Willful Death and Painful Decisions: A Failed Assisted Suicide

1992 ◽  
Vol 1 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Kenneth V. Iserson ◽  
Dorothy Rasinski Gregory ◽  
Kate Christensen ◽  
Marc R. Ofstein
Keyword(s):  
Emergency Department ◽  
Social Life ◽  
Assisted Suicide ◽  
Emergency Department Physician ◽  
Rapid Progression ◽  
Neurologic Disease ◽  
Intellectual Capacity ◽  
Personal Needs ◽  
At Home

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics.

scholarly journals Work-Life Conflict During the COVID-19 Pandemic

2021 ◽  
Vol 7 ◽  
pp. 237802312098285 ◽  
Author(s):  
Scott Schieman ◽  
Philip J. Badawy ◽  
Melissa A. Milkie ◽  
Alex Bierman
Keyword(s):  
National Survey ◽  
Social Life ◽  
Work Life ◽  
Work Family ◽  
High Work ◽  
Work Life Conflict ◽  
At Home

The coronavirus disease 2019 pandemic upended work, family, and social life. These massive changes may have created shifts in exposure to work-life conflict. Using a national survey that followed Canadian workers from September 2019 into April and June 2020, the authors find that work-life conflict decreased among those with no children at home. In contrast, for those with children at home, the patterns depended on age of youngest child. Among individuals with children younger than 6 or between 6 and 12, no decreases in work-life conflict were observed. In contrast, those with teenagers did not differ from the child-free. Although these patterns did not significantly differ by gender, they were amplified among individuals with high work-home integration. These findings suggest an overall pattern of reduced work-life conflict during the pandemic—but also that these shifts were circumscribed by age of youngest child at home and the degree of work-home integration.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

scholarly journals Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Matthew J Molloy ◽  
Wendy Shields ◽  
Molly W Stevens ◽  
Andrea C Gielen
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Short Term ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor ◽  
The Impact ◽  
At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Catheters at home: managing urinary catheters in the home environment

2021 ◽  
Vol 26 (8) ◽  
pp. 370-376
Author(s):  
Drew Payne
Keyword(s):  
Emergency Department ◽  
Health Service ◽  
Literature Review ◽  
Home Environment ◽  
Negative Impact ◽  
Community Settings ◽  
Urinary Catheters ◽  
Factors Affecting ◽  
The Common ◽  
At Home

In England, there are some 90000 people with catheters in the community, and community nurses often have to manage catheter-related problems. This article looks at these common catheter problems found in the community, for example, blockage, infections and positioning problems. These problems were identified by a literature review and from the author's experience, from many years working in the community. It has been found that education, knowledge, empowerment and communication are vital factors affecting patients' ability to manager their catheters themselves. The article begins with a discussion about how patients can be involved in and manage many aspects of care for their own catheters. It goes on to talk about the common catheter-associated problems and how these can be avoided or addressed. It is hoped that better management of catheter-associated complications in the community settings can prevent unnecessary visits to the emergency department, which will save time and costs for the health service, as well as avoid the negative impact of these on patient lives.

Survey of bereavement care at home-visit nursing stations in Japan

2020 ◽  
Author(s):  
Miwa OZAWA ◽  
Seiko UCHINO ◽  
Jungetsu SEI ◽  
Kazuyoshi UEHARA
Keyword(s):  
Social Life ◽  
Home Visit ◽  
Statistical Processing ◽  
Nursing Facilities ◽  
Life Planning ◽  
Nursing Experience ◽  
The Family ◽  
Care At Home ◽  
Bereavement Care ◽  
At Home

Abstract BackgroundWith a rapidly aging population, the importance of promoting end-of-life care at home has been pointed out. Home-visit nurses play an important role as professionals in charge of home care, and pre- and post- bereavement care for bereaved families is included in home-visit nursing services. However, bereaved families are not always provided with care after bereavement in Japan. This present study aims to investigate the relationship between the provision rates of pre- and post-bereavement care for the patient family and the demographics of home-visit nurses through a survey of home-visit nurses, and to clarify the details of post-bereavement care and the reasons why the care is employed, exploratorily through a survey of the managers of home-visit nursing stations.MethodsA self-rating anonymous questionnaire survey was conducted with 2,400 facilities (including 2,200 facilities randomly selected from among the members of Home-Visit Nursing Stations of the National Nursing Business Association). For the analysis, simple aggregation was used and the statistical processing employed SPSS ver21.0.ResultsA total of 680 valid responses were analyzed. The mean length of home-visit nursing experience was 10.6 years and that of hospital nursing experience was 15.2 years. The provision rate of post-bereavement care was 90% or higher in most of the identified items, excluding “Provided continued support/life planning until the family fully recovers social life”. For the provision of post-bereavement care, most items exceeded 70%, but excluding “Provided continued support until the family fully recovers social life”, and “Involved in building a life after bereavement”.Compared to the participants with less than 5 years of home-visit nursing experience, those with 10 years or longer experience had statistically significantly higher rates of providing post-bereavement care in more than half of the identified items. Home-visit nursing facilities with 24-hour services had statistically significantly higher rates of providing care in more than half of the items of both of pre- and post-bereavement care, compared to the facilities without 24-hour services. About 70% of the managers think that bereaved families need follow-up, and visited the families as a post-bereavement care.

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