Статті в журналах з теми "End of life care ethical issues"
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1
Walker, Robert M. "Ethical Issues in End-of-Life Care." Cancer Control 6, no. 2 (March 1999): 162–67. http://dx.doi.org/10.1177/107327489900600204.
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Greenberger, Chaya. "Enteral nutrition in end of life care." Nursing Ethics 22, no. 4 (August 4, 2014): 440–51. http://dx.doi.org/10.1177/0969733014538891.
Повний текст джерелаАнотація:
Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a fatal disease to naturally run its course until an individual’s vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals’ wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues.
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Childress, Sue. "Ethics at the End of Life." Home Health Care Management & Practice 20, no. 5 (December 26, 2007): 414–17. http://dx.doi.org/10.1177/1084822307311829.
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Patients, families, and health care providers all face ethical issues at the end of life. Related to increased technology, decreased resources, and immense cultural diversity, these controversies are a common concern to providers in home care. Increased knowledge and skills related to ethical discussions are crucial tools for providers in home care. Providers'abilities to facilitate these discussions with families and patients at the end of life can ease the transition from aggressive care to hospice care. This article describes basic principles of an ethical discussion and discusses the common ethical dilemmas faced at the end of life.
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Izumi, Shigeko. "Ethical practice in end-of-life care in Japan." Nursing Ethics 17, no. 4 (July 2010): 457–68. http://dx.doi.org/10.1177/0969733010364584.
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Nurses are obliged to provide quality nursing care that meets the ethical standards of their profession. However, clear descriptions of ethical practice are largely missing in the literature. Qualitative research using a phenomenological approach was conducted to explicate ethical nursing practice in Japanese end-of-life care settings and to discover how ethical practices unfold in clinical situations. Two paradigm cases and contrasting narratives of memorable end-of-life care from 32 Japanese nurses were used to reveal four levels of ethical practice: ethical, distressed, uncertain, and unethical. Having the ability to actualize, justify, and recognize what is the good and/or right differentiated between these levels of ethical practice, empirical descriptions of which are given, followed by discussion of how nurses gain the skilled knowledge necessary for ethical practice.
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Kyba, Ferne C. "Legal and ethical issues in end-of-life care." Critical Care Nursing Clinics of North America 14, no. 2 (June 2002): 141–55. http://dx.doi.org/10.1016/s0899-5885(01)00004-1.
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Thorns, Andrew. "Ethical and legal issues in end-of-life care." Clinical Medicine 10, no. 3 (June 2010): 282–85. http://dx.doi.org/10.7861/clinmedicine.10-3-282.
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Matzo, Marianne LaPorte, Deborah Witt Sherman, Paula Nelson-Marten, Anne Rhome, and Marcia Grant. "Ethical and Legal Issues in End-of-Life Care." Journal for Nurses in Staff Development (JNSD) 20, no. 2 (March 2004): 59–66. http://dx.doi.org/10.1097/00124645-200403000-00001.
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Rejnö, Åsa, and Linda Berg. "Strategies for handling ethical problems in end of life care: obstacles and possibilities." Nursing Ethics 22, no. 7 (October 6, 2014): 778–89. http://dx.doi.org/10.1177/0969733014547972.
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Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions.
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Hernández-Marrero, Pablo, Emília Fradique, and Sandra Martins Pereira. "Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis." Nursing Ethics 26, no. 6 (May 28, 2018): 1680–95. http://dx.doi.org/10.1177/0969733018774610.
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Background: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations” (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. Objectives: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses’ current end-of-life care practices. Design: Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. Findings: All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Discussion: Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients’ preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. Conclusion: While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses’ involvement and practices in end-of-life decision-making.
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Karnik, Sameera, and Amar Kanekar. "Ethical Issues Surrounding End-of-Life Care: A Narrative Review." Healthcare 4, no. 2 (May 5, 2016): 24. http://dx.doi.org/10.3390/healthcare4020024.
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Kim, Hyejin, Janet A. Deatrick, and Connie M. Ulrich. "Ethical frameworks for surrogates’ end-of-life planning experiences." Nursing Ethics 24, no. 1 (August 3, 2016): 46–69. http://dx.doi.org/10.1177/0969733016638145.
