scholarly journals Proposta di un percorso decisionale ed assistenziale per la sedazione palliativa

2013 ◽  
Vol 62 (1) ◽  
Author(s):  
Massimiliano Carassiti ◽  
Anna De Benedictis ◽  
Nunziata Comoretto ◽  
Bruno Vincenzi ◽  
Vittoradolfo Tambone
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Professionals ◽  
Cultural Context ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Clinical Work ◽  
University Hospital ◽  
Decision Making Process ◽  
Ethical Implications

Premessa: Nonostante una generale giustificabilità sul piano etico, la sedazione palliativa (SP) presenta ancora numerosi aspetti controversi che richiedono un ulteriore dibattito e chiarificazione. Dal punto di vista pratico, inoltre, si osserva una notevole variabilità per quanto riguarda la procedura clinica della SP e un confine tra la SP alla fine della vita e l’eutanasia involontaria sempre più sottile e incerto. Questa situazione rende particolarmente necessaria l’elaborazione di percorsi decisionali trasparenti, anche nella forma di linee-guida locali, che chiariscano le procedure e le implicazioni etiche della sedazione palliativa. Obiettivi: Lo scopo di questo lavoro è di presentare le principali caratteristiche del percorso decisionale e assistenziale per la SP elaborato presso il Policlinico Universitario “Campus Bio-Medico” di Roma. Metodi: L’elaborazione della proposta presentata è stata preceduta da uno studio, attraverso la somministrazione di questionari semistrutturati, sulle conoscenze del personale medico e infermieristico in merito alla SP e da uno studio retrospettivo sulle cartelle cliniche, per verificare le modalità di utilizzo della SP all’interno dell’ospedale. Risultati: Il percorso decisionale ed assistenziale elaborato considera non solo gli aspetti farmacologici, ma affronta con chiarezza anche le implicazioni etiche e legali della procedura di SP, e in particolare la comunicazione, la cura dei familiari e degli operatori sanitari, la possibilità di avvalersi della consulenza di etica clinica nei casi più complessi o nei quali è difficile raggiungere una decisione condivisa. Si sottolinea, inoltre, come l’applicazione di un percorso decisionale e assistenziale per la SP debba essere supportata da momenti formativi e di confronto attivo tra gli operatori sanitari, per favorire l’adeguata comprensione e il corretto utilizzo di tali strumenti operativi, ma anche per assicurare il rispetto della coscienza degli operatori sanitari coinvolti. Conclusioni: È raccomandabile che tutte le istituzioni sanitarie producano percorsi decisionali ed assistenziali per la SP, attenti non solo agli standard scientifici, ma anche alla sensibilità etica e culturale del contesto in cui verranno utilizzate. Percorsi decisionali ed assistenziali così strutturati forniscono non solo un orientamento operativo e formativo per l’agire clinico, ma costituiscono anche un doveroso strumento di trasparenza nei confronti dei pazienti, dei loro familiari, della stessa struttura sanitaria e di tutta la società. ---------- Background: Despite a general ethical basis for justification, palliative sedation (PS) still has many controversial aspects that require further discussion and clarification. From a practical standpoint, moreover, there is considerable variability in the clinical procedure and an increasingly uncertain boundary between PS and involuntary euthanasia. This situation makes it necessary to develop local guidelines to clarify the procedures and the ethical implications of PS. Purpose: The aim of this paper is to present the main features of the ethical and clinical decision-making process for PS developed at the University Hospital “Campus Bio-Medico”, in Rome. Methods: The development of the present proposal was preceded by a survey, through a questionnaire, on the knowledge of medical and nursing staff on PS, and a retrospective study on medical records, to see how PS is used inside the hospital. Results: The benefit of this decision-making process is that it considers the pharmacological aspects, but also clearly addresses the ethical and legal procedure of PS, communication, the care for family members and health workers, the possibility of taking advantage of a clinical ethics consultation in complex cases or where it is difficult to reach a joint decision. We also emphasize that the application of the decision-making process must be supported by training sessions and active confrontation, to promote proper understanding and correct use of the guidelines themselves, but also to ensure respect for the conscience of health care professionals who are involved in the procedures of PS. Conclusions: It is recommended that all health care institutions produce local guidelines for PS, attentive to scientific standards, but also sensitive to the ethical and cultural context in which they are used. Ethical and clinical guidelines provide not only a well-structured operational guidance and training for clinical work, but are also a necessary tool for transparency with regard to all society.

scholarly journals Understanding the perspectives of older adults and elderly regarding vaccination; a snapshot in four European countries

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Timen ◽  
R Eilers ◽  
S Lockhart ◽  
R Gavioli ◽  
S Paul ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Infectious Diseases ◽  
Health Care Professionals ◽  
Elderly Care ◽  
European Countries ◽  
Decision Making Process ◽  
Ageing Population ◽  
Syncytial Virus

