Stories from the Operating Room: moral dilemmas for nurses

2002 ◽  
Vol 9 (4) ◽  
pp. 405-415 ◽  
Author(s):  
Aileen R Killen
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Ethics Education ◽  
Ethical Issues ◽  
Moral Dilemmas ◽  
Affected Patient ◽  
Perioperative Nurses ◽  
Moral Outcomes ◽  
Ethical Situation

This article explores stories related by perioperative nurses when asked to describe ethical judgements and subsequent actions that affected patient outcomes. A total of 214 patient care situations were analysed for moral actions taken and moral outcomes achieved in the perioperative arena. Content analysis of the patient care situations revealed a wide variety of ethical issues. Concerns about informed consent and quality of care were the most frequently identified issues. Respondents reported that 7% of patients underwent unwanted procedures and that positive moral outcomes were achieved in 65% of situations. It is of concern that, despite the fact that more than two-thirds (69%) of the respondents reported undergoing ethics education, only 27% could relate a story of an ethical situation.

Affordances and Constraints of Analog Games for Ethics Education

2016 ◽  
pp. 219-237
Author(s):  
Spencer P. Greenhalgh
Keyword(s):  
Educational Technology ◽  
Qualitative Study ◽  
Ethics Education ◽  
Ethical Issues ◽  
Digital Games ◽  
Moral Dilemmas ◽  
Educational Resources ◽  
Learning And Teaching ◽  
Wide Range

Today's students face a wide range of complex moral dilemmas, and games have the potential to represent these dilemmas, thereby supporting formal ethics education. The potential of digital games to contribute in this way is being increasingly recognized, but the author argues that those interested in the convergence of games, ethics, and education should more fully consider analog games (i.e., games without a digital component). This argument draws from a qualitative study that focused on the use of an analog roleplaying game in an undergraduate activity that explored ethical issues related to politics, society, and culture. The results of this study are examined through an educational technology lens, which suggests that games (like other educational resources) afford and constrain learning and teaching in certain ways. These results demonstrate that this game afforded and constrained ethics education in both ways similar to digital games and ways unique to analog games.

A Protocol for the Use of Amorphous Hydrogel to Support Wound Healing in Neonatal Patients: An Adjunct to Nursing Skin Care

2006 ◽  
Vol 25 (4) ◽  
pp. 267-273 ◽  
Author(s):  
Lorna Cisler-Cahill
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Quality Indicators ◽  
Patient Outcomes ◽  
Critical Difference ◽  
Skin Breakdown ◽  
Quality Of Patient Care ◽  
Skin Integrity ◽  
Primary Nurse

The care registered nurses offer makes a critical difference in the quality and cost-effectiveness of patient outcomes. The prevention and treatment of alterations in skin integrity remain primary nurse-sensitive quality indicators. Although wound prevention is a primary goal for nurses, iatrogenic wounds do occur. Neonatal patients are at greater risk for alterations in skin integrity because of the fragile nature of their skin. When skin breakdown occurs, nurses must have knowledge of effective treatment alternatives. The purpose of this article is to describe the use of a collaborative practice protocol to introduce and document patient outcomes with the use of amorphous hydrogel as a treatment modality for iatrogenic neonatal wounds. All hospitals collect data on the quality of patient care, and it has been known for some time that registered nurses can make a critical difference in the quality of patient care and the effectiveness of patient outcomes. The American Nurses Association has identified ten specific quality measures that are impacted by nursing care. Referred to as nurse-sensitive quality indicators, these measures include the maintenance of skin integrity.1

Abstract 242: Can Belief Enhance Relief? A Multicenter Study

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Abbas Alshami ◽  
America Avila ◽  
Carlos Romero ◽  
Raphael Villarreal ◽  
Sharon Einav ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Patient Care ◽  
Ethical Issues ◽  
Belief Systems ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Well Being ◽  
Physical Symptoms ◽  
Personal Beliefs

Purpose: While caring for patients, it is important to recognize more than just the apparent physical symptoms. Their emotional well-being, level of comfort, and spiritual concerns are relevant and should be taken into consideration. We aimed to identify if a greater commitment to spiritual belief systems by healthcare providers could have an effect on the patient care they provided. Methods: The Ethics in Intensive Care Study (ETHICS) was conducted in multiple centers all over the world utilizing a confidential survey. Questions were related to personal opinions on ethical issues, including personal beliefs, and patient care. We hypothesized that the personal beliefs of the healthcare providers should not affect the quality of care provided. Pearson’s correlation was used to ascertain statistical significance. Results: A total of 9,720 healthcare providers rated their level of spirituality from 1 (least) to 10 (greatest), and answered whether their beliefs affected their patient care. The majority of the people surveyed (65.6%; n=6,378) assessed themselves between 5 and 8 out of 10. In each individual level, most physicians felt patient care was not affected. However, on closer inspection and analysis, an interesting trend emerged. Only 11.4% (n=45) of those who rated themselves in level 1 of spirituality (n=394) stated their patient care was affected by their personal beliefs. Of people in level 5 (n=1,300), 13.3% (n=173) felt their beliefs affect the quality of care provided, and surprisingly, that number increased to 21.4% (n=193) among those healthcare provider rated in level 10 (n=899) [ p <0.001, Pearson’s R correlation 0.94]. Conclusions: A significant number of physicians identify themselves as religious, whether by belief in God, or based on a level of spirituality. We found a strong correlation between the level of spirituality a provider feels and the perception of how much his/her patient care is affected. We are not aware if this translates into real differences in patient care.