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Background: Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles, and concepts) to understand surrogates’ day-to-day experiences in end-of-life care planning for incapacitated adults. Objectives and Methods: This qualitative systematic review was conducted to identify the types of ethical frameworks used to address surrogates’ experiences in end-of-life care planning for incapacitated adults as well as the most common themes or patterns found in surrogate decision-making research. Findings: Seven research papers explicitly identified ethical theories, principles, or concepts, such as autonomy, substituted judgment, and best interest standards as guidelines for the research. Surrogate decision making themes included the responsibilities and goals of being a surrogate, factors influencing surrogates’ decision making, outcomes for surrogates, and an overarching theme of “wanting to do the right thing” for their loved one and/or themselves. Discussion: Understanding the complexity of surrogates’ experiences of end-of-life care planning is beyond the scope of conventional ethical frameworks. Conclusion: Ethical frameworks that address individuality and contextual variations related to decision making may more appropriately guide surrogate decision-making research that explores surrogates’ end-of-life care planning experiences.
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Akpinar, Aslihan, Muesser Ozcan Senses, and Rahime Aydin Er. "Attitudes to End-of-Life Decisions in Paediatric Intensive Care." Nursing Ethics 16, no. 1 (January 2009): 83–92. http://dx.doi.org/10.1177/0969733008097994.
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The aim of this study was to assess attitudes of intensive care nurses to selected ethical issues related to end-of-life decisions in paediatric intensive care units. A self-administered questionnaire was distributed in 2005 to intensive care nurses at two different scientific occasions in Turkey. Of the 155 intensive care nurse participants, 98% were women. Fifty-three percent of these had intensive care experience of more than four years. Most of the nurses failed to agree about withholding (65%) or withdrawing (60%) futile treatment. In addition, 68% agreed that intravenous nutrition must continue at all costs. In futile treatment cases, the nurses tended to leave the decision to parents or act maternalistically. The results showed that intensive care nurses could ignore essential ethical duties in end-of-life care. We suggest that it is necessary to educate Turkish intensive care nurses about ethical issues at the end of life.
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Pleschberger, Sabine, Jane E. Seymour, Sheila Payne, Reginald Deschepper, Bregje D. Onwuteaka-Philipsen, and Mette L. Rurup. "Interviews on End-of-Life Care With Older People." Qualitative Health Research 21, no. 11 (July 6, 2011): 1588–600. http://dx.doi.org/10.1177/1049732311415286.
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Qualitative research provides important insights into the experiences and perspectives of older people on end-of-life issues, but such research is methodologically and ethically complex. We offer a set of reflections from six end-of-life care studies conducted with older people in four European countries: Belgium, Germany, the Netherlands, and the United Kingdom. The reflection process was informed by four full-day meetings between the authors and referral to sources including the study interview guides, summary “pen portraits” about key issues encountered in the interviews, and key sections of the interview transcripts. We identified as major challenges accessing people, the introduction of end-of-life issues in an interview, managing emotions, the presence of companions, and reciprocity. Formal ethical review committees rarely take into account these complex issues. We concluded that is it necessary to maintain an ongoing reflexive stance to enhance qualitative research practice in the intersecting fields of aging and end-of-life studies.
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Schaffer, Marjorie A. "Ethical Problems in End-of-Life Decisions for Elderly Norwegians." Nursing Ethics 14, no. 2 (March 2007): 242–57. http://dx.doi.org/10.1177/0969733007073707.
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Norwegian health professionals, elderly people and family members experience ethical problems involving end-of-life decision making for elders in the context of the values of Norwegian society. This study used ethical inquiry and qualitative methodology to conduct and analyze interviews carried out with 25 health professionals, six elderly people and five family members about the ethical problems they encountered in end-of-life decision making in Norway. All three participant groups experienced ethical problems involving the adequacy of health care for elderly Norwegians. Older people were concerned about being a burden to their families at the end of their life. However, health professionals wished to protect families from the burden of difficult decisions regarding health care for elderly parents at the end of life. Strategies are suggested for dialogue about end-of-life decisions and the integration of palliative care approaches into health care services for frail elderly people.
