scholarly journals Rapid development of a Clinical Decision-Making Committee in a UK paediatric hospital during the COVID-19 pandemic

2020 ◽  
Vol 20 (2) ◽  
pp. 167-180 ◽  
Author(s):  
Rick Turnock ◽  
Will Weston ◽  
Nicki Murdock ◽  
Amel Alghrani ◽  
Conor Mallucci ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Rapid Development ◽  
Clinical Decision ◽  
Paediatric Hospital ◽  
Ethical Frameworks ◽  
National Guidance ◽  
The Government ◽  
Set Up

To date, the Government has not issued any national ethical guidance to support clinical decision-making in England during periods of potentially reduced healthcare resources in the context of the evolving COVID-19 1 pandemic at the time of writing. In the ensuing vacuum left by a lack of national guidance, ethical frameworks and approaches have been drafted by professional bodies, individual hospitals and trusts. It is clear that in delivering healthcare during this pandemic, more specific guidance is needed to ensure fair and consistent allocation policies, to attain public trust and confidence and to support clinicians so that decisions do not fall on them to make alone and unsupported. This article sets out how we in our institution, a UK tertiary and secondary level stand-alone paediatric provider Trust, set up a Clinical Decision-Making Committee to inform proactive clinical and ethical decision-making, to ensure that all patients are treated appropriately and fairly during these unprecedented times.

Ethical Issues for Neonatal Nurses

1998 ◽  
Vol 5 (3) ◽  
pp. 206-217 ◽  
Author(s):  
Kaye Spence
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Response Rate ◽  
Clinical Decision ◽  
Neonatal Nurses ◽  
Ethical Decisions

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.

Factors that impact on emergency nurses’ ethical decision-making ability

2016 ◽  
Vol 25 (7) ◽  
pp. 855-866 ◽  
Author(s):  
Barbara Alba
Keyword(s):  
Decision Making ◽  
Research Design ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Clinical Decision ◽  
Significant Finding ◽  
Emergency Nurses ◽  
Nursing Experience ◽  
Rational Thought

Background: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Research purpose: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. Research design and context: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions. Participants: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Ethical considerations: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. Findings: A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study. Discussion: This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability. Conclusion: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.

Why Machine Learning Should Be Taught in Medical Schools (Preprint)

2021 ◽  
Author(s):  
Matthew Nagy ◽  
Nathan Radakovich ◽  
Aziz Nazha
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Rapid Development ◽  
Clinical Care ◽  
Clinical Decision ◽  
Medical Schools ◽  
Medical Workforce ◽  
Ethical Concerns ◽  
Clinical Tools

UNSTRUCTURED The rapid development of machine learning (ML) applications in healthcare promises to transform the landscape of healthcare. In order for ML advancements to be effectively utilized in clinical care, it is necessary for the medical workforce to be prepared to handle these changes. As physicians in training are exposed to a wide breadth of clinical tools during medical school, this offers an ideal opportunity to introduce ML concepts. A foundational understanding of ML will not only be practically useful for clinicians, but will also address ethical concerns for clinical decision making. While select medical schools have made effort to integrate ML didactics and practice into their curriculum, we argue that foundational ML principles should be taught to broadly to medical students across the country.

AI-based clinical decision-making systems in palliative medicine: ethical challenges

2021 ◽  
pp. bmjspcare-2021-002948
Author(s):  
Ludovica De Panfilis ◽  
Carlo Peruselli ◽  
Silvia Tanzi ◽  
Carlo Botrugno
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Clinical Decision ◽  
Point Of View ◽  
Ethical Challenges ◽  
Palliative Care Consultation

BackgroundImproving palliative care (PC) is demanding due to the increase in people with PC needs over the next few years. An early identification of PC needs is fundamental in the care approach: it provides effective patient-centred care and could improve outcomes such as patient quality of life, reduction of the overall length of hospitalisation, survival rate prolongation, the satisfaction of both the patients and caregivers and cost-effectiveness.MethodsWe reviewed literature with the objective of identifying and discussing the most important ethical challenges related to the implementation of AI-based data processing services in PC and advance care planning.ResultsAI-based mortality predictions can signal the need for patients to obtain access to personalised communication or palliative care consultation, but they should not be used as a unique parameter to activate early PC and initiate an ACP. A number of factors must be included in the ethical decision-making process related to initiation of ACP conversations, among which are autonomy and quality of life, the risk of worsening healthcare status, the commitment by caregivers, the patients’ psychosocial and spiritual distress and their wishes to initiate EOL discussionsConclusionsDespite the integration of artificial intelligence (AI)-based services into routine healthcare practice could have a positive effect of promoting early activation of ACP by means of a timely identification of PC needs, from an ethical point of view, the provision of these automated techniques raises a number of critical issues that deserve further exploration.

