Ethical Issues in the Supportive Care of Patients With Advanced Kidney Disease

2020 ◽  
pp. 239-247
Author(s):  
Catherine R. Butler ◽  
Alvin H. Moss
Keyword(s):  
Kidney Disease ◽  
Moral Status ◽  
Ethical Issues ◽  
Moral Uncertainty ◽  
Quality Of Patient Care ◽  
Ethical Conflicts ◽  
Underlying Causes ◽  
The Individual ◽  
Social And Cultural Factors

Although the benefits of standard dialysis therapy for many older adults with complex comorbid conditions is equivocal, there continues to be substantial moral uncertainty in the practice of withholding and withdrawing dialysis treatment. This chapter reviews several ethical conundrums in palliative care of patients with advanced kidney disease, including uncertainty about the moral status of withholding dialysis and pursuing medical management without dialysis, challenges in decision-making when patients lack capacity to participate, and ethically relevant social and cultural factors influencing practice. Better understanding of the underlying causes of these conundrums reveals opportunities to improve quality of patient care at the individual and system levels by incorporating palliative practices. The chapter also suggests strategies for clinicians to identify and facilitate resolution of ethical conflicts around end-of-life care for patients with advanced kidney disease in clinical practice.

scholarly journals Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: “If You Can’t Stand the Heat, Get Out of the Kitchen”

2020 ◽  
Vol 17 (12) ◽  
pp. 4442
Author(s):  
Moonok Kim ◽  
Younjae Oh ◽  
Byunghye Kong
Keyword(s):  
South Korea ◽  
Ethics Education ◽  
Phenomenological Study ◽  
Empirical Studies ◽  
Ethical Conflict ◽  
Face To Face ◽  
Quality Of Patient Care ◽  
Ethical Conflicts ◽  
Geriatric Nurses

Ethical conflicts among nurses can undermine nurses’ psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.

The Psychological Impact of Medical Error on Patients, Family Members, and Health Professionals

2017 ◽  
pp. 171-196
Author(s):  
Mary I. Gouva
Keyword(s):  
Medical Errors ◽  
Medical Error ◽  
Health Professionals ◽  
Psychological Impact ◽  
Psychological Effects ◽  
History Of ◽  
Underlying Causes ◽  
The Individual ◽  
The Impact

The current chapter examines the psychological implications emerging from medical errors. Whilst the psychological effects have studied, nonetheless the consequent impacts and the underlying psychological causes have not been sufficiently analysed and/ or interpreted. The chapter will add to the literate by using a psychodynamic approach in analysing the psychological impact of medical errors and provide interpretations of the underlying causes. The chapter concludes that medical errors lead to a series of implications. For the patient the quality of interactions with health professionals are directly affected and usually have immediate consequences. The impact of these consequences in the patient is mediated by the patient's personality, history of the individual and the psychoanalytic destiny of the patient. For the patient's relatives medical errors create emotional cracks leading to regression and eventual transference of the medical errors as a “bad” object. For health professionals medical errors impact upon the psychological defence mechanisms of the psychic Ego.

Medical ethics

2018 ◽  
Author(s):  
Daniel Wikler
Keyword(s):  
Health Care ◽  
Medical Ethics ◽  
Ethical Issues ◽  
Human Subjects ◽  
Truth Telling ◽  
For Profit ◽  
Moral Uncertainty ◽  
Consent To Treatment ◽  
Protection Of Human Subjects ◽  
The Individual

Medical ethics was once concerned with the professional obligations of physicians, spelled out in codes of conduct such as the ancient Hippocratic oath and elaborated by contemporary professional societies. Today this subject is a broad, loosely defined collection of issues of morality and justice in health, health care and related fields. The term ‘bioethics’ is often used interchangeably, though it is also used with its original broad meaning, which included issues in ecology. The range of concerns grouped under ‘medical ethics’ begins with the relationship of doctor to patient, including such issues as consent to treatment, truth-telling, paternalism, confidentiality and the duty to treat. Particular moral uncertainty is engendered by contexts which demand divided allegiances of physicians, such as medical experimentation on human subjects, public health emergencies and for-profit medicine. Issues in medical ethics arise in every stage of life, from the fate of defective newborns to the withholding of life-sustaining therapies from the very old. Medical practices with patients who may not be competent to make their own medical decisions, including paediatrics and psychiatry, raise a distinctive set of ethical issues, as does medical genetics, which involves choices affecting family members, future individuals and offspring in utero. In recent years, medical ethics has broadened its focus beyond the individual physician or nurse to include the organization, operation and financing of the health care system as a whole, including difficult theoretical and practical uncertainties regarding the fair allocation of health care resources. Medical ethics is at once a field of scholarship and a reform movement. The latter has campaigned in many countries on behalf of patients’ rights, better care of the dying and freedom for women in reproductive decisions. As a field of scholarship, medical ethics addresses these and many other issues, but is not defined by positions taken on any of them. Though ethicists often favour an emphasis on informed consent, oppose paternalism, urge permission to end life-sustaining therapy (or choose suicide) and seek protection of human subjects of experimentation, a diversity of viewpoints finds expression in the medical ethics literature.

