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Verdaguer M, Beroiz-Groh P, Busquet-Duran X, Moreno-Gabriel E, Arreciado Marañón A, Feijoo-Cid M, Domènech M, Íñiguez-Rueda L, Vallès-Peris N, Cantarell-Barella G, Toran-Monserrat P. [The euthanasia law and professional experiences: tensions in clinical practice]. GACETA SANITARIA 2024:S0213-9111(24)00020-7. [PMID: 38472012 DOI: 10.1016/j.gaceta.2024.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. METHOD A qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. RESULTS The assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. CONCLUSIONS Throughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.
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Affiliation(s)
- Maria Verdaguer
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España.
| | - Patricia Beroiz-Groh
- Hospital Germans Trias i Pujol, Badalona (Barcelona), España; Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Xavier Busquet-Duran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Programa d'Atenció Domiciliària Equip de Suport, Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Granollers (Barcelona), España
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España
| | - Antonia Arreciado Marañón
- Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Departament d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Maria Feijoo-Cid
- Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Departament d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Miquel Domènech
- Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Lupicinio Íñiguez-Rueda
- Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Núria Vallès-Peris
- Institut d'investigació en Intel·ligència Artificial, Consejo Superior de Investigaciones Científicas (IIIA-CSIC), Bellaterra (Cerdanyola del Vallès, Barcelona), España; Barcelona Science and Technology Studies Group (STS-b), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | | | - Pere Toran-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España
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Akoo C, McMillan K. An Evolutionary Concept Analysis of Palliative Care in Oncology Care. ANS Adv Nurs Sci 2022; 46:199-209. [PMID: 36006006 DOI: 10.1097/ans.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.
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Affiliation(s)
- Chaman Akoo
- School of Nursing, University of Ottawa, Ottawa, Canada
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Sarro EL, Haviland K, Chow K, Sequeira S, McEachen ME, King K, Aho L, Coyle N, Zhang H, Lynch KA, Voigt L, McCabe MS. PASTRY: A nursing-developed quality improvement initiative to combat moral distress. Nurs Ethics 2022; 29:1066-1077. [PMID: 35050811 PMCID: PMC9999433 DOI: 10.1177/09697330211062984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention. AIM "Positive Attitudes Striving to Rejuvenate You: PASTRY" was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses. RESEARCH DESIGN A Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric's Moral Distress Scale-Revised (MDS-R.) This program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving "false hope" to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices. PARTICIPANTS Clinical nurses working on an adult leukemia/lymphoma unit. ETHICAL CONSIDERATIONS This was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution's Ethics Committee oversaw PASTRY's implementation. FINDINGS While improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit's moral distress, led to enhanced camaraderie, and improved nurses' coping skills. DISCUSSION Measurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions. CONCLUSION This QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created.
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Affiliation(s)
| | - Kelly Haviland
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly Chow
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sonia Sequeira
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kerry King
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren Aho
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nessa Coyle
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hao Zhang
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Louis Voigt
- 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary S McCabe
- 51647National Coalition for Cancer Survivorship, Silver Spring, MD, USA
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Campillay Campillay M, Rivas E, Dubó-Araya P, Calle-Carrasco A. Aspectos éticos relacionados con la atención de enfermería en personas en situación de discapacidad: un análisis cualitativo. PERSONA Y BIOÉTICA 2020. [DOI: 10.5294/pebi.2020.24.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Este estudio tiene como propósito describir aspectos éticos relacionados con la atención de enfermería en personas con discapacidad, población considerada socialmente vulnerable y reconocida en condiciones de desigualdad. Corresponde a una primera fase de estudio primario realizado en la región de Atacama, Chile, que utilizó metodología cualitativa y análisis de contenido. Se realizan entrevistas a profesionales de enfermería respetando los criterios éticos de Ezekiel Emanuel. Los principales hallazgos dan cuenta de las categorías ontológicas: razonamiento moral, sistema de valores, modelo de relación enfermera-paciente, consecuencias de la acción ética de enfermería, estrategias para superar conflictos morales y barreras en el cuidado. Se concluye que cuidar personas con discapacidad es fuente de dilema y angustia moral para los profesionales de enfermería, especialmente cuando se trata de sujetos con discapacidad sensitiva o cognitiva. El modelo médico paternalista predomina en el contexto clínico, lo que limita el derecho a la autonomía de las personas con discapacidad. A los valores morales tradicionales promovidos por los profesionales de enfermería se suman valores instrumentales como la eficiencia. No se mencionan valores cívicos considerados fundamentales ante el desafío de la diversidad humana y la vida en democracia.
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