Tracking Clinical Staff Behaviors in an Operating Room

Inadequate staff behaviors in an operating room (OR) may lead to environmental contamination and increase the risk of surgical site infection. In order to assess this statement objectively, we have developed an approach to analyze OR staff behaviors using a motion tracking system. The present article introduces a solution for the assessment of individual displacements in the OR by: (1) detecting human presence and quantifying movements using a motion capture (MOCAP) system and (2) observing doors’ movements by means of a wireless network of inertial sensors fixed on the doors and synchronized with the MOCAP system. The system was used in eight health care facilities sites during 30 cardiac and orthopedic surgery interventions. A total of 119 h of data were recorded and analyzed. Three hundred thirty four individual displacements were reconstructed. On average, only 10.6% individual positions could not be reconstructed and were considered undetermined, i.e., the presence in the room of the corresponding staff member could not be determined. The article presents the hardware and software developed together with the obtained reconstruction performances.

"Loss of situation awareness" by medical staff: reflecting on the moral and legal status of a psychological concept

This article examines the emergence of "accurate situation awareness (SA)" as a legal and moral standard for judging professional negligence in medicine. It argues that SA constitutes a status, an outcome resulting from the confluence of a wide array of factors, some originating inside and others outside the agent. SA does not connote an action, a practice, a role, a task, a virtue, or a disposition--the familiar objects of moral and legal appraisal. The argument contends that invoking SA becomes problematic when its use broadens to include professional or legally appraisable norms for behaviour, which expect a certain state of awareness from practitioners.

Life-prolonging treatment in nursing homes: how do physicians and nurses describe and justify their own practice?

BACKGROUND

Making the right decisions, while simultaneously showing respect for patient autonomy, represents a great challenge to nursing home staff in the issues of life-prolonging treatment, hydration, nutrition and hospitalisation to dying patents in end-of-life.

OBJECTIVES

To study how physicians and nurses protect nursing home patients' autonomy in end-of-life decisions, and how they justify their practice.

DESIGN

A qualitative descriptive design with analysis of the content of transcribed in-depth interviews with physicians and nurses.

PARTICIPANTS

Nine physicians and ten nurses in 10 nursing homes in Norway.

RESULTS AND INTERPRETATIONS

Assessment of the patient's competence to consent to treatment is almost absent. The physicians build their practice on the principles of beneficence and nonmaleficence. Nurses tend to trust the patients' rejection of life support, even when the patients have difficulty speaking or suffer from dementia. Relatives were, according to the health personnel, included in decision-making processes to a very limited extent. However, futile life support is sometimes provided contrary to the physicians' judgement of what constitutes the patient's best interest on occasions when they are pressurised by next of kin.

CONCLUSIONS

The study reveals a need to improve decision-making routines according to ethical ideals and legislation. Conflicts between relatives and healthcare professionals in the decision-making process deflect the focus from searching for the best possible treatment for the terminal patient. Further discussion is required as to whether the concept of autonomy is applicable in situations in which the patient is impaired and dying.

Medical employee ethics: a staff training tool

Ethics is a critical part of medical employee education and is a subject that requires frequent and regular consideration and attention. This article defines ethics particularly as it applies to an individual who works in a medical practice and explores five core ethical values for all medical practice personnel. It suggests the benefits of basing management practices and decisions on ethical core values and explores specific ways that ethics can affect an individual's emotional and physical well being. This article also offers ethical guidelines specifically for medical practice employees regarding the use of their time at work and their workplace communications. Finally, this article offers a set of questions a medical practice employee can use when working through an ethical dilemma and dispels six common myths about medical practice ethics.

