Pediatric nurses’ ethical difficulties in the bedside care of children

2017 ◽  
Vol 26 (2) ◽  
pp. 541-552 ◽  
Author(s):  
Kwisoon Choe ◽  
Yoonjung Kim ◽  
Yoonseo Yang
Keyword(s):  
Ethical Climate ◽  
Ethical Issues ◽  
Phenomenological Approach ◽  
Ethical Review ◽  
Pediatric Nurses ◽  
Nursing Time ◽  
Patient Centered ◽  
Centered Care ◽  
Negative Feelings ◽  
Task Oriented

Background: Pediatric nurses experience ethically difficult situations in their everyday work. Several studies have been conducted to reveal ethical issues among pediatric nurses; we do not think their ethical difficulties have been explored sufficiently from their own perspective. Objectives: This study aimed to explore the ethical difficulties faced by pediatric nurses during bedside care for hospitalized children. Methods: A phenomenological approach was used to collect and analyze interview data from 14 female pediatric nurses in South Korea. Ethical considerations: Ethical review was obtained from an ethics committee. The participants were informed about the aim of the study, and voluntary participation, anonymous response, and confidentiality were explained to them. Findings: Three themes emerged from the analysis: ethical numbness in a task-oriented context, negative feelings toward family caregivers, and difficulty in expressing oneself in an authoritative climate. Conclusion and implications: We need to develop strategies to manage ethical difficulties at an institutional level. Furthermore, it is important that pediatric nurses have the opportunity to communicate with fellow nurses and other medical staff regarding ethical difficulties. In addition, cultivation of pediatric nurses’ moral, ethical, and philosophical thinking patterns requires the immediate provision of continuous education in nursing ethics at the site of clinical nursing, time to discuss ethical difficulties, and other supportive measures. Findings indicated that, to provide high-quality patient-centered care, we should enhance nurses’ ethical sensitivity and autonomy and improve the ethical climate in hospitals.

Forensic Issues and Caregivers of the Elderly

2017 ◽  
Author(s):  
Gary Epstein-Lubow ◽  
Elizabeth Tobin-Tyler
Keyword(s):  
Mental Health ◽  
Family Caregivers ◽  
Mental Health Treatment ◽  
Ethical Issues ◽  
The Elderly ◽  
Patient Centered Care ◽  
Health Condition ◽  
Patient Centered ◽  
Centered Care ◽  
Laws And Policies

Providing patient-centered care for an elderly individual with a mental health condition requires clinicians and family caregivers to work together. This chapter provides a description of a mental health treatment model, the triadic model of caregiving, in which service delivery for a patient includes clinicians communicating with family members or caregivers. Description of the mental health workforce to support patient-centered care is provided along with laws and policies that support family caregivers in their aid of patients. The associated legal responsibilities and ethical issues related to working with patients who have impaired decision-making capacity due to a mental health or substance use condition are explained, including capacity, competence, informed consent, advance care planning, guardianship, fiduciary responsibilities, and ethical concerns.

scholarly journals Understanding barriers to glycaemic control from the patient’s perspective

2013 ◽  
Vol 5 (2) ◽  
pp. 114 ◽  
Author(s):  
Ron Janes ◽  
Janet Titchener ◽  
Joseph Pere ◽  
Rose Pere ◽  
Joy Senior
Keyword(s):  
Glycaemic Control ◽  
Phenomenological Approach ◽  
Structured Interview ◽  
Emotional Reactions ◽  
Patient Centered ◽  
Centered Care ◽  
Interpretative Phenomenological Approach ◽  
Key Barrier ◽  
Patient Relationships

INTRODUCTION: To better understand barriers to glycaemic control from the patient’s perspective. METHODS: An interpretative phenomenological approach was used to study the experiences of 15 adults with Type 2 diabetes. Participants each gave a semi-structured interview of their experiences of living with diabetes. Interviews were transcribed, and themes extracted and organised using a patient-centred framework. FINDINGS: Participants’ stories confirmed many of the barriers in the literature, particularly those related to context, such as family, finances, work. Barriers also related to negative emotional reactions to diabetes: fear of new events (diagnosis, starting pills/insulin); guilt about getting diabetes and not controlling it; and shame about having diabetes. Barriers also related to unscientific beliefs and personal beliefs. There were additional barriers related to poor clinician–patient relationships. Overall, participants had a poor understanding of diabetes, and complained that their clinician simply ‘told them what to do’. CONCLUSION: Using a patient-centred approach, this study identified many barriers to glycaemic control. We suggest that a key barrier is clinician ignorance of their patients’ fears, beliefs, expectations, context; of what constitutes a positive therapeutic relationship; and of the limitations of a biomedical approach to patient non-adherence. Faced with both a worsening diabetes epidemic and increasing health care workforce shortages, clinicians urgently need to understand that it is they, not their patients, who must change their approach if diabetes care is to be improved. KEYWORDS: Communication barriers; diabetes mellitus, type 2; medication adherence; patient-centered care

scholarly journals Clinician distress in seriously ill patient care: A dimensional analysis

