scholarly journals Managing ethical issues in patient care and the need for clinical ethics support

2015 ◽  
Vol 39 (1) ◽  
pp. 44 ◽  
Author(s):  
Evan Doran ◽  
Jennifer Fleming ◽  
Christopher Jordens ◽  
Cameron L Stewart ◽  
Julie Letts ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
Public Hospitals ◽  
Cross Sectional Survey ◽  
Convenience Sample ◽  
Clinical Ethics Support ◽  
Ethical Environment ◽  
Ethics Support ◽  
A Priority

Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.

Preventing moral conflicts in patient care: Insights from a mixed-methods study with clinical experts

2021 ◽  
pp. 147775092110572
Author(s):  
Jan Schürmann ◽  
Gabriele Vaitaityte ◽  
Stella Reiter-Theil
Keyword(s):  
Risk Factors ◽  
Patient Care ◽  
Clinical Ethics ◽  
Process Model ◽  
Healthcare Professionals ◽  
Preventive Measures ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Problems ◽  
Early Indicators

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives.

scholarly journals Clinical Ethics Support in Contemporary Health Care

2016 ◽  
Author(s):  
Evan Doran ◽  
Ian Kerridge ◽  
Christopher Jordens ◽  
Ainsley J. Newson
Keyword(s):  
Health Care ◽  
Support Services ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
Health Care Managers ◽  
Clinical Ethics Support ◽  
Health Care Settings ◽  
Ethics Support ◽  
Political Debates ◽  
Provide Health Care

This chapter discusses clinical ethics support services (CES Services), the development of which has arisen to help respond to ethical issues arising in health care settings. CES services are comprised of an individual or group, usually in an organization, who can provide a suite of services to support all stakeholders in identifying and managing ethical issues they face. While there is a degree of consensus about the potential value of such services, they are also the focus of ongoing theoretical, methodological and political debates. The aim of this chapter is to provide health care managers with an account of how and why CES services are becoming a part of the contemporary organizational landscape of health care, and describe the concerns that bioethicists and others have raised regarding their role, function and dissemination.

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

2021 ◽  
pp. 147775092110366
Author(s):  
Harika Avula ◽  
Mariana Dittborn ◽  
Joe Brierley
Keyword(s):  
Intensive Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
General Setting ◽  
Daily Practice ◽  
Paediatric Intensive Care ◽  
Ethical Challenges ◽  
Legal Cases ◽  
Ethics Support ◽  
The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

scholarly journals Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

2017 ◽  
Vol 44 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Rosalind J McDougall ◽  
Lynn Gillam ◽  
Clare Delany ◽  
Yasmin Jayasinghe
Keyword(s):  
Fertility Preservation ◽  
Clinical Ethics ◽  
Reproductive Potential ◽  
Clinical Ethics Support ◽  
Prepubertal Children ◽  
Ethics Support ◽  
Future Fertility ◽  
Difference Of Opinion ◽  
Proven Efficacy ◽  
Pathway Of Care

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia.

scholarly journals A pragmatist approach to clinical ethics support: overcoming the perils of ethical pluralism

2019 ◽  
Vol 22 (3) ◽  
pp. 427-438 ◽  
Author(s):  
Giulia Inguaggiato ◽  
Suzanne Metselaar ◽  
Rouven Porz ◽  
Guy Widdershoven
Keyword(s):  
Clinical Ethics ◽  
Clinical Ethics Support ◽  
Ethical Pluralism ◽  
Ethics Support

scholarly journals Nursing knowledge of and attitude in cardiopulmonary arrest: cross-sectional survey analysis

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6410 ◽  
Author(s):  
Verónica Tíscar-González ◽  
Joan Blanco-Blanco ◽  
Montserrat Gea-Sánchez ◽  
Ascensión Rodriguez Molinuevo ◽  
Teresa Moreno-Casbas
Keyword(s):  
Ethical Issues ◽  
Cardiopulmonary Arrest ◽  
Categorical Variables ◽  
Survey Analysis ◽  
Cronbach’S Alpha ◽  
Cross Sectional Survey ◽  
Cardiorespiratory Arrest ◽  
Convenience Sample ◽  
Cronbach's Alpha ◽  
The Relationship

Background Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. That is why it is crucial that they keep their knowledge and skills up-to-date and their attitudes to resuscitation are very important. The main aim of this study was to analyse whether the level of theoretical and practical understanding affected the attitudes of nursing staff. Methods A questionnaire was designed using the Delphi technique (three rounds). The questionnaire was adjusted and it was piloted on a test-retest basis with a convenience sample of 30 registered nurses. The psychometric characteristics were evaluated using a sample of 347 nurses using Cronbach’s alpha. Descriptive analysis was performed to describe the sociodemographic variables and Spearman’s correlation coefficient to assess the relationship between two scale variables. Pearson’s chi-squared test has been used to study the relationship between two categorical variables. Wilcoxon Mann Whitney test and the Kruskal–Wallis test were performed to establish relationships between the demographic/work related characteristics and the level of understanding. Results The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic information, theoretical and practical understanding, and attitudes of ethical issues. Cronbach’s alpha for the internal consistency of the attitudes questionnaire was 0.621. The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly affected their attitudes. Their responses raised a number of bioethical issues. Conclusions CAEPCR questionnaire is the first one which successfully linked knowledge of cardiopulmonary resuscitation to the attitudes towards ethical issues Health policies should ensure that CPR training is mandatory for nurses and all healthcare workers, and this training should include the ethical aspects.

scholarly journals Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura Hartman ◽  
Giulia Inguaggiato ◽  
Guy Widdershoven ◽  
Annelijn Wensing-Kruger ◽  
Bert Molewijk
Keyword(s):  
Clinical Ethics ◽  
Theory And Practice ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Joint Experience
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