by content analysis of the narrative representations. RESULTS The studies focused on hospital or rehabilitation contexts and a high number of studies had a qualitative approach. Three main themes were identifiable: "decision-making as an ethically challenging act," "care process-specific ethical issues" and "environmental ethical issues." CONCLUSIONS Ethical issues occur at different stages of the care process of PwS and from the viewpoints of all those involved. However, not all the recognised ethical issues were stroke specific. As the number of the reviewed articles was limited, more research is needed for a comprehensive understanding of the topic. RELEVANCE TO CLINICAL PRACTICE Individual health professionals may use the results in observing their own action from an ethical perspective and to deepen the ethical understanding of the care of PwS. In health care organisations, the results may be used in developing the ethical quality of care.
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Affiliation(s)
| | - Minna Stolt
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
| | - Riitta Suhonen
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Helena Leino-Kilpi
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Scheel-Sailer A, Post MW, Michel F, Weidmann-Hügle T, Baumann Hölzle R. Patients' views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury-A qualitative interview-based study. Health Expect 2017; 20:1133-1142. [PMID: 28338280 PMCID: PMC5600242 DOI: 10.1111/hex.12559] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 12/01/2022] Open
Abstract
Introduction Involving patients in decision making is a legal requirement in many countries, associated with better rehabilitation outcomes, but not easily accomplished during initial inpatient rehabilitation after severe trauma. Providing medical treatment according to the principles of shared decision making is challenging as a point in case for persons with spinal cord injury (SCI). Objectives The aim of this study was to retrospectively explore the patients’ views on their participation in decision making during their first inpatient rehabilitation after onset of SCI, in order to optimize treatment concepts. Methods A total of 22 participants with SCI were interviewed in‐depth using a semi‐structured interview scheme between 6 months and 35 years post‐onset. Interviews were transcribed verbatim and analysed with the Mayring method for qualitative content analysis. Results Participants experienced a substantially reduced ability to participate in decision making during the early phase after SCI. They perceived physical, psychological and environmental factors to have impacted upon this ability. Patients mentioned regaining their ability to make decisions was an important goal during their first rehabilitation. Receiving adequate information in an understandable and personalized way was a prerequisite to achieve this goal. Other important factors included medical and psychological condition, personal engagement, time and dialogue with peers. Conclusion During the initial rehabilitation of patients with SCI, professionals need to deal with the discrepancy between the obligation to respect a patient's autonomy and their diminished ability for decision making.
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Affiliation(s)
| | - Marcel W Post
- Swiss Paraplegic Research, Nottwil, Switzerland.,University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands.,Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | - Tatjana Weidmann-Hügle
- Institute Dialog Ethik, Zurich, Switzerland.,Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Morais HCC, Gonzaga NC, Aquino PDS, Araujo TLD. [Strategies for self-management support by patients with stroke: integrative review]. Rev Esc Enferm USP 2016; 49:136-43. [PMID: 25789653 DOI: 10.1590/s0080-623420150000100018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/18/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze strategies for self-management support by patients with stroke in the light of the methodology of the five A's (ask, advice, assess, assist and arrange). METHODS Integrative review conducted at the following databases CINAHL, SCOPUS, PubMed, Cochrane and LILACS. RESULTS A total of 43 studies published between 2000 and 2013 comprised the study sample. All proposed actions in the five A's methodology and others were included. We highlight the Assist and Arrange, in which we added actions, especially with regard to the use of technological resources and joint monitoring between patients, families and professionals. No study included all five A's, which suggests that the actions of supported self-management are developed in a fragmented way. CONCLUSION The use of five A's strategy provides guidelines for better management of patients with stroke with lower cost and higher effectiveness.
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Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expect 2016; 20:243-259. [PMID: 27075246 PMCID: PMC5354019 DOI: 10.1111/hex.12453] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled. OBJECTIVE To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management. DESIGN Critical interpretive synthesis using systematic searches of literature published 2000-2014. FINDINGS We summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self-management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner-patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice. DISCUSSION AND CONCLUSION Broader approaches seem necessary to fulfil the promise of support for self-management, especially for patient empowerment. A commitment to enable people to live well with long-term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.
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Affiliation(s)
| | | | - Alan Cribb
- Centre for Public Policy Research, King's College London, London, UK
| | - Simon Christmas
- Centre for Public Policy Research, King's College London, London, UK
| | - John Owens
- Centre for Public Policy Research, King's College London, London, UK
| | - Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian S Watt
- Department of Health Sciences/Hull York Medical School, Faculty of Science, University of York, Heslington, York, UK
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Bonikowsky S, Musto A, Suteu KA, MacKenzie S, Dennis D. Independence: An Analysis of a Complex and Core Construct in Occupational Therapy. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13336366278176] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Independence is a core concept in occupational therapy, but there is little consensus within the profession upon a universal definition. The present study employed a critical interpretive synthesis to examine two fundamental research questions: ‘How is independence conceptualised in quantitative and qualitative research within occupational therapy?’ and ‘How does the term “independence”, in its present use, critically impact occupational therapy policy and practice?’ Method: Articles pertaining to occupational therapy and contributing to the definition of independence within the profession were examined. Three successive levels of coding — open, axial and selective — were used to analyse 19 final articles. Findings: From the literature, nine definition themes emerged: function, autonomy and competence, control, context, culture, environment, personal attributes and safety. These themes were then organised into three categories: personal factors, environmental factors and continuum, which were synthesised together to create a model that addresses all factors critical to the composition of independence. In addition, four clinical themes developed: goal of occupational therapy, client-therapist relationship, variable definitions in occupational therapy practice and limitations of present practice. Conclusion: Through the formalisation of the integral components of independence, this study enables a standardised foundation for the examination of this core concept across the profession.