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Hemberg, Jessica, and Elisabeth Bergdahl. "Dealing with ethical and existential issues at end of life through co-creation." Nursing Ethics 27, no. 4 (September 15, 2019): 1012–31. http://dx.doi.org/10.1177/0969733019874496.
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Background In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient’s quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients’ and their relatives’ needs with regard to ethical and existential issues and situations in home care encounters, especially at the end of life. Aim The aim of this study was to explore nurses’ experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care. Research design, participants, and research context The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis. Ethical considerations Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study. Findings A main theme and four subthemes emerged. The main theme was “Deep co-creative relationships are needed to manage ethical and existential issues at the end of life.” A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care. Discussion Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses’ ethical competence within this context. Conclusion The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients’ perspective.
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Hiruy, Kiros, and Lillian Mwanri. "End-of-life experiences and expectations of Africans in Australia." Nursing Ethics 21, no. 2 (March 4, 2013): 187–97. http://dx.doi.org/10.1177/0969733012475252.
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The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider an ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initiates the discussion to highlight the importance of paying sufficient attention to a diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations.
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Abraham, CPA, MBA, FPSQua, Lucille A., and Mary Caroline N. Castaño. "Ethical Standards/Issues: Are They Relevant to Quality Patient Care?" 11th GLOBAL CONFERENCE ON BUSINESS AND SOCIAL SCIENCES 11, no. 1 (December 9, 2020): 21. http://dx.doi.org/10.35609/gcbssproceeding.2020.11(21).
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Ethical standards/issues are sensitive matters which could mean either a life or death situation. This study involves issues like abortion, contraception, euthanasia and sanctity (holiness) of family life. It aims to determine if ethical standards/issues are relevant to quality patient care. Ethical issues can be divisive but a healthcare professional or worker does not have to be a Catholic or Christian in order to understand that one has to be always in favor of life, of human life. Any person for that matter has the natural moral law or the law imprinted in the heart and mind which enables one to do good and avoid evil, to choose what is morally right against what is morally wrong. For what is really important? To save one's life but lose it in the end or to lose one's life but save it in the end. Keywords: Ethical issues, quality patient care
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Pinho-Reis, Cintia, António Sarmento, and Manuel Luís Capelas. "Nutrition and Hydration in the End-of-Life Care: Ethical Issues." Acta Portuguesa de Nutrição 15 (December 31, 2018): 36–40. http://dx.doi.org/10.21011/apn.2017.1507.
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KyungsukChoi. "Legal and Ethical Issues Regarding End-of-Life Care in Korea." Development and Society 45, no. 1 (June 2016): 151–64. http://dx.doi.org/10.21588/dns.2016.45.1.006.
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Thieleman, Kara J., Cara Wallace, Andrea N. Cimino, and Heidi A. Rueda. "Exhaust All Measures: Ethical Issues in Pediatric End-of-Life Care." Journal of Social Work in End-of-Life & Palliative Care 12, no. 3 (July 2, 2016): 289–306. http://dx.doi.org/10.1080/15524256.2016.1200518.
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Laskar, Shamima Parvin. "Challenges of Palliative Care." Bangladesh Journal of Bioethics 4, no. 3 (December 20, 2013): 19–24. http://dx.doi.org/10.3329/bioethics.v4i3.17374.
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It has been moral duty of physicians to save and prolong patients? life for as long as possible. But the philosophy of treatment regime for terminally ill patients had been changed. To save and prolong human life if it is meaningful has got added value. Many criticizes the modern way of death. Palliative sedation, euthanasia as a good death model is criticized for medicalization of management of death. Currently, end of life issues are one of the top 10 health care ethics challenges facing the public. There is a new ethical challenge that human life can be ended by a doctor, passively or actively or a doctor kills the patient. Withholding and withdrawing, refusal of treatments, physician-assisted suicide, do not resuscitate (DNR) orders, advance directives, consent and quality of end of life care and are the main debates in this field. There are many complex ethical issues that can affect patients and families in the health care setting. Good understanding of medical ethics will contribute to the health professional's decision-making and dayto- day practice of medicine for a terminally ill patient. DOI: http://dx.doi.org/10.3329/bioethics.v4i3.17374 Bangladesh Journal of Bioethics 2013; 4(3):19-24
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Whitty-Rogers, Joanne, Marion Alex, Cathy MacDonald, Donna Pierrynowski Gallant, and Wendy Austin. "Working with Children in End-of-Life Decision Making." Nursing Ethics 16, no. 6 (November 2009): 743–58. http://dx.doi.org/10.1177/0969733009341910.
