scholarly journals Decision-making in an emergency department: A nursing accountability model

2019 ◽  
Vol 27 (2) ◽  
pp. 567-586 ◽  
Author(s):  
Alfonso Rubio-Navarro ◽  
Diego José García-Capilla ◽  
Maria José Torralba-Madrid ◽  
Jane Rutty
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Participant Observation ◽  
Ethics Committees ◽  
Healthcare Institution ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Clinical Nursing ◽  
Ethical Approval ◽  
Acute Patients

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen.

scholarly journals Shared clinical decision-making experiences in nursing: A qualitative study

2021 ◽  
Author(s):  
Fen-Fang Chung ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Pao-Yu Wang ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Cultural Sensitivity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Information Communication ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Basic Ability

Abstract Background Shared decision making (SDM) is a patient-centred nursing concept that emphasises the autonomy of the patient. It is a co-operative process of exchanging information, communication and response, and treatment decisions made between medical staff and patients. In this study, we explored the experience of clinical nursing staff participating in SDM. Methods We adopted a qualitative research method. Semi-structured interviews were conducted with 21 nurses at a medical centre in northern Taiwan. The data obtained from interview recordings were transferred to verbatim manuscripts. Content analysis was used to analyse and summarise the data. Results Clinical nursing staff should have basic professional skills, communication and response skills, respect and cultural sensitivity, the ability to form a co-operative team, the ability to search for and integrate empirical data, and the basic ability to edit media to participate in SDM. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM, which can be used as a reference for nursing education and nursing administrative supervisors to plan and enhance professional nursing SDM in nursing education.

Day-to-Day Decision Making by Adolescents and Young Adults with Cancer

2022 ◽  
pp. 275275302110687
Author(s):  
Kimberly A. Pyke-Grimm ◽  
Linda S. Franck ◽  
Bonnie Halpern-Felsher ◽  
Robert E. Goldsby ◽  
Roberta S. Rehm
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Participant Observation ◽  
Healthcare Providers ◽  
Adolescents And Young Adults ◽  
Structured Interviews ◽  
Self Advocacy ◽  
Daily Lives ◽  
Life Threatening Illness ◽  
The Impact

Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.

scholarly journals A review of informed consent and how it has evolved to protect vulnerable participants in emergency care research

2020 ◽  
Vol 5 (2) ◽  
pp. 73-79
Author(s):  
Rajpal Nandra ◽  
Alan F. Brockie ◽  
Faisal Hussain
Keyword(s):  
Informed Consent ◽  
Emergency Care ◽  
Ethics Committees ◽  
Moral Obligations ◽  
Ethical Considerations ◽  
Vulnerable Patients ◽  
Ethical Approval ◽  
Life Threatening ◽  
Time Critical

A vulnerable participant in research lacks capacity to consent or may be exposed to coercion to participate. Capacity may be temporarily impaired due to loss of consciousness, hypoxia, pain and the consumption of alcohol or elicit substances. To advance emergency care, providing life-threatening measures in life-threatening circumstances, vulnerable patients are recruited into research studies. The urgent need for time-critical treatment conflicts with routine informed consent procedures. This article reviews ethical considerations and moral obligations to safeguard these participants and preserve their autonomy. A particular focus is given to research methodology to waive consent, and the role of ethics committees, research audits, research nurses and community engagement. Research on the acutely unwell patient who lacks capacity is possible with well-designed research trials that are led by investigators who are sufficiently trained, engage the community, gain ethical approval to waive consent and continuously audit practice. Cite this article: EFORT Open Rev 2020;5:73-79. DOI: 10.1302/2058-5241.5.180051

scholarly journals Decision-making of the nursing team after the revitalization of a decentralized management model

2014 ◽  
Vol 23 (2) ◽  
pp. 286-293 ◽  
Author(s):  
Karen Yukari Hayashida ◽  
Andrea Bernardes ◽  
Vanessa Gomes Maziero ◽  
Carmen Silvia Gabriel
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Participant Observation ◽  
Management Model ◽  
Participatory Management ◽  
Structured Interviews ◽  
Daily Work ◽  
Decentralized Management ◽  
Qualified Work

This study's objective was to identify changes in decision-making arising from the revitalization of the participatory management model and how these changes impacted the daily work of the nursing staff, as well as to identify potential difficulties. This qualitative case study was conducted in a public hospital in the State of São Paulo, Brazil. Participant observation and semi-structured interviews were conducted with 23 nursing workers and the Health Technical Assistant. We used thematic content analysis for data analysis. The revitalization of the management model was not comprehensive because many professionals were oblivious to the process. Shared actions did not occur and adherence to the model was hampered because the workers were not fully informed of the assumptions concerning this management model. For the implementation of this model to be effective, teamwork and the inclusion of all the stakeholders should be reviewed in order to achieve more cooperative and qualified work.

