Fostering medical staff reflection on the technological alienation of parents in the NICU

2021 ◽  
pp. 147775092110618
Author(s):  
Abram Brummett ◽  
Annie B. Friedrich
Keyword(s):  
Medical Staff ◽  
Moral Distress ◽  
Ethical Issues ◽  
Treatment Refusal ◽  
Healthy Newborn ◽  
Incurable Condition ◽  
Life Sustaining Treatment ◽  
Terminal Diagnosis ◽  
The Relationship

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad.

scholarly journals The relationships between moral distress and quality of nursing care in oncology nurses

2020 ◽  
Vol 26 (4) ◽  
pp. 366-373
Author(s):  
Sae Mi Kim ◽  
Yong Soon Shin
Keyword(s):  
Nursing Care ◽  
Moral Distress ◽  
Correlation Study ◽  
Oncology Nursing ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Distress Scale ◽  
The Relationship ◽  
Quality Of Nursing

Purpose: The study aimed to investigate the relationship between moral distress and the quality of nursing care.Methods: This cross-sectional correlation study included nurses working at oncology nursing units of two secondary general hospitals in Seoul and Gyeonggi-do, Korea. A total of 207 nurses participated. Moral distress was measured by the Moral Distress Scale-Revised Nurse Questionnaire and quality of nursing care was evaluated by the Quality of Oncology Nursing Care Scale. Data were collected from October 5 to 31, 2018. Data analysis included descriptive statistics, independent t-test, ANOVA, Pearson’s correlation coefficient and multiple regression analysis.Results: The quality of oncology nursing care showed a negative correlation with moral distress (r=-.19, <i>p</i>=.007). The factors affecting the quality of oncology nursing care were religion (β=-.22, <i>p</i>=.001), clinical experience in oncology units (β=.27, <i>p</i>=.007), and moral distress (β=-.16, <i>p</i>=.018). Moral distress showed a statistically significant predictive power of 13% in the regression model (F=8.70, <i>p</i>=<.001).Conclusion: The findings of this study suggest that management of moral distress is important to increase the quality of oncology nursing care.

Moral distress and moral competences in midwifery: A latent variable approach

2018 ◽  
Vol 25 (13-14) ◽  
pp. 2340-2351 ◽  
Author(s):  
Stephan Oelhafen ◽  
Eva Cignacco
Keyword(s):  
Health Professionals ◽  
Latent Variable ◽  
Moral Distress ◽  
Ethical Issues ◽  
Negative Consequences ◽  
Variable Approach ◽  
Moral Competences ◽  
Latent Variable Approach ◽  
Impaired Quality

Like other health professionals, midwives need moral competences in order to cope effectively with ethical issues and to prevent moral distress and negative consequences such as fatigue or impaired quality of care. In this study, we developed and conducted a survey with 280 midwives or midwifery students assessing the burden associated with ethical issues, moral competences, and negative consequences of moral distress. Results show that ethical issues associated with asymmetries of power and authority most often lead to the experience of distress. The results are critically discussed in the context of the conceptualization and operationalization of moral distress.

Weekly Rounding With the MICU Team: Description of a Clinical Ethics Project

2018 ◽  
Vol 36 (4) ◽  
pp. 290-293 ◽  
Author(s):  
Elizabeth K. Vig
Keyword(s):  
Palliative Care ◽  
Moral Distress ◽  
Patient Goals ◽  
Project Description ◽  
Life Sustaining Treatment ◽  
Medical Intensive Care ◽  
Seriously Ill Patients ◽  
Attending Physicians ◽  
Seriously Ill

Context: Patients in medical intensive care units (MICUs) are medically complex. This complexity can lead to uncertainty about patient goals and prognosis. Ethical dilemmas arise when there is uncertainty about the clinically and ethically appropriate actions for managing seriously ill patients. Ethics and palliative care involvement may promote improved quality of care and reduced staff moral distress. Project Description: In this clinical project, a physician with ethics, palliative care, and geriatrics expertise attended morning rounds with the MICU team weekly. Data on the logistics and impact from the first 2 years of the project were collected. Project Logistics and Preliminary Impact: Rounds lasted approximately 1.75 hours per week. The rounder was present for discussion of approximately 200 patients per year and made comments on nearly half of the patients. The comments were categorized as 25% ethics, 40% palliative care, 10% geriatrics, and 25% a combination or other topic. Attending physicians rated the project as helpful. The number of ethics and palliative care consults from the MICU increased in the first 2 years. Downstream impact has included a dietician reviewing Physician Orders for Life Sustaining Treatment forms with teams throughout the hospital and routine review of advance directives of newly admitted patients. Discussion: Weekly MICU rounding provides an opportunity to briefly teach staff and trainees about relevant ethics, palliative care, and geriatrics issues. It also provides a forum for discussion of ethically challenging cases. Considerations when starting a similar program are discussed.

scholarly journals Ethical issues in stroke management

2020 ◽  
pp. 10.1212/CPJ.0000000000000925
Author(s):  
James L. Bernat ◽  
Timothy G. Lukovits
Keyword(s):  
Ethical Issues ◽  
Treatment Preference ◽  
Treatment Refusal ◽  
Surrogate Decision Maker ◽  
Stroke Management ◽  
Nonfluent Aphasia ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment ◽  
Surrogate Decision ◽  
Hemispheric Infarction

A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision-maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent aphasia may become an issue when he appears to understand but cannot communicate his treatment preference. Neurologists may be unsure whether to provide medical hydration and nutrition to an elderly patient admitted with a massive intracranial hemorrhage and incipient herniation whose advance directive states that life-sustaining treatment is to be withheld in the event of a hopeless prognosis. A patient with chronic locked-in syndrome from pontine infarction may order that further life-sustaining treatment be withdrawn but her neurologist may be unsure of the ethical adequacy of her treatment refusal because of communication limitations.