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Affiliation(s)
- Sarah Bonikowsky
- MSc in Occupational Therapy, Western University Canada, London, Ontario, Canada
| | - Amanda Musto
- Occupational Therapist, VHA Rehab Solutions and Honeypot Consulting, Toronto, Ontario, Canada
| | - Kerry Ann Suteu
- Occupational Therapist, CBI Health Group, London, Ontario, Canada
| | - Sherry MacKenzie
- Occupational Therapist, Source Rehabilitation Services Inc., Sudbury, Ontario, Canada
| | - Donna Dennis
- Lecturer, School of Occupational Therapy, Western University Canada, London, Ontario, Canada
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Matsui M, Capezuti E. Perceived autonomy and self-care resources among senior center users. Geriatr Nurs 2008; 29:141-7. [PMID: 18394515 DOI: 10.1016/j.gerinurse.2007.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 09/04/2007] [Accepted: 09/09/2007] [Indexed: 11/25/2022]
Abstract
Personal autonomy-the ability to make freely self-directed choices in one's life-is considered critical to an older person's quality of life. Informed by model and role-modeling nursing theory, this descriptive, correlational study examined the relationship of perceived enactment of autonomy to self-care resources, both internal (age, race, functional ability) and external (social support, living arrangements, community-based service utilization, and service satisfaction) among 120 older adults from 6 Manhattan senior centers. Participants demonstrated positive perceived autonomy. Study participants used a variety of community-based services, and their satisfaction with the services was significantly linked to autonomy. Using multiple linear regression model, the only significant predictors of perceived autonomy were race (white > nonwhite), service satisfaction, and social support. Nursing strategies such as providing information that promotes informed decision making and encouraging independence, as well as working collaboratively with members of an older persons' social network, can enhance an older persons' autonomy.
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Affiliation(s)
- Miho Matsui
- Nagasaki University School of Health Sciences, Nagasaki-shi, Japan
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van de Ven L, Post M, de Witte L, van den Heuvel W. Strategies for autonomy used by people with cervical spinal cord injury: a qualitative study. Disabil Rehabil 2008; 30:249-60. [PMID: 17852311 DOI: 10.1080/09638280701265687] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify strategies used by people with high cervical spinal cord injury (SCI) to function autonomously. A multidimensional concept of autonomy was used, with four dimensions: independence, self-determination, participation and identification. METHODS Qualitative methods were used, involving literature study and semi-structured interviews with eight individuals with high SCI who had been discharged from the rehabilitation centre for several years and were members of a sports club. RESULTS Strategies for independence included making independent functioning a personal challenge and learning from others with SCI. Strategies for self-determination included keeping oneself informed, setting personal goals and being assertive. Strategies for participation were making challenges out of barriers, planning and organizing, asking and accepting help, and dealing with reactions from others. Strategies for identification involved taking life as it comes and focussing on positive aspects of life. CONCLUSIONS Different strategies are necessary for different dimensions of autonomy. Some strategies seem contradictory in terms of their effects on different dimensions of autonomy. Patients can be made aware of strategies for autonomy during the rehabilitation phase.
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Proot IM, ter Meulen RHJ, Abu-Saad HH, Crebolder HFJM. Supporting stroke patients' autonomy during rehabilitation. Nurs Ethics 2007; 14:229-41. [PMID: 17425151 DOI: 10.1177/0969733007073705] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients' autonomy was found to be helpful for restoration of their autonomy. Two patterns in health professionals' approach appeared to be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients' progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients' preparation for autonomous living after discharge.
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Affiliation(s)
- Ireen M Proot
- Department of Health Care Studies, Section of Health Ethics and Philosophy, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Collis Pellatt G. Patients and professionals' views of the patient's role in spinal cord injury rehabilitation. ACTA ACUST UNITED AC 2006. [DOI: 10.12968/bjnn.2006.2.4.21516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Glynis Collis Pellatt
- University of Luton, Aylesbury Vale Education Centre, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL
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Abstract
The purpose of the study was to further explore the methods that nurses use to solve ethically difficult care situations in nursing homes while the aim of this article was to present a model for nursing practice in such situations. Fourteen nurses from three nursing homes in Norway were observed and interviewed in order to discern the strategies they used to deal with ethically difficult care situations. To analyse this information, we used a constant comparative method until a grounded theory emerged. The nurses' principal strategy was to apply earlier experiences while striving for the best outcome for the elderly patients. This article discusses this strategy and compares it to a theory of ethics called casuistry. We suggest that by using the method of experiences combined with casuistry in a more systematic way, nurses can develop acceptable solutions for difficult care situations in nursing homes.
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