scholarly journals Doctors, families and the industry in the clinic: the management of ‘intersex’ children in Swiss paediatric medicine (1945–1970)

2021 ◽  
Vol 65 (3) ◽  
pp. 286-305
Author(s):  
Mirjam Janett ◽  
Andrea Althaus ◽  
Marion Hulverscheidt ◽  
Rita Gobet ◽  
Jürg Streuli ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Rapid Development ◽  
Rapid Change ◽  
Clinical Decision ◽  
New Drugs ◽  
Diagnostic Tools ◽  
Diagnostic Categories ◽  
Paediatric Medicine ◽  
The University

AbstractThis manuscript investigates clinical decisions and the management of ‘intersex’ children at the University Children’s Hospital Zurich between 1945 and 1970. This was an era of rapid change in paediatric medicine, something that was mirrored in Zurich. Andrea Prader, the principal figure in this paper, started his career during the late 1940s and was instrumental in moving the hospital towards focusing more on expertise in chronic diseases. Starting in 1950, he helped the Zurich hospital to become the premier centre for the treatment of so-called ‘intersex’ children. It is this treatment, and, in particular, the clinical decision-making that is the centre of our article. This field of medicine was itself not stable. Rapid development of diagnostic tools led to the emergence of new diagnostic categories, the availability of new drugs changed the management of the children’s bodies and an increased number of medical experts became involved in decision-making, a particular focus lay with the role of the children themselves and of course with their families. How involved were children or their families in an era widely known as the golden age of medicine?

scholarly journals ANZICS guiding principles for complex decision making during the COVID-19 pandemic

2020 ◽  
Vol 22 (2) ◽  
pp. 98-102
Author(s):  
Stephen Warrillow ◽  
◽  
Danielle Austin ◽  
Winston Cheung ◽  
Eliana Close ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Clinical Decision ◽  
Intensive Care Society ◽  
Admission Policies ◽  
Complex Decision Making ◽  
Complex Decision

The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity. In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic. This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities.

The ethics of clinical judgment in critical care

1990 ◽  
Vol 10 (1) ◽  
pp. 24-28 ◽  
Author(s):  
AL Gaul
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Clinical Decision ◽  
Critical Care Nursing ◽  
Ethical Component ◽  
Care Nursing

Ethical decision making is an inherent part of the clinical judgment process in critical care nursing. It can cause considerable mental discomfort and stress. Although applying ethical theories to the clinical decision-making process does not provide absolute solutions, it does increase the nurse's confidence in the basis on which the decisions are made. Increasing the awareness of the ethical component of clinical decisions will increase the nurse's ability to deal with the perplexing ethical issues that permeate critical care nursing.

scholarly journals Assessing whether COVID-19 patients will benefit from critical care, and an objective approach to capacity challenges during a pandemic: An Intensive Care Society clinical guideline

2020 ◽  
pp. 175114372094853 ◽  
Author(s):  
J Montgomery ◽  
HJ Stokes-Lampard ◽  
MD Griffiths ◽  
D Gardiner ◽  
D Harvey ◽  
...  
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Decision Making ◽  
Clinical Guideline ◽  
Resource Limitation ◽  
Clinical Decision ◽  
Mutual Aid ◽  
Ethical Frameworks ◽  
Available Information ◽  
Case Basis

This national professional society guidance lays out operational and ethical principles for decision-making during a pandemic, in the immediate context of COVID-19 in the early 2020 surge iteration but with potential ongoing relevance. It identifies the different phases of a pandemic and the implications for capacity and mutual aid within a national healthcare system, and introduces a revised CRITCON-PANDEMIC framework for shared operational responsibilities and clinical decision-making. Usual legal and ethical frameworks should continue to apply while capacity and mutual aid are available (CRITCON-PANDEMIC levels 0-3); clinicians should focus on current clinical needs and should not treat patients differently because of anticipated future pressures. In conditions of resource limitation (CRITCON-PANDEMIC 4), a structured and equitable approach is necessary and an objective Decision Support Aid is proposed. In producing this guidance, we emphasise that all patients must be treated with respect and without discrimination, because everyone is of equal value. The guidance has been put together with input from patient and public groups and aims to provide standards that are fair to everyone. We acknowledge that COVID-19 is a new disease with a partial and evolving knowledge base, and aim to provide an objective clinical decision-making framework based on the best available information. It is recognised that a factual assessment of likely benefit may take into account age, frailty and comorbidities, but the guidance emphasises that every assessment must be individualised on a balanced, case by case, basis and may inform clinical judgement but not replace it. The effects of a comorbidity on someone's ability to benefit from critical care should be individually assessed. Measures of frailty should be used with care, and should not disadvantage those with stable disability.