Privacy and dual loyalties in occupational health practice

This survey set out to explore occupational health professionals' courses of action with respect to privacy in a situation of dual loyalty between employees and employers. A postal questionnaire was sent to randomly selected potential respondents. The overall response rate was 64%: 140 nurses and 94 physicians returned the questionnaire. Eight imaginary cases involving an ethical dilemma of privacy were presented to the respondents. Six different courses of action were constructed within the set alternatives proposed. The study indicated that privacy as an absolute value is not in the interest of either employees or employers. It also showed that, where dual loyalty is concerned, the most valid course of action in dealing with sensitive subjects such as drug and work community problems, sexual harassment and sick leave is to rely on tripartite co-operation. If they maintain their professional independence and impartiality, health professionals are well placed to succeed in this challenging task; if not, there are bound to be severe violations of privacy.

From cure to palliation: agreement, timing, and decision making within the staff

Important issues in the transition from curative treatment to palliative care are agreement, timing, and decision making. A survey of 309 nurses and 415 physicians in Sweden showed that 61% of the nurses and 83% of the physicians thought agreement was current practice. None said that the decisions were made too early, but 19% of the nurses and 14% of the physicians thought that they often were made too late. Very few respondents stated that such decisions are changed, 0% and 1%, respectively. More than half of the informants made detailed comments on such transitions indicating that awareness and flexibility are desirable to make well-informed decisions. Three themes that emerged from the analysis concerning the decision to stop curative treatment and focus on palliative care were that the staff members should (if possible) make such decisions in agreement and should sometimes make the decisions earlier and that well-based reasons are required to make changes.

Positive and negative outcomes from values and beliefs held by healthcare clinician and non-clinician managers

AIM

The aim of this paper is to present the values and beliefs of clinicians and non-clinicians working in not-for-profit healthcare organizations, and the positive and negative outcomes of holding such values.

BACKGROUND

Ethical values are part of the essence of healthcare management and delivery. Although studies have identified what some of those values are, few studies have been undertaken to identify if the values and beliefs held are ethical, and what the outcomes, positive and negative, to holding such values are.

METHODS

This study was undertaken in 60 of the 65 acute care hospitals in the Republic of Ireland, and in eight regional health boards during 2001. The study population included all accessible professional clinician and non-clinician department heads. The sample size was 862 and the valid response rate was 42%. Research findings from questions requiring qualitative responses are presented and are part of a wider study. Responses were subjected to content analysis.

RESULTS

Eleven key values identified are excellence in care delivery, positive value system, managerial receptiveness and non-receptiveness, organizational dependability and lack of dependability, peer cohesion and lack of peer cohesion, equity in care delivery, personal contribution to the organization and personal importance. Findings also demonstrated positive and negative outcomes for the organization, patients and staff as a result of the values held.

CONCLUSIONS

Findings show that healthcare clinicians and non-clinicians demonstrated a range of values in the delivery of health care, some of which have not been identified before. Should professionals now reconsider the values required in the delivery of health care? The most widely perceived values held by both groups were similar, although clinicians perceived that non-clinicians did not hold the same ethical values and beliefs as they did, and vice-versa, demonstrating a lack of trust in each other's moral and ethical value system.

Patients' right to decide whether to be resuscitated

While the issue of do-not-resuscitate orders is often discussed in nursing journals, there appears to be little consideration given to the other side of the issue--are some patients in danger of being resuscitated when they would prefer to be left alone? This article looks at whether all patients should be asked what their preferences are regarding resuscitation.

Antipsychotic depot medication and attitudes of community psychiatric nurses

Utilization of long-acting antipsychotic injections (depots) shows wide regional variation. In many countries, community psychiatric nurses (CPNs) administer depots but their concerns and attitudes regarding these drugs are seldom considered. We aimed to investigate attitudes and knowledge towards depots in a cross-sectional survey of CPNs in London, and compare them with those of psychiatrists obtained in a previous study. Three subscales of a depot attitude/knowledge questionnaire were used with additional items which referred to aspects of the CPN role. Participants were 70 CPNs who attended an academic meeting. Most CPNs reported that they were involved in treatment decisions (78%) although some CPNs seldom asked their patients about side effects (19%) and felt that they did not have sufficient time for consultations (23%) or training (23%). Several CPNs believed that depots are old fashioned (34%) and stigmatizing (44%). Compared to psychiatrists, CPNs believed more that depots compromised patient autonomy (28%, P = 0.003) and were coercive (42%, P < 0.001). Familiarity with depots and their knowledge of side effects were positively associated with favourable attitudes. CPNs have several strongly endorsed attitudes towards depot medication. Interprofessional group differences also exist which may undermine the treatment process. Training/refresher courses about depots should highlight systematic treatment decision-making and side effect monitoring which, in turn, may improve professionals' attitudes, knowledge and clinical monitoring of depots.

