Life-Sustaining Support: Ethical, Cultural, and Spiritual Conflicts Part II: Staff Support– A Neonatal Case Study

As medical knowledge and technology continue to increase, so will the ability to provide life-sustaining support to patients who otherwise would not survive. Along with these advances comes the responsibility of not only meeting the clinical needs of our patients, but also of understanding how the family’s culture and spirituality will affect their perception of the situation and their decision-making process. As the U.S. continues to become a more culturally diverse society, health care professionals will need to make changes in their practice to meet the psychosocial needs of their patients and respect their treatment decisions. Part I of this series (April 2002) discussed how the cultural and spiritual belief systems of Baby S’s family affected their decisionmaking processes and also their ability to cope with the impending death of their infant. The development of a culturally competent health care team can help bridge the gap between culturally diverse individuals.This article addresses the following questions:1. What legal alternatives are available to the staff to protect the patient from suffering associated with the continuation of futile life-sustaining support?2. What conflicts might the staff experience as a result of the continuation of futile life-sustaining support?3. What efforts can be made to support members of the staff?4. What can be done to prepare others in the health care professions to deal more effectively with ethical/cultural issues?

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Life-Sustaining Support: Ethical, Cultural, and Spiritual Conflicts Part I: Family Support— A Neonatal Case Study

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.21.3.23 ◽

2002 ◽

Vol 21 (3) ◽

pp. 23-29 ◽

Cited By ~ 9

Author(s):

Amy Stutts ◽

Johanna Schloemann

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Belief Systems ◽

Medical Knowledge ◽

Health Care Team ◽

Best Interest ◽

Ethical Commitment ◽

Spiritual Conflicts ◽

Decision Making Model

As medical knowledge and technology continue to increase, so will types of life-sustaining support as well as the public’s expectations for use of this support with positive outcomes. Health care professionals will continue to be challenged by the issues surrounding the appropriate use of life-sustaining support and the issues it raises. This is especially apparent in the NICU. When parents’ belief systems challenge the health care team’s ethical commitment to beneficence and nonmaleficence, a shared decision-making model based on mutual understanding of and respect for different viewpoints can redirect the focus onto the baby’s best interest. This article addresses three questions:1. How do nonmaleficence, beneficence, and concern about quality of life guide the use of life-sustaining support?2. To what extent should parental autonomy and spirituality influence treatment decisions?3. What efforts can the health care team make to support the family?

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Improving support for breastfeeding mothers: a qualitative study on the experiences of breastfeeding among mothers who reside in a deprived and culturally diverse community

International Journal for Equity in Health ◽

10.1186/s12939-021-01419-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Erica Jane Cook ◽

Faye Powell ◽

Nasreen Ali ◽

Catrin Penn-Jones ◽

Bertha Ochieng ◽

...

Keyword(s):

Health Care ◽

Focus Groups ◽

Health Care Professionals ◽

Culturally Diverse ◽

Local Community ◽

Framework Analysis ◽

Black African ◽

Early Stages ◽

Practical Support ◽

Diverse Community

Abstract Background The United Kingdom has one of the lowest breastfeeding rates in Europe, with the initiation and continuation of breastfeeding shown to be closely related to the mothers’ age, ethnicity and social class. Whilst the barriers that influence a woman’s decision to breastfeed are well documented, less is known how these barriers vary by the UK’s diverse population. As such, this study aimed to explore mothers’ experiences of breastfeeding and accessing breastfeeding services offered locally amongst a deprived and culturally diverse community. Methods A qualitative interpretive study comprising of 63 mothers (white British n = 8, Pakistani n = 13, Bangladeshi n = 10, black African n = 15 and Polish n = 17) who took part in single-sex focus groups, conducted in local community centres across the most deprived and ethnically diverse wards in Luton, UK. The focus groups were audio-recorded, transcribed and analysed thematically using Framework Analysis. Results The most common barriers to breastfeeding irrespective of ethnicity were perceptions surrounding pain and lack of milk. Confidence and motivation were found to be crucial facilitators of breastfeeding; whereby mothers felt that interventions should seek to reassure and support mothers not only during the early stages but throughout the breastfeeding journey. Mothers particularly valued the practical support provided by health care professions particularly surrounding positioning and attachment techniques. However, many mothers felt that the support from health care professionals was not always followed through. Conclusions The findings presented inform important recommendations for the design and implementation of future programs and interventions targeted at reducing breastfeeding inequalities. Interventions should focus on providing mothers practical support and reassurance not only during the early stages but throughout their breastfeeding journey. The findings also highlight the need for tailoring services to support diverse communities which acknowledge different traditional and familial practices.