Ethical issues experienced by healthcare workers in nursing homes

2016 ◽  
Vol 23 (5) ◽  
pp. 490-506 ◽  
Author(s):  
Deborah HL Preshaw ◽  
Kevin Brazil ◽  
Dorry McLaughlin ◽  
Andrea Frolic
Keyword(s):  
Nursing Home ◽  
Healthcare Workers ◽  
Ethics Education ◽  
Moral Distress ◽  
Ethical Issues ◽  
Nursing Assistants ◽  
Care Providers ◽  
Moral Issues ◽  
Staff Burnout

Background: Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress. Objectives: The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs’ experiences of ethical issues. Methods: Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home. Findings: The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work. Conclusions: The review highlighted a need for improved ethics education for care-providers.

scholarly journals The biological encoding of design and the premises for a new generation of 'living' products : the example of Sinapsi.

2019 ◽  
pp. 116-139
Author(s):  
Sabrina Lucibello ◽  
Carmen Rotondi
Keyword(s):  
Ethical Issues ◽  
Track And Field ◽  
Smart Device ◽  
Disabled People ◽  
Smart Systems ◽  
Dependent Relationship ◽  
New Generation ◽  
The Relationship

The following article aims to briefly describe the long and intricate search path which led to the design of Sinapsi, a smart device inspired by nature, for helping blind people’s mobility and orientation in track and field. The description will be accompanied by an analysis of different solutions already developed for helping blind people and by multiple thoughts, theoretical and methodological, that aim to critically explain the renewed role of design, as well as to highlight the importance of biological reference in a complex world populated by artificial intelligence. In particular, we will show how inspiration from biological systems can be one of the most innovative and attainable methods, not just to incorporate biological characteristics into machines and artifacts (nothing particularly new, even in AI) but to use it in the design process of smart systems as an instrument for improving quality of life and to expand our best human qualities. In fact, the growing complexity derived from the AI systems’ increasing degrees of autonomy has raised issues concerning the relationship between the user and the intelligent entity, as well as important ethical issues that call into question the design and that can be overcome through inspiration from the logic and the principles governing the intimate intelligence of nature. Finally, the explanation becomes particularly interesting and deep when we talk about assistive devices for sensory disabled people, in which the co-dependent relationship between the user and the technology becomes stronger and in which the boundary between help and substitution, between enhancement and helplessness, risks fading.

scholarly journals Ethical Issues at the Beginning of Life

2021 ◽  
Vol 28 (4) ◽  
pp. 143-148
Author(s):  
In Gyu Song
Keyword(s):  
High Risk ◽  
Medical Staff ◽  
Ethical Issues ◽  
Medical Condition ◽  
Neonatal Resuscitation ◽  
Treatment Decision ◽  
Heart Association ◽  
Best Interest ◽  
Treatment Plans ◽  
Life Sustaining Treatment

With improvements in the survival rate of high-risk newborns, the need for ethical considerations is increasing. In the event of a conflict of opinion between the parents and the medical staff about the treatment decision, often there are concerns about who needs to make the decision that would be in the best interest of the baby. In this article, focusing on the guidelines for neonatal resuscitation revised in 2020, ethical issues that may arise before and soon after birth are reviewed. In addition, the considerations in determining the treatment direction for neonates with poor prognosis and the care required for babies and their families during the neonatal period have been investigated. Decisions about withholding or discontinuing neonatal resuscitation are often time-pressed since they are often made when labor is imminent or are needed shortly after the baby’s birth. The recommendations put forth by the American Heart Association in 2020 may be referred toward decision making. Since the medical condition of high-risk newborns also often change rapidly following admission, it becomes necessary to review the treatment goals periodically. Though principles suggested by the American Academy of Pediatrics regarding the treatment decision of high-risk newborns are available, in Korea, it is also essential to consider the country’s law while discussing life-sustaining treatment. Improving the patient's quality of life is equally important as deciding treatment plans and approaches for sustaining life. Toward this, it becomes necessary that the medical staff treating high-risk newborns be educated on palliative care and build a support system.

The Relationship Between Interoception and Metacognition

2016 ◽  
Vol 30 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Judith Meessen ◽  
Verena Mainz ◽  
Siegfried Gauggel ◽  
Eftychia Volz-Sidiropoulou ◽  
Stefan Sütterlin ◽  
...  
Keyword(s):  
Memory Performance ◽  
Memory Task ◽  
Demographic Characteristics ◽  
Metacognitive Awareness ◽  
Interoceptive Awareness ◽  
Future Research ◽  
Heartbeat Perception ◽  
Interoceptive Accuracy ◽  
The Relationship

Abstract. Recently, Garfinkel and Critchley (2013) proposed to distinguish between three facets of interoception: interoceptive sensibility, interoceptive accuracy, and interoceptive awareness. This pilot study investigated how these facets interrelate to each other and whether interoceptive awareness is related to the metacognitive awareness of memory performance. A sample of 24 healthy students completed a heartbeat perception task (HPT) and a memory task. Judgments of confidence were requested for each task. Participants filled in questionnaires assessing interoceptive sensibility, depression, anxiety, and socio-demographic characteristics. The three facets of interoception were found to be uncorrelated and interoceptive awareness was not related to metacognitive awareness of memory performance. Whereas memory performance was significantly related to metamemory awareness, interoceptive accuracy (HPT) and interoceptive awareness were not correlated. Results suggest that future research on interoception should assess all facets of interoception in order to capture the multifaceted quality of the construct.

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