scholarly journals A REVIEW ON DECISION PROTOCOL AND FATWA IN MALAYSIA DISCUSSING ISSUE OF WITHHOLDING AND WITHDRAWAL OF LIFE-SUSTAINING TREATMENT IN INTENSIVE CARE UNIT

2021 ◽  
Vol 9 (2) ◽  
pp. 1-18
Author(s):  
Muhamad Rafiqi Hehsan ◽  
Wan Fadzlina Wan Muhd Shukeri
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Treatment Withdrawal ◽  
Decision Making Process ◽  
Final Decision ◽  
The Family ◽  
Life Sustaining Treatment ◽  
The Relationship

Withholding and withdrawal of life-sustaining treatments is one of the hot topics discussing in intensive care unit as most of the death occurs as a result of it. This point of transition from active intervention to the palliation process required a crucial decision-making process. The decision conveys information to families to be well prepared beforehand especially during the process of withdrawing life-sustaining treatment. Once the final decision to withdraw the treatment has been made, procedure of cessation of care, treatment withdrawal and nature of follow-up support will be informed to the family members. This article aims to explore the relationship between decision in withholding and withdrawal of life-sustaining treatment based on Malaysian intensive care unit protocol and the related fatwa in Malaysia. The methodology chosen for this study is content analysis of the relevant published literatures. This study reveals the decision for withholding and withdrawal life sustaining treatment in intensive care unit has correlation between the protocol and related fatwa in Malaysia.

Clinicians’ moral distress and family satisfaction in the intensive care unit

2018 ◽  
Vol 25 (12) ◽  
pp. 1894-1904 ◽  
Author(s):  
Giulia Lamiani ◽  
Matteo Ciconali ◽  
Piergiorgio Argentero ◽  
Elena Vegni
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Emotional Support ◽  
Moral Distress ◽  
Family Satisfaction ◽  
Satisfaction With Care ◽  
Decision Making Process ◽  
The Family ◽  
Distress Scale ◽  
The Relationship

This study explored the relationship between clinicians’ moral distress and family satisfaction with care in five intensive care units in Italy. A total of 122 clinicians (45 physicians and 77 nurses) and 59 family members completed the Italian Moral Distress Scale-Revised and the Family Satisfaction in the ICU questionnaire, respectively. Clinicians’ moral distress inversely correlated with family satisfaction related to the inclusion in the decision-making process. Specifically, physicians’ moral distress inversely correlated with satisfaction regarding the respect shown toward the patient. Nurses’ moral distress inversely correlated with satisfaction regarding breathlessness and agitation management, provision of emotional support, understanding of information, and inclusion in the decision-making process.

Half the family members of intensive care unit patients do not want to share in the decision-making process: A study in 78 French intensive care units*

2004 ◽  
Vol 32 (9) ◽  
pp. 1832-1838 ◽  
Author(s):  
Élie Azoulay ◽  
Frédéric Pochard ◽  
Sylvie Chevret ◽  
Christophe Adrie ◽  
Djilali Annane ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Family Members ◽  
Decision Making Process ◽  
The Family

Sense of responsibility in ICU end-of-life decision-making: Relatives’ experiences

2017 ◽  
Vol 26 (1) ◽  
pp. 270-279 ◽  
Author(s):  
Ranveig Lind
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Secondary Analysis ◽  
Active Role ◽  
Decision Making Process ◽  
Science Data ◽  
End Of Life Decision ◽  
Life Decision

Background: Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the situation. Research objectives: To examine and describe relatives’ experiences of responsibility in the intensive care unit decision-making process. Research design: A secondary analysis of interviews with bereaved relatives of intensive care unit patients was performed, using a narrative analytical approach. Participants and research context: In all, 27 relatives of 21 deceased intensive care unit patients were interviewed about their experiences from the end-of-life decision-making process. Most interviews took place in the participants’ homes, 3–12 months after the patient’s death. Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services and by the Regional Committee for Medical and Health Research Ethics. Findings: The results show that intensive care unit relatives experienced a sense of responsibility in the decision-making process, independently of clinicians’ intention of sparing them. Some found this troublesome. Three different variants of participation were revealed, ranging from paternalism to a more active role for relatives. Discussion: For the study participants, the sense of responsibility reflects the fact that ethics and responsibility are grounded in the individual’s relationship to other people. Relatives need to be included in a continuous dialogue over time to understand decisions and responsibility. Conclusion: Nurses and physicians should acknowledge and address relatives’ sense of responsibility, include them in regular dialogue and help them separate their responsibility from that of the clinicians.

scholarly journals Conflict in the intensive care unit: Nursing advocacy and surgical agency

2016 ◽  
Vol 25 (1) ◽  
pp. 69-79 ◽  
Author(s):  
Kristen E Pecanac ◽  
Margaret L Schwarze
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Personal Responsibility ◽  
Well Being ◽  
Ethical Review ◽  
Best Interest ◽  
Team Conflict ◽  
Nursing Advocacy ◽  
Life Sustaining Treatment