2021 ◽  
pp. 096973302110032
Author(s):  
Anessa M. Foxwell ◽  
Salimah H. Meghani ◽  
Connie M. Ulrich
Keyword(s):  
Dimensional Analysis ◽  
Clinical Situation ◽  
The United States ◽  
Emotional Reactions ◽  
Ethical Review ◽  
Patient Centered ◽  
Serious Illness ◽  
Centered Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Caring for patients with serious illness may severely strain clinicians causing distress and probable poor patient outcomes. Unfortunately, clinician distress and its impact historically has received little attention. Research purpose: The purpose of this article was to investigate the nature of clinician distress. Research design: Qualitative inductive dimensional analysis. Participants and research context: After review of 577 articles from health sciences databases, a total of 33 articles were eligible for analysis. Ethical considerations: This study did not require ethical review and the authors adhered to appropriate academic standards in their analysis. Findings: A narrative of clinician distress in the hospital clinician in the United States emerged from the analysis. This included clinicians’ perceptions and sense of should or the feeling that something is awry in the clinical situation. The explanatory matrix consequence of clinician distress occurred under conditions including: the recognition of conflict, the recognition of emotion, or the recognition of a mismatch; followed by a process of an inability to feel and act according to one’s values due to a precipitating event. Discussion: This study adds three unique contributions to the concept of clinician distress by (1) including the emotional aspects of caring for seriously ill patients, (2) providing a new framework for understanding clinician distress within the clinician’s own perceptions, and (3) looking at action outside of a purely moral lens by dimensionalizing data, thereby pulling apart what has been socially constructed. Conclusion: For clinicians, learning to recognize one’s perceptions and emotional reactions is the first step in mitigating distress. There is a critical need to understand the full scope of clinician distress and its impact on the quality of patient-centered care in serious illness.

scholarly journals Ethical Issues of Social Media Usage in Healthcare

2015 ◽  
Vol 24 (01) ◽  
pp. 137-147 ◽  
Author(s):  
P. Bamidis ◽  
C. Bond ◽  
E. Gabarron ◽  
M. Househ ◽  
A. Y. S. Lau ◽  
...  
Keyword(s):  
Social Media ◽  
Private Information ◽  
Ethical Issues ◽  
Information Gain ◽  
Relevant Literature ◽  
Patient Centered Care ◽  
Mobile Technologies ◽  
Ethical Perspective ◽  
Patient Centered ◽  
Centered Care

Summary Objective: Social media, web and mobile technologies are increasingly used in healthcare and directly support patient-centered care. Patients benefit from disease self-management tools, contact to others, and closer monitoring. Researchers study drug efficiency, or recruit patients for clinical studies via these technologies. However, low communication barriers in social-media, limited privacy and security issues lead to problems from an ethical perspective. This paper summarizes the ethical issues to be considered when social media is exploited in healthcare contexts. Methods: Starting from our experiences in social-media research, we collected ethical issues for selected social-media use cases in the context of patient-centered care. Results were enriched by collecting and analyzing relevant literature and were discussed and interpreted by members of the IMIA Social Media Working Group. Results: Most relevant issues in social-media applications are confidence and privacy that need to be carefully preserved. The patient-physician relationship can suffer from the new information gain on both sides since private information of both healthcare provider and consumer may be accessible through the Internet. Physicians need to ensure they keep the borders between private and professional intact. Beyond, preserving patient anonymity when citing Internet content is crucial for research studies. Conclusion: Exploiting medical social-media in healthcare applications requires a careful reflection of roles and responsibilities. Availability of data and information can be useful in many settings, but the abuse of data needs to be prevented. Preserving privacy and confidentiality of online users is a main issue, as well as providing means for patients or Internet users to express concerns on data usage.

Pediatric Nurses’ Experiences in Caring for Non–English Speaking Patients and Families

2021 ◽  
pp. 104365962098660
Author(s):  
Jennifer M. Stephen
Keyword(s):  
Limited English Proficiency ◽  
Phenomenological Study ◽  
English Proficiency ◽  
Medical Center ◽  
Future Research ◽  
Inpatient Setting ◽  
Pediatric Nurses ◽  
Face To Face ◽  
Centered Care ◽  
Task Oriented

Introduction: Language barriers challenge patient- and family-centered care. Literature guiding pediatric nurses caring for patients and families with limited English proficiency in the inpatient setting is nonexistent. The purposes of this phenomenological study were to understand pediatric nurses’ experiences in caring for patients and families with limited English proficiency and to explore how nurses navigate the communication gap. Method: A purposive sample of 15 pediatric Registered Nurses at a large urban children’s medical center participated in face-to-face semistructured interviews. Verbatim transcribed interviews were analyzed line-by-line and categorized into themes. Results: Themes included personal framework of care, consequences of caring, starting off right, nurse sensing, verbal/nonverbal methods, and interpreters. Discussion: Nurses did not perceive differences in task-oriented care; they described compromised personal paradigms, held negative feelings, and utilized verbal/nonverbal communication methods. Future research is needed exploring patients’ and families’ perceptions regarding care by other language–speaking nurses.