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Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.
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Holmberg, Bodil, Ingrid Hellström, and Jane Österlind. "End-of-life care in a nursing home: Assistant nurses’ perspectives." Nursing Ethics 26, no. 6 (June 27, 2018): 1721–33. http://dx.doi.org/10.1177/0969733018779199.
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Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.
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Fetherston, Anne A., Grace Rowley, and Charlotte L. Allan. "Challenges in end-of-life dementia care." Evidence Based Mental Health 21, no. 3 (May 18, 2018): 107–11. http://dx.doi.org/10.1136/eb-2018-102889.
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Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild–moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals’ prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection. To navigate complexity at the end of life, open communication that involves patients and families in decisions, and is responsive to their needs is vital and can vastly improve subjective experiences. Complex ethical dilemmas may pervade both the illness of dementia and provision of palliative care; we consider how ethical issues (eg, providing care under restraint) influence complex decisions relating to resuscitation, artificial nutrition and treatment refusal in order to optimise quality of life.
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Rejnö, Åsa, Gunilla Silfverberg, and Britt-Marie Ternestedt. "Reasoning about truth-telling in end-of-life care of patients with acute stroke." Nursing Ethics 24, no. 1 (September 23, 2016): 100–110. http://dx.doi.org/10.1177/0969733016664974.
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Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.
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Deng, Renli, Jianghui Zhang, Liuliu Chen, Jiarui Miao, Jiazhong Duan, Yeyin Qiu, Doris Leung, Helen Chan, and Diana TF Lee. "The effectiveness of a modified advance care planning programme." Nursing Ethics 27, no. 7 (June 26, 2020): 1569–86. http://dx.doi.org/10.1177/0969733020922893.
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Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society.
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Ramvi, Ellen, and Venke Irene Ueland. "Between the patient and the next of kin in end-of-life care: A critical study based on feminist theory." Nursing Ethics 26, no. 1 (January 24, 2017): 201–11. http://dx.doi.org/10.1177/0969733016688939.
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Background: For the experience of end-of-life care to be ‘good’ many ethical challenges in various relationships have to be resolved. In this article, we focus on challenges in the nurse–next of kin relationship. Little is known about difficulties in this relationship, when the next of kin are seen as separate from the patient. Research problem: From the perspective of nurses: What are the ethical challenges in relation to next of kin in end-of-life care? Research design: A critical qualitative approach was used, based on four focus group interviews. Participants: A total of 22 registered nurses enrolled on an Oncology nursing specialisation programme with experience from end-of-life care from various practice areas participated. Ethical considerations: The study was approved by the Norwegian Social Science Data Service, Bergen, Norway, project number 41109, and signed informed consent obtained from the participants before the focus groups began. Findings and discussion: Two descriptive themes emerged from the inductive analysis: ‘A feeling of mistrust, control and rejection’ and ‘Being between hope and denial of next of kin and the desire of the patient to die when the time is up’. Deductive reinterpretation of data (in the light of moral distress from a Feminist ethics perspective) has made visible the constraints that certain relations with next of kin in end-of-life care lay upon the nurses’ moral identity, the relationship and their responsibility. We discuss how these constraints have political and societal dimensions, as well as personal and relational ones. Conclusion: There is complex moral distress related to the nurse–next of kin relationship which calls for ethical reflections regarding these relationships within end-of-life care.
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Blank, Robert H. "End-of-Life Decision Making across Cultures." Journal of Law, Medicine & Ethics 39, no. 2 (2011): 201–14. http://dx.doi.org/10.1111/j.1748-720x.2011.00589.x.
