Integrating care when the end is near: Ethical dilemmas in end-of-life care.

2013 ◽  
Vol 31 (1) ◽  
pp. 75-83 ◽  
Author(s):  
Tziporah Rosenberg ◽  
Jenny Speice
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Life Care

A Qualitative Metasynthesis From Nurses' Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care

2015 ◽  
Vol 19 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Margareta Karlsson ◽  
Ingela Berggren ◽  
Anne Kasén ◽  
Carola Wärnå-Furu ◽  
Maud Söderlund
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Life Care ◽  
Ethical Problems

scholarly journals Dilema Etik dalam Merawat Pasien Terlantar yang Menjelang Ajal di IGD

2017 ◽  
Vol 3 (2) ◽  
pp. 145
Author(s):  
Maria Imaculata Ose
Keyword(s):  
Emergency Department ◽  
End Of Life ◽  
End Of Life Care ◽  
Qualitative Method ◽  
Ethical Dilemmas ◽  
Life Care ◽  
Interpretive Phenomenology ◽  
Emergency Department Nurses ◽  
Depth Interview ◽  
Research Findings

ABSTRAK Perawat IGD memiliki beban kerja yang lebih tinggi dibandingkan dengan perawat yang berkerja diruang lain. Kepadatan pasien di IGD selain mengupayakan keselamatan pasien, juga mengancam privasi pasien, dan membuat frustasi staf di  IGD. Dilema etik sering dialami oleh perawat IGD dalam merawat pasien terlantar yang berada dalam fase menjelang ajal, namun tidak memiliki identitas. Fokus perawatan yang diberikan pada fase menjelang ajal dikenal dengan istilah End Of Life Care. Ketidakhadiran keluarga untuk mendampingi pasien dan tingginya beban kerja perawat yang tidak seimbang seringkali menyebabkan perawat tidak dapat fokus memberikan pendampingan menyebabkan timbulnya dilema etik. Tujuan penelitian ini adalah untuk mengeksplorasi makna dilema etik perawat dalam merawat pasien terlantar yang menjelang ajal di IGD. Desain penelitian ini  menggunakan metode kualitatif dengan pendekatan fenomenologi interpretif, yang melibatkan 7 orang perawat IGD. Data dikumpulkan melalui indepth interview dan dianalisis secara tematik Braun dan Clark. Hasil penelitian didapatkan bahwa tiga tema yaitu: 1) Menyadari pasien terlantar menjelang ajal bukan prioritas pertama di IGD; 2) Bersikap profesional dan bertanggung Jawab; dan 3) Penerapan kebijakan yang menunjukan respect dan mendukung perawatan pasien terlantar. Kesimpulan: Kehadiran pasien terlantar menimbulkan dilema etik, perawat memaknai walaupun pasien tersebut bukanlah pasien prioritas tetapi harus bersikap professional dan bertanggung jawab. Dengan adanya dukungan dan kebijakan dalam penanganan pasien terlantar penerapan caring dapat tetap diberikan walaupun perawatan End of life care yang diberikan di IGD belum optimal.  ABSTRACT Nurses who work in the emergency department have more workload compared to nurses who come from other departments. In the emergency department, the nurses not only have to struggle for the patients’ safety but they also need to deal with the patients’ privacy which is frustrating. Therefore, the nurses are often faced with many ethical dilemmas especially when they need to take care of homeless patients whose identity are not yet verified. The focus of the treatment is known as the End Of Life Care. The absence of the patients’ family members makes it harder for the nurses to focus on giving an assistance. As a result, ethical dilemmas may arise. The objective of this study, thus, was to explore the meaning of ethical dilemmas faced by the nurses when taking care of the homeless in the emergency department of RSSA Malang. Research design: this research employed a qualitative method using the interpretive phenomenology approach which involved 7 emergency department nurses. Data was collected through in-depth interview and analyzed thematically (Braun and Clark, 2006). Research Findings were categorized into 3 themes that are: 1) Recognizing dormant patients before death is not the first priority in the emergency department; 2) Be professional and responsible; and 3) Implementation of policies that show respect and support the care of abandoned patients. Conclusion: The presence of displaced patients raises ethical dilemma, nurses interpret the patient even though the patient is not a priority but should be professional and responsible. On the other hand with the support and policy in handling these abandoned patients so that the application of caring is given although the care of End of life care provided in the emergency department has not been optimal 

Countertransference and ethics: A perspective on clinical dilemmas in end-of-life decisions

2003 ◽  
Vol 1 (4) ◽  
pp. 367-375 ◽  
Author(s):  
BRIAN J. KELLY ◽  
FRANCIS T. VARGHESE ◽  
DAN PELUSI
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Clinical Decision Making ◽  
Ethical Dilemmas ◽  
Clinical Decision ◽  
Life Care ◽  
End Of Life Decisions ◽  
The Relationship ◽  
Dying Patient

Ethical dilemmas in end-of-life care, such as the request for assisted suicide, must be understood in the context of the relationship that exists between patients and the clinicians treating them. This context includes the way health professionals respond to the tasks in caring for a dying patient. This article reviews the literature exploring the factors the influence clinical decision making at the end of life. The interplay of ethics, countertransference and transference are explained in detail.

