Ethical Issues When Caring for a Pregnant Patient in the Intensive Care Unit

2020 ◽  
Vol 31 (4) ◽  
pp. 425-430
Author(s):  
Kayla Tabari ◽  
Melissa Kurtz Uveges ◽  
Aimee Milliken
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ethical Issues ◽  
Pregnant Patient

Heart Transplantation

PEDIATRICS ◽  
1987 ◽  
Vol 80 (4) ◽  
pp. 595-596
Author(s):  
F. JAY FRICKER ◽  
LARRY M. GOLD
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Transplantation ◽  
Ethical Issues ◽  
Inotropic Support ◽  
Orthotopic Heart Transplantation ◽  
The Political ◽  
Children's Hospital ◽  
Additional Information ◽  
Political Economic

In Reply.— The authors would like to thank Mr. Lantos for his comments. The political, economic, and ethical issues raised are important ones but obviously not the focus of our paper. We will, however, provide additional information in an attempt to answer some of Mr Lantos' questions. The question about what encouraged us to start is easy to answer. An 8-year-old child languishing in our intensive care unit on IV inotropic support with no hope of survival was the first orthotopic heart transplantation performed at Children's Hospital of Pittsburgh.

Neonatal nurse practitioner ethics knowledge and attitudes

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2247-2258
Author(s):  
Mobolaji Famuyide ◽  
Caroline Compretta ◽  
Melanie Ellis
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Neonatal Nurse Practitioners

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

scholarly journals The ethical concerns of seeking consent from critically ill, mechanically ventilated patients for research – A matter of possessing capacity or surrogate insight

2018 ◽  
Vol 13 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Avelino C Verceles ◽  
Waqas Bhatti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Informed Consent ◽  
Critically Ill ◽  
Ethical Issues ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ethical Concerns ◽  
Multiple Factors ◽  
Ventilated Patients

Conducting clinical research on subjects admitted to intensive care units is challenging, as they frequently lack the capacity to provide informed consent due to multiple factors including intensive care unit acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from mechanically ventilated, critically ill patients, in addition to the concerns that may arise when a legally authorized representative is asked to provide informed consent on behalf of these patients.

Ethical Issues in the Cardiac Intensive Care Unit

2019 ◽  
pp. 11-26.e3
Author(s):  
Michael S. O'Connor ◽  
Martin L. Smith ◽  
Timothy Gilligan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ethical Issues ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Resolving Communication Challenges in the Intensive Care Unit

2015 ◽  
Vol 26 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Marian Grant
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ethical Issues ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Patient Acuity ◽  
Good Communication ◽  
Practice Nurses ◽  
Difficult Conversations ◽  
Communication Challenges

Communication in the intensive care unit (ICU) is challenging because of complexity, high patient acuity, uncertainty, and ethical issues. Unfortunately, conflict is common, as several studies and reviews confirm. Three types of communication challenges are found in this setting: those within the ICU team, those between the ICU team and the patient or family, and those within the patient’s family. Although specific evidence-based interventions are available for each type of communication challenge, all hinge on clinicians being culturally competent, respectful, and good communicators/listeners. Critical care advanced practice nurses promote a positive team environment, increase patient satisfaction, and model good communication for other clinicians. All advanced practice nurses, however, also need to be adept at having difficult conversations, handling conflict, and providing basic palliative care, including emotional support.

scholarly journals Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sandra Malak ◽  
Jean-Jacques Sotto ◽  
Joël Ceccaldi ◽  
Philippe Colombat ◽  
Philippe Casassus ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Hematological Malignancies ◽  
Ethical Issues ◽  
Clinical Aspects ◽  
French Society ◽  
Initial Decision ◽  
Global Health Policy ◽  
Ethics Commission

Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice.

scholarly journals Death Cafés for prevention of burnout in intensive care unit employees: study protocol for a randomized controlled trial (STOPTHEBURN)

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marjorie E. Bateman ◽  
Rachel Hammer ◽  
Abigail Byrne ◽  
Nithya Ravindran ◽  
Jennifer Chiurco ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Randomized Controlled Trial ◽  
Intensive Care ◽  
Mental Health Problems ◽  
Ethical Issues ◽  
Controlled Trial ◽  
Maslach Burnout Inventory ◽  
Full Time ◽  
Innovative Strategy ◽  
Randomized Controlled

Abstract Background Burnout is an occupational syndrome that leads to mental health problems, job turnover, and patient safety events. Those caring for critically ill patients are especially susceptible due to high patient mortality, long hours, and regular encounters with trauma and ethical issues. Interventions to prevent burnout in this population are needed. Preliminary studies suggest debriefing sessions may reduce burnout. This study aims to assess whether participation in regular debriefing can prevent burnout in intensive care unit (ICU) clinicians. Methods A randomized controlled trial will be conducted in two large academic medical centers. Two hundred ICU clinicians will be recruited with target enrollment of 100 physicians and 100 non-physicians (nurses, pharmacists, therapists). Participants must have worked in the ICU for the equivalent of at least 1 full time work week in the preceding 4 weeks. Enrolled subjects will be randomized to virtually attend biweekly debriefing sessions facilitated by a psychotherapist for 3 months or to a control arm without sessions. Our debriefs are modeled after Death Cafés, which are informal discussions focusing on death, dying, loss, grief, and illness. These sessions allow for reflection on distressing events and offer community and collaboration among hospital employees outside of work. The primary outcome is clinician burnout as measured by the Maslach Burnout Inventory (MBI) Score. Secondary outcomes include depression and anxiety, as measured by the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7-item scale (GAD-7), respectively. Questionnaires will be administered prior to the intervention, at 1 month, at 3 months, and at 6 months after enrollment. These values will be compared between groups temporally. Qualitative feedback will also be collected and analyzed. Discussion With ICU clinician burnout rates exceeding 50%, Death Café debriefing sessions may prove to be an effective tool to avert this debilitating syndrome. With COVID-19 limiting social interactions and overloading ICUs worldwide, the virtual administration of the Death Café for ICU clinicians provides an innovative strategy to potentially mitigate burnout in this vulnerable population. Trial registration ClinicalTrials.gov NCT04347811. Registered on 15 April 2020

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