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As is evident from the other articles in this special issue, end-of-life treatment has engendered a vigorous dialogue in the United States over the past few decades because decision making at the end of life raises broad and difficult ethical issues that touch on health professionals, patients, and their families. This concern is exacerbated by the high cost related to the end of life in the U.S. Moreover, in light of demographic patterns, progressively scarce health care resources, and an expanding array of life-saving technologies, decisions at the end of life are becoming problematic matters of public and, thus, scholarly concern in most countries. Issues at the end of life are central not only to bioethics but also raise important ancillary policy dimensions.
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BokKyuKwon and BAEHYUNA. "A Narrative Analysis of Ethical Issues regarding End of Life Care Decision." Korean Journal of Medical Ethics 14, no. 2 (June 2011): 157–70. http://dx.doi.org/10.35301/ksme.2011.14.2.157.
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Stensland, Meredith, and Sara Sanders. "Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison." Journal of Social Work in End-of-Life & Palliative Care 12, no. 3 (July 2, 2016): 259–76. http://dx.doi.org/10.1080/15524256.2016.1200517.
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Taylor, Helen. "Legal and ethical issues in end of life care: implications for primary health care." Primary Health Care 25, no. 5 (May 29, 2015): 34–41. http://dx.doi.org/10.7748/phc.25.5.34.e1032.
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Giabicani, Mikhael, Sylvie Janny, Bénédicte Grigoresco, Tristan Thibault-Sogorb, and Emmanuel Weiss. "End-of-life ethical issues in the ICU: Who should decide?" Anaesthesia Critical Care & Pain Medicine 41, no. 1 (February 2022): 100992. http://dx.doi.org/10.1016/j.accpm.2021.100992.
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Walker, Andreas, and Christof Breitsameter. "Ethical decision-making in hospice care." Nursing Ethics 22, no. 3 (June 29, 2014): 321–30. http://dx.doi.org/10.1177/0969733014534873.
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Background: Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care. Research question and design: Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory. Ethical considerations: The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent. Results: Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse’s individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse’s own style of administering care. The nurse’s decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework. Discussion: An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care – namely, physical, psychological, social and spiritual care – into the practice of her daily work. Conclusion: Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted.
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Turner, Kelly, Gretchen Agans, Erin Donohue, Barqueisha Madison, Jason Lesandrini, Jennifer Morgan, and Candace Kemp. "PEEKING UNDER THE COVERS: EXAMINING ETHICAL ISSUES IN ASSISTED LIVING." Innovation in Aging 6, Supplement_1 (November 1, 2022): 700. http://dx.doi.org/10.1093/geroni/igac059.2562.
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Abstract Assisted living (AL) communities comprise complex social environments composed of residents, staff, and other care partners, including external workers and residents’ family and friends. Interactions among these stakeholders, especially pertaining to decisions related to resident care, frequently are fraught with value conflicts and uncertainties. Although much attention has been devoted to the ethics of aging and end-of-life in acute care settings, there is very little research on ethical issues in AL. To address this critical knowledge gap, our interdisciplinary team of gerontologists and bioethicists developed a typology of ethics issues in AL, adapting existing categorizations designed for acute care. We applied this typology to qualitative data gathered over a one-year period as part of an NIA-funded longitudinal study focused on residents with dementia living in four diverse AL communities (R01AG062310). The team coded 465 fieldnotes and interviews, analyzing data for the frequency and context of ethical issues. We found ubiquitous conflicts between residents’ autonomy and care partners’ obligations to maintain resident safety, as well as a high prevalence of organizational issues related to staffing and expertise. Comparing code frequency and type across the four communities, we discovered manifold ways in which facility size, organizational structure, and care practices affect the profile of value conflicts in resident care. During data analysis, we also developed new codes for ethics issues arising in AL, including, ‘cognitive decline stigma’ and ‘uncertainty regarding professional obligations,’ creating new avenues of study. We conclude our presentation by discussing implications for best practices and policy formation in AL.
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Giebel, Heidi. "Ethical end-of-life palliative care: response to Riisfeldt." Journal of Medical Ethics 46, no. 1 (August 8, 2019): 51–52. http://dx.doi.org/10.1136/medethics-2019-105451.