Respecting the Wishes of Patients in Intensive Care Units

2007 ◽  
Vol 14 (5) ◽  
pp. 651-664 ◽  
Author(s):  
Satomi Kinoshita
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Time Constraints ◽  
Life Care ◽  
University Hospitals ◽  
Japanese University ◽  
Dying Patients ◽  
Patients Wishes

This study examined why intensive care unit (ICU) nurses experience difficulties in respecting the wishes of patients in end-of-life care in Japan. A questionnaire survey was conducted with ICU nurses working in Japanese university hospitals. The content of their narratives was analyzed concerning the reasons why the nurses believed that patients' wishes were not respected. The most commonly stated reason was that patients' wishes were impossible to realize, followed by the fact that decision making was performed by others, regardless of whether the patients' wishes were known, if the death was sudden, and time constraints. Many nurses wanted to respect the wishes of dying patients, but they questioned how patients die in ICUs and were therefore faced with ethical dilemmas. However, at the same time, many of the nurses realized that respecting patients' wishes about end-of-life care in an ICU would be difficult and that being unable to respect these wishes would often be unavoidable. The results thus suggest that there has been insufficient discussion about respecting the wishes of patients undergoing intensive care.

scholarly journals Cultural Issues and Ethical Dilemmas in Palliative and End-of-Life Care in Spain

2001 ◽  
Vol 8 (1) ◽  
pp. 46-54 ◽  
Author(s):  
Juan M. Núñez Olarte ◽  
D. Gracia Guillén
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Life Care ◽  
Cultural Issues

A good death

2016 ◽  
Vol 24 (1) ◽  
pp. 9-19 ◽  
Author(s):  
Judith L Hold
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Good Death ◽  
Ethical Review ◽  
Life Care ◽  
Hospice Nurses ◽  
Institutional Review ◽  
Purposeful Sampling ◽  
Ethical Conflicts

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.

scholarly journals Ethical Dilemmas of End of Life Care in Intensive Care Unit : A Literature Review

2018 ◽  
Vol 4 (2) ◽  
Author(s):  
Albertus Budi Arianto ◽  
Yanny Trisyani ◽  
Etika Emiliyawati
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Ethical Principle ◽  
Life Care ◽  
Eol Care

 ABSTRACTThe end-of-life (EOL) care is the progressive terminal illness, leading to death; that in the situation the nurse have significant role in decision making. In decision making, temporarily, the nurse will experiences the ethical dilemmas, including in intensive care unit (ICU) with any factors resulting in problem in medical decision making. The literature review intends to analyze the description of ethical dilemmas occurred in intensive care unit, especially to the EOL care. A method used is critical review full text of 2007-2018 periods in English langguage. The multiple databases used is PubMed, Proquest and Google Scholar with keyword “End of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life critical care”, and “Dilemmas Ethic in ICU.” The articles selected gradually by using of Appraisal tool of PRISMA and obtained 21 articles. The literature study obtaining 4 themes related to description of the ethical dilemmas in ICU including (1) the ethical principle involved in EOL care at ICU, (2) resource of ethical conflict in ICU, (3) impact of ethical conflict in ICU, and (4) response of nurse in dealing with ethical dilemmas. The discussion of literature review related to the perception of nurse on EOL care; that nurse have important role in medical decision making involving ethical principle in the implementation. it is required further research on exploration of nurse experience on implementation of ethical principle in case of EOL care.ABSTRAKPerawatan end of life (EOL) merupakan suatu perawatan pada penyakit terminal yang bersifat progresif, yang akan berujung dengan kematian, pada kondisi ini perawat mempunyai peran dalam pengambilan keputusan perawatan. Terkadang dalam pengambilan keputusan ini perawat akan mengalami kondisi dilema etik, tak terkecuali di ruangan intensive care unit dimana diruangan tersebut banyak faktor yang mengakibatkan kesulitan dalam pengambilan keputusan medis. Literature reviews ini bertujuan untuk menganalisia gambaran dilema etik yang terjadi di area intensive khususnya pada kasus end of life care. Metode yang digunakan adalah critical review full text dengan rentang tahun 2007-2018 dalam Bahasa Inggris. Multiple database yang digunakan adalah PubMed, Proquest dan Google Scholar merupakan database yang digunakan, dengan kata kunci “End Of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life in critical care”, and“Dilema Ethic in ICU”. Artikel diseleksi bertahap menggunakan Appraisal tool PRISMA dan didapatkan 21 artikel. Studi literatur diperoleh 4 tema terkait gambaran dilema etik di ruang ICU diantaranya (1) Prinsip etik yang terlibat dalam end of life care di ICU, (2) Sumber konflik etik di ICU, (3) Dampak konflik etik di ICU, dan (4) Respon perawat dalam menghadapi dilema etik. Pembahasan telaah literatur ini terkait persepsi perawat mengenai perawatan end of life, dimana perawat mempunyai peran penting dalam pengambilan keputusan medis yang melibatkan prinsip etik dalam pelaksanaannya. Diperlukan penelitian lebih lanjut mengenai eksplorasi pengalaman perawat terhadap implementasi prinsip etik pada kasus perawatan menjelang ajal.

A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care

2015 ◽  
Vol 19 (1) ◽  
pp. 40-48
Author(s):  
Margareta Karlsson, ◽  
Ingela Berggren, ◽  
Anne Kasén, ◽  
Maud Söderlund,
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Evidence Based Practice ◽  
Ethical Dilemmas ◽  
Qualitative Studies ◽  
Best Interests ◽  
Evidence Based ◽  
Life Care ◽  
Human Beings ◽  
Ethical Problems

This metasynthesis aimed to translate, interpret, and present a synthesis of qualitative studies from nurses’ perspectives dealing with ethical dilemmas and ethical problems in end-of-life care and to gain a deeper understanding of the phenomena. Nurses and other care professionals need to gain a deeper understanding and alleviate the suffering of patients through evidence-based practice end-of-life care. The metasynthesis, inspired by Noblit and Hare, generated an overarching metaphor, The Loving Eye. The Loving Eye illustrates how nurses are deeply involved with patients as human beings and connotes an inner responsibility to struggle for patients’ best interests and wishes at the end of life. With The Loving Eye, nurses can see and feel patients’ need to be confirmed, comforted, and healed approaching the end of life.

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