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On Being a Physician

10.2310/neuro.1221 ◽

2015 ◽

Author(s):

Elizabeth G Nabel

Keyword(s):

Health Care ◽

Medical Education ◽

Lifelong Learning ◽

Communication Skills ◽

Medical Practice ◽

Medical Knowledge ◽

Health Care Team ◽

Medical Professionalism ◽

Standards Of Accreditation

The role of a physician as healer has grown more complex, and emphasis will increasingly be on patient and family-centric care. Physicians must provide compassionate, appropriate, and effective patient care by demonstrating competence in the attributes that are essential to successful medical practice. Beyond simply gaining medical knowledge, modern physicians embrace lifelong learning and need effective interpersonal and communication skills. Medical professionalism encompasses multiple attributes, and physicians are increasingly becoming part of a larger health care team. To ensure that physicians are trained in an environment that fosters innovation and alleviates administrative burdens, the Accreditation Council for Graduate Medical Education has recently revamped the standards of accreditation for today’s more than 130 specialties and subspecialties. This chapter contains 6 references and 5 MCQs.

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On Being a Physician

10.2310/im.1221 ◽

2013 ◽

Author(s):

Elizabeth G Nabel

Keyword(s):

Health Care ◽

Medical Education ◽

Lifelong Learning ◽

Communication Skills ◽

Medical Practice ◽

Medical Knowledge ◽

Health Care Team ◽

Medical Professionalism ◽

Standards Of Accreditation

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The South African traditional belief scale as an instrument to aid culture-congruent health care

Health SA Gesondheid ◽

10.4102/hsag.v10i4.205 ◽

2005 ◽

Vol 10 (4) ◽

pp. 29-40 ◽

Cited By ~ 1

Author(s):

Johann Beuster ◽

Gerhard Schwär

Keyword(s):

Health Care ◽

Effective Treatment ◽

South African ◽

Psychological Health ◽

Health Care Professionals ◽

Full Text ◽

Culturally Diverse ◽

Cultural Beliefs ◽

Traditional Belief ◽

Belief Scale

Medical and psychological health care professionals are becoming increasingly aware that effective treatment in culturally diverse societies requires sensitivity to the patient’s cultural beliefs and customs (Davidhizar & Giger, 2001:2; Foley & Wurmser, 2004:2; Hickson & Christie, 1989:162; Mkize, 2003:4; Narayanasamy, 2003:1). Opsomming Mediese en sielkundige gesondheidsorgberoepslui word toenemend daarvan bewus dat doeltreffende behandeling in kultureel diverse gemeenskappe sensitiwiteit teenoor die pasiënt se kulturele oortuigings en gebruike vereis (Davidhizar & Giger, 2001:2; Foley & Wurmser, 2004:2; Hickson & Christie, 1989:162; Mkize, 2003:4; Narayanasamy, 2003:1). *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

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Provider-patient communication about cost of care: Results from a national patient education program.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9578 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9578-9578 ◽

Cited By ~ 2

Author(s):