The features of comorbid status and its impact on the quality of life of patients with chronic kidney disease on programmed hemodialysis

2021 ◽  
pp. 32-40
Author(s):  
Aksana Mukhamedovna Kardangusheva ◽  
Rustam Khasanovich Keshokov ◽  
Dzhanneta Magometovna Urusbieva ◽  
Albina Anatolievna Pshukova ◽  
Alina Latifovna Betuganova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Treatment ◽  
Renal Diseases ◽  
Chronic Glomerulonephritis ◽  
Ckd Stage ◽  
Common Causes ◽  
The Individual

The purpose of the research is to study the features of comorbid status in patients with chronic kidney disease (CKD) Stage 5 on programmed hemodialysis (PHD) and its impact on quality of life (QOL). Methodology: we examined 86 patients (60 men and 26 women) with CKD Stage 5 receiving PHD treatment. The average age of the patients was 55.5±13.9 years. The study protocol included an assessment of the QOL level according to the KDQOL-SF™ questionnaire, the comorbidity index according to M.E. Charlson (CCI), clinical and instrumental studies in accordance with clinical guidelines. Results: the most common causes of CKD Stage 5 in the examined patients were chronic glomerulonephritis and diabetes mellitus (26.7% each), tubulointerstitial renal diseases (23.3%) and polycystic kidney disease (13.3%). High and medium levels of CCI were found in 67.4% of the examined patients. Among the comorbidities, cardiovascular diseases rank first (51.2%). QOL of patients with CKD Stage 5 on PHD was characterized by the lowest scores on the scales of physical functioning and the burden of kidney disease. Correlation analysis revealed that comorbidities in patients with CKD Stage 5 who are on PHD negatively affect their QOL. Conclusion: the obtained results can be used in planning and organizing the provision of medical care to patients with CKD. The introduction of the used QOL and CCI assessment methods in the protocol for the management of patients with CKD Stage 5 in dialysis centers will make it possible to monitor the individual QOL indicators of patients, evaluate the effectiveness of patient treatment and correct it in a timely manner.

scholarly journals LONG OF HEMODIALYSIS THERAPY WITH QUALITY LIFE PATIENT FAILS OF KIDNEY CHRONIC IN RS GATOEL MOJOKERTO: STUDY CROSS-SECTIONAL

2017 ◽  
Vol 1 (1) ◽  
pp. 56-64
Author(s):  
Arif Wicaksono ◽  
Muhammad Sajidin
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cross Sectional ◽  
Quality Life ◽  
Cross Sectional Design ◽  
The Individual ◽  
The Relationship

Hemodialysis therapy of patients with chronic kidney disease can changes the patients physically, psychological, social and economics because they have to deal with it for the rest of their life. This can affect the quality of life of the patients because of the long-term of hemodialysis therapy, this is one of the factors that affect the quality of life of the patients with chronic kidney disease. Quality of life is focused on the assessment of the individual against conditions acceptance. Each individual takes different phases to accept the condition. The purposes of the study were to determine if the relationship between the duration of hemodialysis and quality of life of the patients with chronic kidney disease at Gatoel Hospital Mojokerto. This research used cross-sectional design. The patient's population with chronic kidney disease undergoing hemodialysis is 150 people. The research sample is drawn using sampling techniques with the type of nonprobability purposive sampling with 130 people as a sample. Data obtained from questionnaires KDQoL 36. The result using Spearman rho test using SPSS V.16 shows p < α (0,006 < 0,05). H0 rejected, this means that there is a relationship between the duration of hemodialysis and quality of life with chronic kidney disease at Gatoel Hospital Mojokerto. The quality of life of the patients fluctuated based on the stage adaptation of the hemodialysis and disease. However, most patients with the duration of hemodialysis for more than 12 months had a sufficient quality of life and their therapy are already familiar with the symptoms and complications, but there are other factors that affect the quality of life such as gender, marital status, and education level. Patients are also expected to cooperate in what to do and not to do to improve the quality of life of the patients.