scholarly journals Patient Psychopathology and the Management of Clinical Dilemmas in Psychotherapy: A Qualitative Analysis of Clinical Decision-Making

2020 ◽  
Vol 10 (1) ◽  
pp. 29
Author(s):  
Sarah B. Trasmundi ◽  
Marie S. Bloch ◽  
Stine S. Høgenhaug ◽  
Vicki T. Jensen ◽  
Katharina K. Wrist ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Interaction Analysis ◽  
Mental Healthcare ◽  
Clinical Decision ◽  
Video Data ◽  
Interaction Patterns ◽  
Clinical Dilemma ◽  
Dilemma Management

Introduction: Clinical dilemma management is an important part of daily decision-making processes in psychotherapy, and hence important for the quality of mental healthcare. However, the situated particularities of such dilemmas have been given little systematic attention – both in research and in practice, even though an improved understanding of the nature of clinical dilemmas is a central key to managing dilemmas successfully. Method: Eight cases of authentic clinical dilemma management in psychotherapy have been analysed from the perspective of interaction analysis and psychopathology. The article uses video data and narrative interviews from a larger cognitive ethnography study conducted at a psychiatric Hospital in Denmark. Results: The analysis demonstrates how clinical dilemma management in psychotherapy is particularly difficult due to the nature of a patient’s psychopathology. Thus, it is often difficult to discern whether a given dilemma is intrinsically ethical, or if it is a manifestation of the patient’s pathology. Two overall interaction patterns were identified: In the first pattern, the therapist fails to manage the clinical decision-making in accordance with the therapeutic goal, which strengthens the patient’s psychopathological behaviour, for instance by giving in and do what the patient demands. In the second pattern, the therapist uses the situation as an opportunity to work with the patient’s psychopathological behaviour in situated interaction. Conclusion: This article presents a model for integrating an understanding of patient pathology into clinical and ethical decision-making. It establishes a window into how psychotherapists manage clinical dilemmas (successfully or not) through interaction. This illustration might impact on how we address, evaluate and understand clinical and ethical dilemma management, which again can contribute to the reduction of moral distress amongst healthcare practitioners, as well as amongst patients.

scholarly journals Understanding the Lived Experiences of Patients: Application of a Phenomenological Approach to Ethics

2010 ◽  
Vol 90 (8) ◽  
pp. 1185-1197 ◽  
Author(s):  
Bruce H. Greenfield ◽  
Gail M. Jensen
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Clinical Decision ◽  
Phenomenological Approach ◽  
Phenomenological Inquiry ◽  
Ethical Decisions ◽  
Moral Context ◽  
The Everyday

This perspective article provides a justification, with an overview, of the use of phenomenological inquiry and the interpretation into the everyday ethical concerns of patients with disabilities. Disability is explored as a transformative process that involves physical, cognitive, and moral changes. This perspective article discusses the advantages of phenomenology to supplement and enhance the principlist process of ethical decision making that guides much of contemporary medical practice, including physical therapy. A phenomenological approach provides a more contextual approach to ethical decision making through probing, uncovering, and interpreting the meanings of “stories” of patients. This approach, in turn, provides for a more coherent and genuine application of ethical principles within the “textured life-world” of patients and their evolving values as they grapple with disability to make ethical and clinical decisions. The article begins with an in-depth discussion of the current literature about the phenomenology of people with disability. This literature review is followed by a discussion of the traditional principlist approach to making ethical decisions, which, in turn, is followed by a discussion of phenomenology and its tools for use in clinical inquiry and interpretation of the experiences of patients with disabilities. A specific case is presented that illustrates specific tools of phenomenology to uncover the moral context of disability from the perspective of patients. The article concludes with a discussion of clinical, educational, and research implications of a phenomenological approach to ethics and clinical decision making.

Sign in / Sign up

Export Citation Format

Share Document