Background: Nurses and surgeons may experience intra-team conflict during decision making about the use of postoperative life-sustaining treatment in the intensive care unit due to their perceptions of professional roles and responsibilities. Nurses have a sense of advocacy—a responsibility to support the patient’s best interest; surgeons have a sense of agency—a responsibility to keep the patient alive. Objectives: The objectives were to (1) describe the discourse surrounding the responsibilities of nurses and surgeons, as “advocates” and “agents,” and (2) apply these findings to determine how differences in role responsibilities could foster conflict during decision making about postoperative life-sustaining treatment in the intensive care unit. Research design: Articles, books, and professional documents were explored to obtain descriptions of nurses’ and surgeons’ responsibilities to their patients. Using discourse analysis, responsibilities were grouped into themes and then compared for potential for conflict. Ethical considerations: No data were collected from human participants and ethical review was not required. The texts were analyzed by a surgeon and a nurse to minimize profession-centric biases. Findings: Four themes in nursing discourse were identified: responsibility to support patient autonomy regarding treatment decisions, responsibility to protect the patient from the physician, responsibility to act as an intermediary between the physician and the patient, and the responsibility to support the well-being of the patient. Three themes in surgery discourse were identified personal responsibility for the patient’s outcome, commitment to patient survival, and the responsibility to prevent harm to the patient from surgery. Discussion: These responsibilities may contribute to conflict because each profession is working toward different goals and each believes they know what is best for the patient. It is not clear from the existing literature that either profession understands each other’s responsibilities. Conclusion: Interventions that improve understanding of each profession’s responsibilities may be helpful to reduce intra-team conflict in the intensive care unit.

Family involvement in the end-of-life decisions of competent intensive care patients

2012 ◽  
Vol 20 (1) ◽  
pp. 61-71 ◽  
Author(s):  
Ranveig Lind ◽  
Per Nortvedt ◽  
Geir Lorem ◽  
Olav Hevrøy
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Family Involvement ◽  
Decision Making Process ◽  
Primary Role ◽  
Her Family ◽  
Intensive Care Patients ◽  
The Family ◽  
End Of Life Decision

In this article, we report the findings from a qualitative study that explored how relatives of terminally ill, alert and competent intensive care patients perceived their involvement in the end-of-life decision-making process. Eleven family members of six deceased patients were interviewed. Our findings reveal that relatives narrate about a strong intertwinement with the patient. They experienced the patients’ personal individuality as a fragile achievement. Therefore, they viewed their presence as crucial with their primary role to support and protect the patient, thereby safeguarding his values and interests. However, their inclusion in decision making varied from active participation in the decision-making process to acceptance of the physicians’ decision or just receiving information. We conclude that models of informed shared decision making should be utilised and optimised in intensive care, where nurses and physicians work with both the patient and his or her family and regard the family as partners in the process.

Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission

2006 ◽  
Vol 32 (7) ◽  
pp. 1045-1051 ◽  
Author(s):  
Maité Garrouste-Orgeas ◽  
Jean-François Timsit ◽  
Luc Montuclard ◽  
Alain Colvez ◽  
Olivier Gattolliat ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Decision Making Process

scholarly journals Ultrasound Monitoring of Umbilical Catheters in the Neonatal Intensive Care Unit—A Prospective Observational Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Alina Sobczak ◽  
Aleksandra Dudzik ◽  
Piotr Kruczek ◽  
Przemko Kwinta
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Observational Study ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Prospective Observational Study ◽  
Central Line ◽  
Decision Making Process ◽  
Umbilical Catheters

Introduction: Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. The aim of our study was to determine whether the repeated ultrasound scanning can influence the catheterization time, prevent some of the catheter-related complications, support the decision-making process and allow prolonged catheterization in patients without an alternative central access route.Methods: A prospective observational study was performed in a tertiary neonatal intensive care unit. A total of 129 patients and 194 umbilical catheters (119 venous and 75 arterial) were analyzed with a total of 954 scans. Ultrasound screening consisted of 1) assessing the catheter tip, location, movability, and surface and 2) analyzing the catheter trajectory. The outcome variables were defined as 1) catheter dislocation and 2) associated thrombosis.Results: Dislocation of catheter throughout the whole catheterization period was observed in 68% (81/119) of UVCs and 23% (17/75) of UACs. Thrombotic complications were observed in 34.5% (41/119) of UVCs and 12% (9/75) of UACs. 1/3 of UAC-associated thrombi were visible only after catheter removal. 51% (61/119) of UVC patients and 8% (6/75) of UAC patients made a clinical decision regarding the obtained catheter image.Conclusion: Bedside ultrasound imaging of catheters supports the decision-making process related to the catheterization duration, shortening the time if abnormalities are detected and allowing a safer prolonged UC stay when an alternative central line cannot be inserted.

INFORMED CONSENT

PEDIATRICS ◽  
1982 ◽  
Vol 70 (4) ◽  
pp. 556-556
Author(s):  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Informed Consent ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Newborn Baby ◽  
Maximum Extent ◽  
The Family ◽  
Do So

Let us address ourselves to the problem of informed consent. I believe, as a physician who has had prior contact with the family, that I can persuade 99% of parents to my way of thinking if I really work at it, even if I am 100% wrong. If I tell them in such a way that I appear concerned and that I am knowledgeable and that I have their interests at heart and the interest of their foetus or their newborn baby, there is no question they will be totally agreeable to my suggestion. I think informed consent is an absolute farce, legalistically, morally and ethically. The information is what I want it to be. Certainly, the physician must try to involve the parents in decision making. He should do so to the maximum extent feasible, but we are fooling ourselves if we believe that the parent or the physician can make all the decisions.—Director of a Neonatal Intensive Care Unit.

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