scholarly journals LONG OF HEMODIALYSIS THERAPY WITH QUALITY LIFE PATIENT FAILS OF KIDNEY CHRONIC IN RS GATOEL MOJOKERTO: STUDY CROSS-SECTIONAL

2017 ◽  
Vol 1 (1) ◽  
pp. 56-64
Author(s):  
Arif Wicaksono ◽  
Muhammad Sajidin
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cross Sectional ◽  
Quality Life ◽  
Cross Sectional Design ◽  
The Individual ◽  
The Relationship

Hemodialysis therapy of patients with chronic kidney disease can changes the patients physically, psychological, social and economics because they have to deal with it for the rest of their life. This can affect the quality of life of the patients because of the long-term of hemodialysis therapy, this is one of the factors that affect the quality of life of the patients with chronic kidney disease. Quality of life is focused on the assessment of the individual against conditions acceptance. Each individual takes different phases to accept the condition. The purposes of the study were to determine if the relationship between the duration of hemodialysis and quality of life of the patients with chronic kidney disease at Gatoel Hospital Mojokerto. This research used cross-sectional design. The patient's population with chronic kidney disease undergoing hemodialysis is 150 people. The research sample is drawn using sampling techniques with the type of nonprobability purposive sampling with 130 people as a sample. Data obtained from questionnaires KDQoL 36. The result using Spearman rho test using SPSS V.16 shows p < α (0,006 < 0,05). H0 rejected, this means that there is a relationship between the duration of hemodialysis and quality of life with chronic kidney disease at Gatoel Hospital Mojokerto. The quality of life of the patients fluctuated based on the stage adaptation of the hemodialysis and disease. However, most patients with the duration of hemodialysis for more than 12 months had a sufficient quality of life and their therapy are already familiar with the symptoms and complications, but there are other factors that affect the quality of life such as gender, marital status, and education level. Patients are also expected to cooperate in what to do and not to do to improve the quality of life of the patients.

scholarly journals 論胚胎的道德地位——儒家倫理的視角

2021 ◽  
Vol 19 (2) ◽  
pp. 47-51
Author(s):  
Xiuqin SHEN ◽  
Feng PAN
Keyword(s):  
Stem Cell ◽  
Stem Cell Research ◽  
Moral Status ◽  
Ethical Issues ◽  
Confucian Ethics ◽  
Embryo Research ◽  
Present Moment ◽  
Cultural Perspectives ◽  
Ethical Conflicts ◽  
Human Embryo Research

LANGUAGE NOTE | Document text in Chinese; abstract also in English. For 40 years, international rules have limited human embryo research to the first 14 days of embryonic development. On May 26, 2021, in its latest guidelines for stem cell research and its medical applications, the International Society for Stem Cell Research eased the 14-day restriction. This raises myriad ethical issues. At their core is the debate over the moral status of embryos, which exposes ethical conflicts between cultural perspectives. This article discusses the moral status of embryos and argues from the perspective of Confucian ethics that the 14-day limit should not be waived at the present moment.

scholarly journals Predictors of health activation for patients with chronic kidney disease undergoing hemodialysis

2021 ◽  
Vol 9 (7) ◽  
pp. 100-113
Author(s):  
Isabela Naiala Martins de Moraes ◽  
Nadaby Maria de Jesus ◽  
Clesnan Mendes-Rodrigues ◽  
Cristiane Martins Cunha ◽  
Leonardo Santos ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Activation ◽  
Self Care ◽  
Cross Sectional ◽  
Linear Effect ◽  
Level 3 ◽  
The Individual