Ivy A. Ahmed ◽

Allison Harvey ◽

Marni Amsellem ◽

Thomas J. Smith

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Cancer Care ◽

Health Care Team ◽

Cost Of Care ◽

Care Team ◽

Cancer Support ◽

Support Organizations ◽

National Patient ◽

The Cost

9578 Background: A 2010 NIH study indicates direct cancer care expenditures will reach $158 billion in the U.S. by 2020, impacting millions of Americans. The cost of insurance for a family of 4 has increased from $6000 (2000) to over $16,000 (2011). Medical debt is a significant cause of personal bankruptcy, even if insured. The financial realities posed by costs associated with cancer care greatly complicate a cancer diagnosis. The most recent American College of Physicians Ethics Manual recommends all parties must interact honestly, openly, and fairly. (Snyder L, et al. Ann Int Med 2012, p86) This analysis explores the occurrence and value of patient-provider communication surrounding costs associated with care in a national survey of those affected by cancer. Methods: From 2011-12, 505 individuals attending Frankly Speaking About Cancer: Coping with the Cost of Care workshops completed a survey assessing experiences about the costs of cancer care. This is a Cancer Support Community national evidence-based educational program. All attendees (n=708) were eligible to complete survey. Results: Most attendees (71.3%) responded. The majority (62.4%) were people with cancer/survivors; the remainder included spouses/partners, family members, and 8.7% were health care professionals. Most (80.8%) were Caucasian, and averaged 57.2 years. Of those with cancer, 89.9% were insured at diagnosis. 59.4% reported no one on their health care team initiated a discussion about the financial aspects of their care. Included in this figure, 22.7% actively sought information from health care team, and 36.7% received no information about cost. When topic was initiated, it was by social workers (16.2%), physicians (12.3%), nurses (6.3%) or financial specialists (8.2%). When information was provided, 72.1% found it somewhat or very useful. Also, regardless of provider discussion, respondents independently sought resources for managing costs, such as other patients (44.2%), the Internet (41.5%), and patient support organizations (38.1%). Conclusions: Patients want financial information but do not receive it. These data highlight the need and value of providers initiating a dialogue about the cost of cancer care with patients.

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The Standardized Professional Encounter: A New Model to Assess Professionalism and Communication Skills

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00275.1 ◽

2015 ◽

Vol 7 (2) ◽

pp. 230-233 ◽

Cited By ~ 7

Author(s):

Scott D. Lifchez ◽

Carisa M. Cooney ◽

Richard J. Redett

Keyword(s):

Health Care ◽

Conflict Management ◽

Communication Skills ◽

Health Care Professionals ◽

Treatment Plan ◽

Health Care Team ◽

Standardized Patient ◽

Self Assessment ◽

Assessment Scores ◽

Patient Model

Abstract Background Physician-patient communication is vital to patient care, and physician-nurse interactions are equally critical. Conflict between nurses and physicians can greatly impair communication, increasing the risk of treatment errors, yet physicians receive little education during training on recognizing and resolving professional conflicts. Innovation We created and implemented the Standardized Professional (S-Pro) Encounter to improve training and provide opportunities to evaluate resident professionalism and communication with health care team colleagues. Methods The standardized patient model is well established for teaching and assessing clinical and communication skills. Using the standardized patient concept, we created a nurse-resident encounter with 2 professionally trained medical portrayers (1 “nurse,” 1 “patient”), in which the nurse disagrees with the resident's treatment plan. Residents were surveyed for prior experience with nurse-physician conflict management, and we assessed postencounter for collaborative skills and conflict resolution. Results All residents (n = 18) observed at least 1 physician-nurse conflict in front of patients. Eleven (61%) reported being involved in at least 1 conflict. Twelve residents (67%) had 2 or fewer prior education experiences in interprofessional conflict management. Faculty assessment and S-Pro scores demonstrated high agreement, while resident self-assessment scores demonstrated low agreement with faculty and S-Pro scores. Conclusions Participants and evaluators found the encounter to be reasonably authentic. There was strong agreement between the faculty and S-Pro assessment of resident performance when using the Boggs scale. The S-Pro Encounter is easily adapted for other clinical situations or training programs, and facilitates the assessment of professionalism and communication skills between residents and other health care professionals.