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In a recent article, 1 Riisfeldt attempts to show that the principle of double effect (PDE) is unsound as an ethical principle and problematic in its application to palliative opioid and sedative use in end-of-life care. Specifically, he claims that (1) routine, non-lethal opioid and sedative administration may be “intrinsically bad” by PDE’s standards, (2) continuous deep palliative sedation (or “terminal sedation”) should be treated as a bad effect akin to death for purposes of PDE, (3) PDE cannot coherently be applied in cases where death “indirectly” furthers an agent’s intended end of pain relief via medically appropriate palliative care, and (4) application of PDE requires sacrificing common beliefs about the sanctity of human life. I respond by showing that Riisfeldt’s understanding of PDE is seriously mistaken: he misattributes Kantian and Millian reasoning to the principle and conflates acts’ intrinsic properties with their effects. Further, a corrected understanding of PDE can address Riisfeldt’s case-specific objections.
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Hold, Judith L. "A good death." Nursing Ethics 24, no. 1 (August 3, 2016): 9–19. http://dx.doi.org/10.1177/0969733015602051.
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Background: On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients. Research objective: The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. Research design: The study used a qualitative narrative approach. Participants: Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher’s university Institutional Review Board for ethical review was obtained. Findings: Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions. Discussion: The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses’ deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance. Conclusion: A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.
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Leslie, Paula, and Dominika Lisiecka. "Ethical Issues in Dysphagia Management." Seminars in Speech and Language 41, no. 03 (June 2020): 257–65. http://dx.doi.org/10.1055/s-0040-1710561.
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AbstractDysphagia management is complex and requires balancing individuals' preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing one's own presuppositions and beliefs may be fundamental to ensuring an ethical approach. The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia; the influence of culture on decision-making about eating and feeding; the importance of information disclosure and respect for individuals' refusal of recommendations; and the interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind to ensure compassionate and competent care of the person with eating, drinking, or swallowing problems and their family caregivers.
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Baumann, Steven L., and Vidette Todaro-Franceschi. "Graduate Students’ Reflections on Elder and End-of-Life Care for Prisoners." Nursing Science Quarterly 30, no. 3 (June 21, 2017): 253–59. http://dx.doi.org/10.1177/0894318417708416.
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The focus of this report was graduate nursing students’ reflections on elder and end-of-life care for prisoners. The personal reflections of 21 graduate nursing students who attended a presentation by Susan J. Loeb on October 26, 2016 were included in this report. The title of the presentation was “Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community.” The student essays were synthesized to construct a summary essay, from which four themes were identified: aging in prison, dying in prison, ethical and professional issues in the elder and end-of-life care of prisoners, and ethical and professional issues in research involving elderly and end-of-life care of prisoners. These findings were interpreted from a global perspective in light of two different nursing perspectives: the humanbecoming tradition and the science of unitary human beings.
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Sener, Ugur, Elizabeth C. Neil, Alan Carver, Eli L. Diamond, and Louis Voigt. "Ethics consultations in patients with neuro-oncologic diseases." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e13519-e13519. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e13519.
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e13519 Background: In patients with cancer, ethical issues regarding patient autonomy, surrogate decision making, and end-of-life care often arise. Ethics consultation can help clarify perspectives of different stakeholders involved in a patient’s care, facilitate communication, and resolve conflicts. Neurologic manifestations of cancer can cause impairment of cognition, communication, and functional independence. Ethical conflicts in the specific context of neuro-oncologic diseases have yet to be characterized. Methods: In this retrospective study, we reviewed 50 cases where ethics consultation was requested for patients with neurologic malignancies or neurologic complications of cancer treated at Memorial Sloan Kettering Cancer Center (MSK). Results: Of 50 patients (ages 4-76, 56% female) reviewed, 27 had a primary central nervous system (CNS) malignancy, 21 had CNS metastasis, one had a vascular malformation, and one had no clear diagnosis. Neurologic issues contributing to patients’ clinical status included toxic metabolic encephalopathy (14), leptomeningeal disease (10), intracerebral hemorrhage (10), hydrocephalus (9), seizures (6), cord compression (5), and ischemic stroke (3). At the time of ethics consultation, 39 patients lacked decision-making capacity, 47 did not have an advance directive, and 38 did not have a do not resuscitate (DNR) order. Ethical issues identified included surrogate decision making (20), DNR (18), capacity (6), refusal of treatment (5), futility (4), brain death (4), and research ethics (2). Contextual issues included staff-family conflict (22), cultural or religious considerations (10), intra-family conflict (7), intra-staff conflict (6), and physician attitude toward treatment (3). Conclusions: Neuro-oncologic diseases present a unique constellation of ethical conflicts, particularly about end-of-life care. Language and cognitive deficits, impaired decision-making, and sudden neurological decline are factors that shape ethical conflicts in this clinical setting. Further study of ethical issues in neuro-oncology may help patients receive care that is consistent with their goals and values.
