Ethically difficult situations in hemodialysis care – Nurses' narratives

2014 ◽  
Vol 22 (6) ◽  
pp. 711-722 ◽  
Author(s):  
Catarina EC Fischer Grönlund ◽  
Anna IS Söderberg ◽  
Karin M Zingmark ◽  
S Mikael Sandlund ◽  
Vera Dahlqvist
Keyword(s):  
Registered Nurses ◽  
Ethical Dilemmas ◽  
Research Question ◽  
Moral Integrity ◽  
Ethical Considerations ◽  
Ethical Problems ◽  
Deliberative Dialogue ◽  
Stage Renal Disease ◽  
End Stage ◽  
Difficult Situations

Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

Validity of the Italian Code of Ethics for everyday nursing practice

2016 ◽  
Vol 25 (7) ◽  
pp. 906-917
Author(s):  
Paola Gobbi ◽  
Maria Grazia Castoldi ◽  
Rosa Anna Alagna ◽  
Anna Brunoldi ◽  
Chiara Pari ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Nursing Practice ◽  
Code Of Ethics ◽  
Research Question ◽  
Daily Practice ◽  
Ethical Considerations ◽  
Clinical Competencies ◽  
Ethical Problems ◽  
Specific Theme

Background: The research question for this study was as follows: Is the Code of Ethics for Nurses in Italy (Code) a valid or useful decision-making instrument for nurses faced with ethical problems in their daily clinical practice? Method: Focus groups were conducted to analyze specific ethical problems through 11 case studies. The analysis was conducted using sections of the Code as well as other relevant documents. Each focus group had a specific theme and nurses participated freely in the discussions according to their respective clinical competencies. Ethical considerations: The executive administrative committee of the local nursing licensing council provided approval for conducting this project. Measures were taken to protect the confidentiality of consenting participants. Findings: The answer to the research question posed for this investigation was predominantly positive. Many sections of the Code were useful for discussion and identifying possible solutions for the ethical problems presented in the 11 cases. Conclusion: We concluded that the Code of Ethics for Nurses in Italy can be a valuable aid in daily practice in most clinical situations that can give rise to ethical problems.

Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones

2017 ◽  
Vol 26 (2) ◽  
pp. 480-495 ◽  
Author(s):  
Kristina Lundberg ◽  
Sofia Kjellström ◽  
Lars Sandman
Keyword(s):  
Registered Nurses ◽  
Healthcare Personnel ◽  
Humanitarian Law ◽  
Military Operations ◽  
Ethical Considerations ◽  
Common View ◽  
Ethical Problems ◽  
Ethical Codes ◽  
Individual Interviews ◽  
Nurses And Physicians

Background: When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively. Aim: This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones. Design: Abductive qualitative design. Participants and research context: Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali. Ethical considerations: The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014). Findings: Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties. Discussion/conclusion: These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

Patient selection when resources are limited

2018 ◽  
Author(s):  
Bernadette A. Thomas ◽  
Christopher R. Blagg
Keyword(s):  
Population Ageing ◽  
Ethical Considerations ◽  
Number Of Patients ◽  
The World ◽  
History Of ◽  
Developing Societies ◽  
Stage Renal Disease ◽  
End Stage ◽  
Global Growth ◽  
Triage Decisions

More than 50 years ago, outpatient care for patients with end-stage renal disease (ESRD) became possible through the invention of the Scribner shunt. Since that time, renal replacement therapy (RRT) has expanded to include haemodialysis, peritoneal dialysis, and renal transplantation. There has been tremendous global growth in the number of patients with access to RRT for ESRD, but many societies face difficult triage decisions for these costly modalities similar to those faced by the pioneers of outpatient dialysis in the early 1960s. Developed and developing societies will face the complex challenges of addressing the costly needs of an ESRD population that is projected to rise rapidly secondary to population ageing, as well as the increased burden of chronic diseases such as diabetes mellitus and hypertension. The history of outpatient RRT is outlined and trends in RRT growth throughout the world noted. The ethical considerations with which both developed and developing societies will have to contend to address the growing global burden of ESRD are discussed.

Everyday Ethical Problems in Dementia Care: A teleological Model

2006 ◽  
Vol 13 (4) ◽  
pp. 340-359 ◽  
Author(s):  
Ingrid Ågren Bolmsjö ◽  
Anna-Karin Edberg ◽  
Lars Sandman
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Nursing Care ◽  
Ethical Dilemmas ◽  
Dementia Care ◽  
Nursing Home Care ◽  
Structural Constraints ◽  
Ethical Problems ◽  
Side Constraints ◽  
Difficult Situations

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

Serum Thiamine Values in End-Stage Renal Disease Patients under Maintenance Hemodialysis

2015 ◽  
Vol 85 (5-6) ◽  
pp. 348-355 ◽  
Author(s):  
Masamitsu Ubukata ◽  
Nobuyuki Amemiya ◽  
Kosaku Nitta ◽  
Takashi Takei
Keyword(s):  
Thiamine Deficiency ◽  
Risk Index ◽  
Nutritional Risk ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Significant Difference ◽  
Nutritional Risk Index ◽  
Serum Aspartate Aminotransferase ◽  
Stage Renal Disease ◽  
End Stage

Abstract. Objective: Hemodialysis patients are prone to malnutrition because of diet or many uremic complications. The objective of this study is to determine whether thiamine deficiency is associated with regular dialysis patients. Methods: To determine whether thiamine deficiency is associated with regular dialysis patients, we measured thiamine in 100 patients undergoing consecutive dialysis. Results: Average thiamine levels were not low in both pre-hemodialysis (50.1 ± 75.9 ng/mL; normal range 24 - 66 ng/mL) and post-hemodialysis (56.4 ± 61.7 ng/mL). In 18 patients, post-hemodialysis levels of thiamine were lower than pre-hemodialysis levels. We divided the patients into two groups, the decrease (Δthiamine/pre thiamine < 0; - 0.13 ± 0.11) group (n = 18) and the increase (Δthiamine/pre thiamine> 0; 0.32 ± 0.21)) group (n = 82). However, there was no significance between the two groups in Kt/V or type of dialyzer. Patients were dichotomized according to median serum thiamine level in pre-hemodialysis into a high-thiamine group (≥ 35.5 ng/mL) and a low-thiamine group (< 35.4 ng/mL), and clinical characteristics were compared between the two groups. The low-thiamine value group (< 35.4 ng/ml; 26.8 ± 5.3 ng/ml) exhibited lower levels of serum aspartate aminotransferase and alanine aminotransferase than the high-thiamine value group (≥ 35.4 ng/ml; 73.5 ± 102.5 ng/ml) although there was no significance in nutritional marker, Alb, geriatric nutritional risk index , protein catabolic rate and creatinine generation rate. Conclusion: In our regular dialysis patients, excluding a few patients, we did not recognize thiamine deficiency and no significant difference in thiamine value between pre and post hemodialysis.

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