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The Excellence of Pharmacy Practice

INNOVATIONS in pharmacy ◽

10.24926/iip.v11i1.1662 ◽

2020 ◽

Vol 11 (1) ◽

pp. 3

Author(s):

AK Mohiuddin

Keyword(s):

Health Care ◽

Health Care Costs ◽

Health Care Professionals ◽

Medication Management ◽

Pharmacy Practice ◽

Health Care Team ◽

Care Needs ◽

Medication Therapy ◽

State Management ◽

Care Costs

Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs. Article Type: Review

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Exploring Strategies for Using Social Media to Self-Manage Health Care When Living With and Beyond Breast Cancer: In-Depth Qualitative Study (Preprint)

10.2196/preprints.16902 ◽

2019 ◽

Author(s):

Cathy Ure ◽

Anna Mary Cooper-Ryan ◽

Jenna Condie ◽

Adam Galpin

Keyword(s):

Breast Cancer ◽

Health Care ◽

Social Media ◽

Health Care Professionals ◽

Cancer Survival ◽

Management Strategies ◽

Survival Rates ◽

Self Management ◽

Health Providers ◽

Psychosocial Needs

BACKGROUND As breast cancer survival rates improve and structural health resources are increasingly being stretched, health providers require people living with and beyond breast cancer (LwBBC) to self-manage aspects of their care. OBJECTIVE This study aimed to explore how women use and experience social media to self-manage their psychosocial needs and support self-management across the breast cancer continuum. METHODS The experiences of 21 women (age range 27-64 years) were explored using an in-depth qualitative approach. The women varied in the duration of their experiences of LwBBC, which facilitated insights into how they evolve and change their self-management strategies over time. Semistructured interviews were analyzed inductively using a thematic analysis, a polytextual analysis, and voice-centered relational methods. RESULTS The use of multiple social media platforms, such as YouTube, Facebook, WhatsApp, and Twitter, enabled women to self-manage aspects of their care by satisfying needs for timely, relevant, and appropriate support, by navigating identities disrupted by diagnosis and treatment and by allowing them to (re)gain a sense of control. Women described extending their everyday use of multiple platforms to self-manage their care. However, women experienced social media as both empowering and dislocating, as their engagement was impacted by their everyday experiences of LwBBC. CONCLUSIONS Health care professionals (HCPs) need to be more aware, and open to the possibilities, of women using multiple social media resources as self-management tools. It is important for HCPs to initiate value-free discussions and create the space necessary for women to share how social media resources support a tailored and timely self-managed approach to their unique psychosocial needs.

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Psychosocial Challenges Faced by Female Health Care Professionals During the COVID-19 Outbreak in Lahore, Pakistan: A Qualitative Study

10.21203/rs.3.rs-116788/v1 ◽

2020 ◽

Author(s):

Sumbal Shahbaz ◽

Muhammad Zeshan Ashraf ◽

Rubeena Zakar ◽

Florian Fischer

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Qualitative Interviews ◽

Working Environment ◽

Cultural Issues ◽

Self Reflection ◽

Proper Training ◽

Phenomenological Methodology ◽

Psychosocial Challenges ◽

Novel Coronavirus

Abstract Background: The novel coronavirus disease (COVID-19) is disseminating rapidly, increasing stress and challenges for health care professionals around the world. This study aims to discover the psychosocial challenges faced by female health care professionals (HCPs) treating COVID-19 patients in Pakistan.Methods: Using an empirical phenomenological methodology, semi-structured telephone-based qualitative interviews were taken from 22 female HCPs who were providing their expertise for COVID-19 patients in tertiary level hospitals of Lahore, Pakistan. Purposive sampling has been used for recruitment. The interviews were taken from July 20 to August 20, 2020. The interviews were analysed using thematic analysis.Results: This study discovered the psychosocial challenges faced by female HCPs serving COVID-19 patients. Five themes have been observed in the interviews: psychological concerns of HCPs while treating COVID-19 patients; feelings towards COVID-19 patients; confidence in government, administration and self-reflection; challenges as female HCPs and coping strategies; and finally, future concerns and recommendations. Many of these themes have also been linked with cultural issues, making the results specific for Pakistan.Conclusions: During the COVID-19 pandemic, female front-line HCPs have faced immense psychosocial pressure, starting from unsupportive family norms to unwelcoming working environment and insensitive hospital administration. Moreover, rumours among general public, lack of proper training, missing incentives and improper system surveillance had increased the anxiety and stress among HCPs. Hence, legislators are advised to take appropriate actions countrywide in order to improve the still on-going challenges and to support female HCPs in their working environment.

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