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 What is the effect of electronic clinical handovers on patient outcomes? A systematic review

2020 ◽  
Vol 26 (4) ◽  
pp. 2422-2434
Author(s):  
Belinda Delardes ◽  
Lisa McLeod ◽  
Samantha Chakraborty ◽  
Kelly-Ann Bowles
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
High Risk ◽  
Patient Care ◽  
Patient Outcomes ◽  
Healthcare Personnel ◽  
Risk Event ◽  
Event Rates ◽  
Communication Errors

Handover between physicians is a high-risk event for communication errors. Using electronic handover platforms has potential to improve the quality of informational transfer and therefore minimise this risk. This systematic review sought to compare the effectiveness of electronic handover methods on patient outcomes. Articles were identified by searching MEDLINE, EMbase, Scopus and CINAHL databases. Studies involving electronic handover between two healthcare personnel or teams, and which described patientspecific outcomes, were included. This search yielded 390 articles, with a total of nine publications included in the analysis. Outcomes reported in studies included length of stay, adverse event rates, time to procedure and handover completeness. This review suggests that e-handover may improve the handover completeness; however, it is unclear at this time if that translates to an improvement in patient care. The lack of reliable evidence highlights the need for further research exploring the effect of e-handovers on patient care.

Evaluating evidence and quality of care in the critical care unit

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Critical Care ◽  
Patient Outcomes ◽  
Continuous Improvement ◽  
Audit Quality ◽  
Ethical Issues ◽  
Scoring Systems ◽  
Critical Care Nurses ◽  
Treatment Withdrawal

Critical care nurses and the whole multidisciplinary team have a responsibility to ensure that they use the most appropriate treatments and care procedures, to continually evaluate the effectiveness and value of the interventions they perform and the care they give, and to aim for continuous improvement of their service. This chapter discusses how research should be applied in practice, key principles of audit, quality assurance and quality improvement, standard setting, illness severity scoring systems, and the prediction and measurement of patient outcomes. The challenges of managing long-term patients and ethical issues, such as treatment withdrawal, bereavement, and care of relatives, are also reviewed

Preventing Medication Prescribing Errors

DICP ◽  
1991 ◽  
Vol 25 (12) ◽  
pp. 1388-1394 ◽  
Author(s):  
Josephine A. Vitillo ◽  
Timothy S. Lesar
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Medication Errors ◽  
Prescribing Errors ◽  
Error Prevention ◽  
Prevention Services ◽  
Quality Of Patient Care ◽  
Physician Prescribing ◽  
Error Types

Medication errors may arise in the manufacture, preparation, distribution, and administration of drugs. Physician prescribing errors are of particular importance as such errors have been associated with significant adverse patient outcomes. The pharmacist plays an important role in preventing such errors from reaching the patient. The purpose of this article is to define and illustrate the various error types and the mental attitudes that cause individuals to prescribe errant orders. Through better understanding of the cause of prescribing errors, pharmacists may be able to improve the error prevention services they provide. Based on the error types discussed and their causes, recommendations are proposed to decrease the frequency of such errors and thereby improve the quality of patient care.

The Ethics of AI in Biomedical Research, Patient Care, and Public Health

2020 ◽  
pp. 702-718 ◽  
Author(s):  
Alessandro Blasimme ◽  
Effy Vayena
Keyword(s):  
Public Health ◽  
Patient Care ◽  
Biomedical Research ◽  
Disease Surveillance ◽  
Ethical Issues ◽  
Ethical Review ◽  
Ethical Challenges ◽  
Healthcare Provision ◽  
Social Scientists ◽  
Ethical Frameworks

This chapter explores ethical issues raised by the use of artificial intelligence (AI) in the domain of biomedical research, healthcare provision, and public health. The litany of ethical challenges that AI in medicine raises cannot be addressed sufficiently by current regulatory and ethical frameworks. The chapter then advances the systemic oversight approach as a governance blueprint, which is based on six principles offering guidance as to the desirable features of oversight structures and processes in the domain of data-intense biomedicine: adaptivity, flexibility, inclusiveness, reflexivity, responsiveness, and monitoring (AFIRRM). In the research domain, ethical review committees will have to incorporate reflexive assessment of the scientific and social merits of AI-driven research and, as a consequence, will have to open their ranks to new professional figures such as social scientists. In the domain of patient care, clinical validation is a crucial issue. Hospitals could equip themselves with “clinical AI oversight bodies” charged with the task of advising clinical administrators. Meanwhile, in the public health sphere, the new level of granularity enabled by AI in disease surveillance or health promotion will have to be negotiated at the level of targeted communities.

scholarly journals Randomized controlled study of the impact of a participatory patient care plan among primary care patients with common chronic diseases: a one-year follow-up study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Tusa ◽  
Hannu Kautiainen ◽  
Pia Elfving ◽  
Sanna Sinikallio ◽  
Pekka Mäntyselkä
Keyword(s):  
Quality Of Life ◽  
Patient Care ◽  
Usual Care ◽  
Care Plan ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Disease Specific

Abstract Backround Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension. Methods The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017–2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up. Results A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes. Conclusions During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline. Trial registration ClinicalTrials.gov Identifier: NCT02992431. Registered 14/12/2016

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