Ethics rounds

2014 ◽  
Vol 23 (2) ◽  
pp. 203-213 ◽  
Author(s):  
Marit Silén ◽  
Mia Ramklint ◽  
Mats G Hansson ◽  
Kristina Haglund
Keyword(s):  
Ethical Climate ◽  
Ethical Issues ◽  
Healthcare Personnel ◽  
Ethical Review ◽  
Ethical Considerations ◽  
Daily Work ◽  
Individual Interviews ◽  
Ethics Rounds ◽  
Difficult Situations ◽  
Insight Into

Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff. Research design: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews. Participants and research context: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed. Ethical considerations: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards. Findings: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work. Discussion: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care. Conclusion: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues.

Healthcare professionals’ perceptions of the ethical climate in paediatric cancer care

2016 ◽  
Vol 23 (8) ◽  
pp. 877-888 ◽  
Author(s):  
Cecilia Bartholdson ◽  
Margareta af Sandeberg ◽  
Kim Lützén ◽  
Klas Blomgren ◽  
Pernilla Pergert
Keyword(s):  
Ethical Climate ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Ethical Review ◽  
Good Care ◽  
Moral Stress ◽  
Paediatric Hospital ◽  
Ethics Support ◽  
Ethical Conflicts ◽  
Nurse Aides

Background: How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care. Objectives: The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Research design: Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Findings: Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Discussion: Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. Conclusion: The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.

Dreams and Nightmares: Practical and Ethical Issues for Patients and Physicians Using Personal Health Records

2010 ◽  
Vol 38 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Matthew Wynia ◽  
Kyle Dunn
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Ethical Issues ◽  
Care Delivery ◽  
Code Word ◽  
Patient Privacy ◽  
Patient Centered ◽  
Health Records ◽  
Centered Care ◽  
Care Relationships

The term “Electronic Health Records” (EHR) means something different to each of the stakeholders in health care, but it always seems to carry a degree of emotional baggage. Increasingly, EHRs are advertized as a nearly unmitigated good that will transform medical care, improve safety and efficiency, allow better patient engagement, and open the door to an era of cheap, effective, timely, and patient-centered care. Indeed, for some EHR proponents the benefits of adopting them are so obvious that adoption has become an end in itself. But for others — and especially for a number of skeptical practitioners and patients — EHR is a code word that portends the corporate transformation of health care delivery, the loss of patient privacy, the demand that patients bear more responsibility in health care, and the unreflective takeover of the health care system by people who do not understand medical care or how health care relationships unfold.

scholarly journals Ethical climate and moral distress in paediatric oncology nursing

2021 ◽  
pp. 096973302199416
Author(s):  
Päivi Ventovaara ◽  
Margareta af Sandeberg ◽  
Janne Räsänen ◽  
Pernilla Pergert
Keyword(s):  
Ethical Climate ◽  
Moral Distress ◽  
Ethical Issues ◽  
Paediatric Oncology ◽  
Study Data ◽  
Ethical Review ◽  
Oncology Nursing ◽  
Ethical Behaviour ◽  
Cross Sectional ◽  
Distress Scale

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

Older Adults and Integrated Health Settings: Opportunities and Challenges for Mental Health Counselors

2015 ◽  
Vol 37 (2) ◽  
pp. 124-137 ◽  
Author(s):  
Jill Goldsmith ◽  
Sharon Kurpius
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Ethical Issues ◽  
Medical Personnel ◽  
Mental Health Counselors ◽  
Patient Centered ◽  
Career Opportunities ◽  
Integrated Health ◽  
Centered Care ◽  
Biopsychosocial Perspective

The growing number of older adults and the increasing recognition and growth of integrated health teams are creating expanded career opportunities for mental health counselors (MHCs). Collaborative integrated teams, staffed with medical personnel and MHCs, can provide comprehensive patient-centered care that addresses client issues from a biopsychosocial perspective. However, working with older adults on an integrated health team or in an interdisciplinary setting presents unique challenges and raises ethical issues. The evolving opportunities and strategies to address accompanying challenges are highlighted so that MHCs can be prepared to work effectively with older adults in interdisciplinary settings and on integrated health care teams.

Sign in / Sign up

Export Citation Format

Share Document