Introduction: the quality of self-care in patients with chronic kidney disease (CKD) is important to improve quality of life, increase survival and reduce complications. Self-care can be evaluated by measuring the health activation of these patients. Objectives: evaluating the health activation of patients with CKD undergoing hemodialysis (HD) compared to a normative group (health self-reported subjects), and to identify the social, demographic and clinical determinants that are associated with the health activation. Method: cross-sectional, analytical, descriptive and quantitative study approved by the local ethics committee and conducted in a public and a private outpatient hemodialysis clinic. Participants were patients with CKD on HD (focal group) and subjects on a normative group. All of them answered the questionnaire of sociodemographic and clinical characterization and the instrument "Patient Activation Measure" (PAM13). For scores comparisons were used the Mann-Whitney test. Regarding the evaluation of the linear effect of the variables of profile on PAM13, multiple linear regression was used, including the evaluation of the two groups and only for patients with CKD. Results: the study included in each group. Regarding the characteristics of the CKD patients, there was a predominance of males (59%), incomplete high school or less (68%). Most of them too was from a private administration clinic (53%) and reported having already presented some type of complication stemming from CKD (57%). Regarding the evaluation of activation, the activation scores did not differ between the two groups (median of 56.4 in CKD patients and 56.4 in normative group, p > 0.05) and the activation scores of both groups corresponded to activation level 3 with 34.5% of prevalence (p > 0.05). When the two groups were analyzed together, schooling (Bi = 5.38; p= 0.002), practice physical activity (Bi = 4.2; p= 0.019) and the number of people who co-reside (Bi = -2.22; p= 0.001) influenced the activation score. In the CKD patients, independently, the variables that influenced the activation score were gender (Bi = -4.69; p = 0.050); schooling (Bi = 6.55; p = 0.008); type of clinic of origin (Bi = -5.48; p = 0.02) and the presence of complications related to CKD (Bi = -5.25; p = 0.026). Conclusion: activation scores did not differ between the patients with CKD on HD and the health subjects. Schooling, practice physical activity and number of people residing with the individual were predictors of health activation in both groups. For the CKD patients group, the variables that influenced positively the activation was schooling; and that influenced negatively was the gender, type of clinic of origin and the presence of complications related to CKD.

scholarly journals Diet in Chronic Kidney Disease: an integrated approach to nutritional therapy

2020 ◽  
Vol 66 (suppl 1) ◽  
pp. s59-s67 ◽  
Author(s):  
Raíssa Antunes Pereira ◽  
Christiane Ishikawa Ramos ◽  
Renata Rodrigues Teixeira ◽  
Gisselma Aliny Santos Muniz ◽  
Gabriele Claudino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Integrated Approach ◽  
Nutritional Therapy ◽  
Healthy Diet ◽  
Adherence To Treatment ◽  
Essential Requirement ◽  
Renal Functions ◽  
The Individual

SUMMARY A healthy diet is an essential requirement to promote and preserve health, even in the presence of diseases, such as chronic kidney disease (CKD). In this review, nutritional therapy for CKD will be addressed considering not only the main nutrients such as protein, phosphorus, potassium, and sodium, which require adjustments as a result of changes that accompany the reduction of renal functions, but also the benefits of adopting dietary patterns associated with better outcomes for both preventing and treating CKD. We will also emphasize that these aspects should also be combined with a process of giving new meaning to a healthy diet so that it can be promoted. Finally, we will present the perspective of an integrated approach to the individual with CKD, exploring the importance of considering biological, psychological, social, cultural, and economic aspects. This approach has the potential to contribute to better adherence to treatment, thus improving the patient's quality of life.

The UK's National Programme for IT: Why was it dismantled?

2016 ◽  
Vol 30 (1) ◽  
pp. 2-9 ◽  
Author(s):  
Taghreed Justinia
Keyword(s):  
Electronic Patient Record ◽  
Management Approach ◽  
User Engagement ◽  
End User ◽  
Top Down ◽  
National Programme ◽  
The Core ◽  
Quality Of Patient Care ◽  
Underlying Causes

This paper discusses the UK’s National Programme for IT (NPfIT), which was an ambitious programme launched in 2002 with an initial budget of some £6.2 billion. It attempted to implement a top-down digitization of healthcare in England’s National Health Service (NHS). The core aim of the NPfIT was to bring the NHS’ use of information technology into the 21st century, through the introduction of an integrated electronic patient record systems, and reforming the way that the NHS uses information, and hence to improve services and the quality of patient care. The initiative was not trusted by doctors and appeared to have no impact on patient safety. The project was marred by resistance due to the inappropriateness of a centralized authority making top-down decisions on behalf of local organizations. The NPfIT was officially dismantled in September 2011. Deemed the world’s largest civil IT programme, its failure and ultimate demise sparked a lot of interest as to the reasons why. This paper summarises the underlying causes that lead to dismantling the NPfIT. At the forefront of those circumstances were the lack of adequate end user engagement, the absence of a phased change management approach, and underestimating the scale of the project.

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