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Axelsson, Lena, Eva Benzein, Jenny Lindberg, and Carina Persson. "Processes toward the end of life and dialysis withdrawal Physicians’ and nurses’ perspectives." Nursing Ethics 27, no. 2 (June 11, 2019): 419–32. http://dx.doi.org/10.1177/0969733019848050.
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Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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McGlade, Ciara, Edel Daly, Joan McCarthy, Nicola Cornally, Elizabeth Weathers, Rónán O’Caoimh, and D. William Molloy. "Challenges in implementing an advance care planning programme in long-term care." Nursing Ethics 24, no. 1 (September 22, 2016): 87–99. http://dx.doi.org/10.1177/0969733016664969.
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Background: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care. Research design: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community hospital. Ethical considerations: The local research ethics committee granted ethical approval. Findings: Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. Discussion: The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Conclusions: Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice.
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Elmore, James, David Kenneth Wright, and Maude Paradis. "Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research." Nursing Ethics 25, no. 8 (December 28, 2016): 955–72. http://dx.doi.org/10.1177/0969733016679468.
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Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
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Blasszauer, Bela, and Ilona Palfi. "Moral Dilemmas of Nursing in End-of-Life Care in Hungary: a personal perspective." Nursing Ethics 12, no. 1 (January 2005): 92–105. http://dx.doi.org/10.1191/0969733005ne760oa.
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The authors’ aim is to bring to the attention of readers the inadequacies of care for people in Hungary who are terminally ill. They believe that both objective and subjective factors cause these inadequacies. Most of these factors arise from moral dilemmas that could be eased or even solved if ethics education had a much more prominent place in the nursing curriculum. Even if nurses would not become automatically better persons morally, a much wider knowledge of medical/nursing ethics could significantly improve nursing care both before and at the end of life. Although the article is also critical of the nursing care provided, it is not its purpose to make any generalizations. The study utilized selected passages from essays written by 76 practicing nurses on their personal experience of ethical dilemmas in their work environment, and a questionnaire administered to 250 students (registered nurses and health care students) studying for a college degree. This article is written by two authors who have formed an unusal alliance: a registered nurse with 29 years’ experience of bedside nursing, but who is currently a teacher of nursing ethics at a local health college, and a lawyer turned bioethicist.
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Fernandes, Maria ID, and Isabel MPB Moreira. "Ethical issues experienced by intensive care unit nurses in everyday practice." Nursing Ethics 20, no. 1 (August 22, 2012): 72–82. http://dx.doi.org/10.1177/0969733012452683.
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This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies.
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Baily, Mary Ann. "Futility, Autonomy, and Cost in End-of-Life Care." Journal of Law, Medicine & Ethics 39, no. 2 (2011): 172–82. http://dx.doi.org/10.1111/j.1748-720x.2011.00586.x.
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In 1989, Helga Wanglie, 86 years old, broke her hip. This began a medical downhill course that a year later caused her health care providers to conclude that she would not benefit from continued medical treatment. It would be futile, and therefore, should not be provided. Her husband (the surrogate decision maker) disagreed, and the conflict eventually led to a lawsuit. The Wanglie case touched off an extended debate in the medical and bioethical literature about medical futility: what it means and how useful the concept is in making ethical decisions about starting or stopping treatment.