scholarly journals P140: Emergency department decision-making for incapacitated and unrepresented patients: a comprehensive review of the literature

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S124-S125
Author(s):  
J.L. Willinsky ◽  
I. Hyun
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Medical Decision Making ◽  
Hospital Setting ◽  
Ethics Committees ◽  
Medical Decision ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Patient Cohort ◽  
Decision Making Processes

Introduction: Incapacitated patients who lack substitute decision-makers (SDM) are commonly encountered in the emergency department (ED). The number of these patients will rise dramatically as the Baby Boomers age. We can expect an influx of elderly patients who lack decisional capacity due to dementia and other illnesses, and who present without family. It is estimated that 3 to 4 percent of U.S. nursing home residents have no SDM or advance directives. Medical decision-making for this cohort poses an ethical challenge, particularly in the ED setting. Methods: A comprehensive review of the literature was conducted surrounding decision-making for incapacitated and unrepresented patients in the hospital setting. Articles were identified using MEDLINE (1946-October 2015) and Embase (1974-October 2015). The reference lists of relevant articles were hand searched. Articles describing decision-making processes that have been proposed, tested or applied in practice were chosen for full review. The aim of this review was to outline recognized medical decision-making processes for incapacitated and unrepresented patients, and to identify areas for future research. Results: The search yielded 20 articles addressing decision-making for incapacitated and unrepresented patients in the hospital setting. All of these articles focus on the intensive care unit and other hospital wards; no literature on the ED setting was found. Five types of formal consulting bodies exist to assist physicians in applying the best interest standard for this patient cohort: internal hospital ethics committees, external ethics committees, public guardians, court-appointed guardians, or judges. The majority of decisions for these patients, however, are made informally by a single physician or by a healthcare team, although it is well recognized that this approach lacks appropriate safeguards. There is no consensus surrounding the optimal approach to decision-making in these cases, and as such there is significant inconsistency in how medical decisions are made for these patients. Conclusion: There are several articles describing decision-making processes for incapacitated and unrepresented patients, none of which focus on the ED. These processes are not practical for use in the ED. Further inquiry is needed into the most ethical and respectful method of decision-making for this patient cohort in the ED.

Ethical considerations in oncology: balancing the interests of patients, oncologists, and society.

1995 ◽  
Vol 13 (9) ◽  
pp. 2464-2470 ◽  
Author(s):  
T J Smith ◽  
J N Bodurtha
Keyword(s):  
Decision Making ◽  
Conflicts Of Interest ◽  
Daily Practice ◽  
Ethics Committees ◽  
Ethical Principles ◽  
Allocation Of Resources ◽  
Ethical Considerations ◽  
Ethical Frameworks ◽  
Choice Of Treatment ◽  
Hospital Ethics

BACKGROUND Oncologists face ethical dilemmas every day in deciding about choice of treatment, continuation of treatments, events near the end of life, conflicts of interest, and risk management. Yet, many oncologists have limited training in ethics. METHODS Review of existing studies and definitions of useful terms. Case studies analyzed according to ethical principles. RESULTS Individual oncology cases can be analyzed according to ethical principles with benefit to the patient, physician, and possibly society. Ethics cannot resolve many of the thorny questions about allocation of resources, justice, or possible conflict of interest. CONCLUSION Oncology decision-making fits into formal ethical frameworks, and understanding both can help doctors and patients make difficult choices. Understanding of ethical principles can help daily practice, but does not solve current dilemmas of allocation of resources, unrealistic demands, etc. More formal collaboration between hospital ethics committees or personnel and clinical oncologists is recommended for the day-to-day decision-making process.

scholarly journals Gamble on the Uncertain. Negotiating Medical Decision-Making

2016 ◽  
Vol 12 (4) ◽  
pp. 44-59
Author(s):  
Helena Serra
Keyword(s):  
Decision Making ◽  
Strategic Alliances ◽  
Medical Decision Making ◽  
Participant Observation ◽  
Medical Decision ◽  
Structured Interviews ◽  
Complex Processes ◽  
Transplant Program ◽  
The Social ◽  
Constructivist Approaches

The aim of this paper is to analyze the medical decision-making process in the admission of patients into a Liver Transplant Program in a hospital in Lisbon, Portugal. The relationships and main strategies established among the medical specializations involved in this process will be investigated. The theoretical basis was drawn from medical sociology, in particular, from the social constructivist approaches, which highlight the relation between medical power and knowledge in the construction of medical decision-making. I attempt to elucidate the processes of negotiation through which a medical decision is constructed. The research methodology included non-participant observation and semi-structured interviews with participants from the two medical specializations of interest: liver surgeons and hepatologists. The management of risk and uncertainty in relation to patients’ access to liver transplantation is discussed and the strategic alliances that are formed during medical decision-making in search of consensus are investigated. The research findings show that medical practices and knowledge do not converge linearly to produce a coherent network of actions with a view to decision-making. Instead, medical decision-making is constructed through complex processes of negotiation. The different natures and levels of uncertainty and indetermination that are inherent in the social world of medicine have a fundamental influence on medical decision-making.