A study of the ethical sensitivity of physicians in Turkey

In order to prepare bioethics and clinical ethics courses for clinicians in Turkey, we needed to know the attitudes of physicians when placed in ethically difficult care situations. We presented four cases to 207 physicians who are members of the Physicians' Association in Kocaeli, Turkey. Depending on the decisions they made in each case, we determined whether they were aware of the ethical aspects of the cases and the principles they chose as a basis for their decisions. We aimed to gain information about their ethical tendencies and moral sensitivity. A small number of physicians stated that they would 'show respect for a patient's living will' in the first case, but more stated that they would 'let the patient refuse the treatment' in the second. In the third case, where medical confidentiality was the significant ethical issue, most of the physicians said that they would act in order to maintain confidentiality. For the last case, more than half the physicians chose to 'tell the truth' to the patient. The paternalism shown in the doctors' decisions on the first two cases was no longer observed in those made for the last two cases. We concluded that the physicians who participated in our study have low sensitivity to living wills (or advance directives) and patients refusing treatment. However, when issues of medical confidentiality and truth-telling are concerned, they take care to protect the autonomy of the individual an are relatively more aware of the ethical aspects of these cases.

Staff beliefs about drug abuse clinical trials

Staff from 10 community-based addiction treatment organizations in the National Drug Abuse Clinical Trials Network participated in an educational session about addiction research practices and human subject protections. This 1.5-hour presentation addressed "informed consent," "confidentiality of research information," "inclusion and exclusion criteria," "random assignment," "patient protections," and "patient payments." Pre- and postsession surveys were administered to 115 staff members measuring their beliefs about clinical trials. At baseline, 52% of staff believed patients could transfer out of a study even if they were doing poorly, and 55% believed staff had this right; 44% agreed that patients could participate in a clinical trial without understanding what would take place in the study. After the educational session, staff beliefs about patient protections were significantly increased in five of the seven items. A fourth of staff continued to believe patient payments were harmful, and 37% did not believe participation in a clinical trial would increase a patient's chances at recovery.

[Expectations of patients from hospital staff]

Irrespective of the level of care, possible objections and even complaints lodged to various institutions concerning functioning of health care units, expectations of patients from doctors and middle medical staff as for health services and respecting their rights are of very different character. Investigations of patients' opinions on their expectations from health service personnel in hospitals were carried out in 49 wards of 13 hospitals in the Lublin district from 24.08. to 06.09.1999. For solving research problems of this study the method of diagnostic survey was used with the use of questionnaire technique. Patients in individual wards were randomly selected on the basis of hospital discharge sequence. Opinions on the subject under study were collected from patients leaving investigated wards in whom: the awareness of discharge and independence of the staff allowed frank opinions, the fact of hospitalisation gave experience, hospital stay enabled comprehensive assessment of problems under discussion. The study comprising 353 patients has shown that: patients expect from doctors, first of all, respecting the right to information (31.8%) on the whole subject range from diagnosis, assessment of health condition, and prognosis to the aim, risk, benefits and ways of carrying out medical procedures (20.02%); expectations of patients from middle medical staff mainly concern respecting the right to partner treatment, with dignity and respect (29.5%); over two thirds of patients (41.5%) also express their expectations from auxiliary medical staff concerning their manners in contacts with them.