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Aleksandrova-Yankulovska, Silviya Stoyanova. "Application of METAP methodology for clinical ethics consultation in end-of-life care in Bulgaria." Clinical Ethics 15, no. 4 (June 3, 2020): 204–12. http://dx.doi.org/10.1177/1477750920930372.
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Although clinical ethics consultation has existed for more than 40 years in the USA and Europe, it was not available in Bulgaria until recently. In introducing clinical ethics consultation into our country, the Modular, Ethical, Treatment, Allocation of resources, Process (METAP) methodology has been preferred because of its potential to be used in resource-poor settings and its strong educational function. This paper presents the results of a METAP evaluation in a hospital palliative care ward in the town of Vratsa. The evaluation was based on Beauchamp and Childress’ four principles of biomedical ethics and involves implementation of specific instruments for clinical ethics decision-making. Research tasks emphasised analyses of ethics meetings in the ward. Data were processed by SPSS v.24 using descriptive statistical analysis. Altogether, 32 ethics meetings of an average duration 20.63 min were conducted on cases involving critically ill patients. Most of the participants (86.0%) expressed satisfaction with the ethics process. The principlist approach supported resolution of conflicts between autonomous patients and their relatives, clarified definitions of “medical benefit” and “social good,” and enabled assessments of the risk of unequal treatment. Even as the specific research tasks were achieved, further participant follow-up is necessary to identify any improvement in healthcare personnel’s ethical competence. METAP worked well in end-of-life care settings. Participants experienced several benefits, including improved team communication, better understanding of patient preferences, and confidence in the correctness of decisions. Despite the significant educational potential of METAP, the need for additional and ongoing ethics training of health professionals should not be underestimated.
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Krishna, Lalit. "Nasogastric feeding at the end of life: A virtue ethics approach." Nursing Ethics 18, no. 4 (June 3, 2011): 485–94. http://dx.doi.org/10.1177/0969733011403557.
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The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family.
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Fernández-Sola, Cayetano, María Mar Díaz Cortés, José Manuel Hernández-Padilla, Cayetano José Aranda Torres, José María Muñoz Terrón, and José Granero-Molina. "Defining dignity in end-of-life care in the emergency department." Nursing Ethics 24, no. 1 (August 3, 2016): 20–32. http://dx.doi.org/10.1177/0969733015604685.
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Background: Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. Objective: The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. Research design: A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013–2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). Findings: The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Discussion: Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Conclusion: Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.
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Lind, Ranveig, Geir F. Lorem, Per Nortvedt, and Olav Hevrøy. "Intensive care nurses’ involvement in the end-of-life process – perspectives of relatives." Nursing Ethics 19, no. 5 (September 2012): 666–76. http://dx.doi.org/10.1177/0969733011433925.
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In this article, we report findings from a qualitative study that explored how the relatives of intensive care unit patients experienced the nurses’ role and relationship with them in the end-of-life decision-making processes. In all, 27 relatives of 21 deceased patients were interviewed about their experiences in this challenging ethical issue. The findings reveal that despite bedside experiences of care, compassion and comfort, the nurses were perceived as vague and evasive in their communication, and the relatives missed a long-term perspective in the dialogue. Few experienced that nurses participated in meetings with doctors and relatives. The ethical consequences imply increased loneliness and uncertainty, and the experience that the relatives themselves have the responsibility of obtaining information and understanding their role in the decision-making process. The relatives therefore felt that the nurses could have been more involved in the process.
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Wiegand, Debra Lynn-McHale, Sally A. Norton, and Judith Gedney Baggs. "Challenges in Conducting End-of-Life Research in Critical Care." AACN Advanced Critical Care 19, no. 2 (April 1, 2008): 170–77. http://dx.doi.org/10.4037/15597768-2008-2010.
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Critical care units present some unique challenges to the researcher, especially when the research topic of interest is related to end-of-life care. The purpose of this article is to address some of the methodological and practical issues related to conducting end-of-life research in the critical care setting. Recruitment barriers include gaining access to a clinical site, gaining access to patients, and prognostic uncertainty. Additional barriers include challenges related to informed consent, data collection, the research team, and ethical considerations. Strategies are described that can be used to guide researchers to conduct end-of-life research successfully in critical care.