scholarly journals Clinical nursing care to comfort women with acute myocardial infarction

2014 ◽  
Vol 23 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Keila Maria de Azevedo Ponte ◽  
Lúcia de Fátima da Silva ◽  
Antonia Eliana de Araújo Aragão ◽  
Maria Vilani Cavalcante Guedes ◽  
Ivete Palmira Sanson Zagonel
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Data Collection ◽  
Nursing Care ◽  
Participant Observation ◽  
Clinical Care ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Care Approach ◽  
Heart Hospital

The objective of this article was to describe the contribution of clinical nursing care to the environmental comfort of women with Acute Myocardial Infarction, based on the Comfort Theory and mediated by the research-care approach. Data collection took place from April to June 2011 with nine women admitted with an infarction to the Heart Hospital of Sobral, Ceará, Brazil. Four meetings were held; the first being four starting at the admission to the hospital. The participants were informed about the study objectives and the proposed method, and following care was provided based both on method and theory. Data collection was performed using individual semi-structured interviews, field diary, participant observation and thematic category content analysis. The clinical care implemented in the environmental context aimed at promoting adaptation to the coronary care unit and also providing an enabling environment for comfort and relaxed atmosphere. Clinical care targeted at promoting environmental comfort contributes to the wellbeing of women with infarction.

scholarly journals Help Me Breathe, Please

2019 ◽  
Vol 2 (3) ◽  
pp. 36
Author(s):  
Karin Dam Eikhof
Keyword(s):  
Emergency Department ◽  
Healthcare Professionals ◽  
Focal Point ◽  
Well Being ◽  
Chronic Obstructive ◽  
Structured Interviews ◽  
Care Needs ◽  
Obstructive Pulmonary Disease ◽  
Meaning Interpretation ◽  
Acute Patients

Background: The aim was to gain insight into how patients with chronic obstructive pulmonary disease (COPD) experience being acutely admitted to an emergency department in Denmark. The Department is characterized by a large number of acute patients, which means that the focal point for the healthcare professionals may be to ensure vacant beds. This may be at the expense of caring for the patients sufficiently due to their individual needs. Focus on the flow culture may be contrary to the need for e.g. silence, safety, continuity in care and time with the healthcare professionals. Methods:  This study has a qualitative design with a phenomenological hermeneutic approach. The empirics consist of qualitative semi-structured interviews with fourteen patients admitted to an emergency department in Denmark. The data has been analysed through the four steps about meaning condensation and meaning interpretation as described by Kvale and Brinkmann. Results: The preliminary analyses indicated that patients being admitted to the Emergency Department experience a strong need for getting help to breathe and rest. They have struggled with their breathing when they were at home and therefore feel extremely tired. Thus, the chaos that often exists in the Emergency Department may affect the patients’ well-being. In addition, the healthcare professionals’ way of communicating with the patients has a great impact on patient´s feeling safe and comfortable. Conclusion: By focusing on the patients´ individual fundamental care needs in a busy department, it may qualify continuity of care for patients with COPD.

Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement

2015 ◽  
Vol 36 (7) ◽  
pp. 1526-1554 ◽  
Author(s):  
YUE WANG ◽  
MIKE NOLAN
Keyword(s):  
Decision Making ◽  
Older People ◽  
Cultural Values ◽  
Participant Observation ◽  
Social Process ◽  
Active Role ◽  
Theory Approach ◽  
Family Carers ◽  
Structured Interviews ◽  
Essential Information

ABSTRACTDecision-making among older patients with stroke, their families and professionals has been extensively studied in a Western context, but there has been little prior work in China. The study reported here explored how decision-making took place between older people with stroke, their family carers and professionals in an acute care context in mainland China using a constructivist grounded theory approach. Data were collected through semi-structured interviews, participant observation and documentary analysis. Constant comparative analysis of the data was carried out. This paper focuses on the key social process of ‘hiding’ and its dynamic relationship with the core category ‘keeping the peace’. In order to meet the traditional Chinese cultural value of ‘maintaining harmony’, both family carers and professionals hid essential information from older stroke survivors who, as a consequence, were effectively precluded from playing an active role in major decisions. In understanding ‘hiding’, the paper draws upon both Chinese cultural values and ‘awareness context theory’ and in so doing questions the relevance to the Chinese context of key Western notions such as involvement in health-care decision-making. A better understanding of the experiences of decision-making processes between older people with stroke, their family carers and professionals in China will help professionals to provide the best possible support and care whilst promoting informed decision-making amongst all concerned.

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