Abstract Prevention of infectious diseases in elderly by immunization is a prerequisite to ensuring healthy ageing. However, in order for the vaccine programs to be effective, these need to be provided by health care professionals who have up-to-date knowledge and high motivation. Furthermore, the knowledge and attitudes towards vaccination in the targeted age groups needs to be fully understood. When focusing on the information provision, it is important to know from whom or which institution older adults and elderly would like to receive and in which form. In January 2019, an international project called the VITAL (The Vaccines and InfecTious diseases in the Ageing population) project was started, within the framework of IMI (Innovative Medicines Initiatives). One of the goals of the VITAL project is to develop strategies to educate and train health care professionals (HCPs) and to promote awareness among stakeholders involved in elderly care management. We briefly focus on the results of studies undertaken in four European countries (Italy, France, The Netherlands and Hungary), which reveal the perspective of older adults and elderly regarding influenza, pneumococcal, herpes zoster vaccination and respiratory syncytial virus (RSV) as well as generic characteristics of the vaccines and diseases. We will show how attitudes towards vaccination are represented in our study population and which determinants influence the decision-making process of accepting vaccination. Furthermore, we shall elaborate on how the decision-making process towards vaccination takes place and which additional information is needed. In the second part of the session, we shall invite the audience to reflect on the findings and identify the factors they consider most important for setting up a training and education programme on vaccination.

scholarly journals Health record systems that meet clinical needs

2012 ◽  
Author(s):  
Gabriella Negrini
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Patient Safety ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
Health Record ◽  
Record System ◽  
Health Records

Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

The Covert Administration of Medications: Legal and Ethical Complexities for Health Care Professionals

2017 ◽  
Vol 45 (2) ◽  
pp. 182-192 ◽  
Author(s):  
L. Martina Munden
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Professionals ◽  
Codes Of Ethics ◽  
Legal Framework ◽  
Decision Making Process ◽  
Legal Questions ◽  
Professional Codes ◽  
Professional Codes Of Ethics ◽  
The Right

The practice of covertly administering medications to patients without their consent is often discussed in the framework of legal questions around the right of patients to consent and refuse medical treatment. However, this practice also raises significant questions surrounding the professional duties and obligations of health care professionals as it relates to the decision-making process of whether to engage in the covert administration of medications. In this paper, I present an overview of the origin of those duties and obligations, and discuss how those duties and obligations when seen from different perspectives may either justify or prohibit the practice. Further, I discuss whether the duties and obligations of health care professionals as they are currently framed are suited to address the complexities of this issue both from the health care professional and patient perspectives. This analysis is conducted in the context of duties and obligations that arise from not only legal framework but also from the ethical requirements from professional codes of ethics.

Supporting the Decision Making of Children With Cancer: A Meta-synthesis

2020 ◽  
Vol 37 (6) ◽  
pp. 431-443
Author(s):  
Noyuri Yamaji ◽  
Maiko Suto ◽  
Yo Takemoto ◽  
Daichi Suzuki ◽  
Katharina da Silva Lopes ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Health Care Professionals ◽  
Data Sources ◽  
Future Research ◽  
Decision Making Process ◽  
Inclusion Criteria ◽  
Children With Cancer ◽  
Prisma Statement

Background: Recently, awareness of children’s decision making has increased in an effort to enhance palliative care. However, the conceptual framework for decision making among children with cancer remains unclear. Aims: We clarified the decision-making process of children with cancer regarding their care, treatment, and support from family and health care professionals, and identified their needs and preferences. Design: We used metaethnography to conduct a metasynthesis of relevant studies. Data sources: We searched PubMed, EMBASE, PsycINFO, MEDLINE, and CINAHL. This report was prepared in accordance with the PRISMA statement. Results: Of the 7,237 retrieved studies, 27 met our inclusion criteria. Four themes emerged that reflected the decision-making process of children with cancer: (a) facing changes brought about by a health threat, (b) preparing for action, (c) asserting one’s choice, and (d) internal and external influences. Conclusion: Children with cancer initially undergo a decision-making process. Respecting children’s preferences, values, and emotions may help build trusting relationships and promote their decision-making capability. Future research should focus on children’s emotions, cognition, development, and interactions with parents and health care professionals.

scholarly journals The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer–Analysis from a Systematic Review of Prospective Studies

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 301
Author(s):  
Alazne Belar ◽  
Maria Arantzamendi ◽  
Johan Menten ◽  
Sheila Payne ◽  
Jeroen Hasselaar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Prospective Studies ◽  
Health Care Professionals ◽  
Disease Process ◽  
Palliative Sedation ◽  
Clinical Aspects ◽  
Decision Making Process

Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. Conclusion. Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process.

scholarly journals Real time location systems: Is it big brother or a big opportunity for professional practice?

2020 ◽  
Vol 10 (11) ◽  
pp. 67
Author(s):  
Jacqueline Limoges ◽  
Sara Lankshear ◽  
Joseph Church
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Real Time ◽  
Professional Practice ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Location Systems

Purpose: Real Time Location Systems (RTLS) is an emerging health care technology with the potential to capture data that can be used to improve professional practice and patient outcomes. However, there is a paucity of literature in this area to guide health professionals and leaders in both the implementation and use of RTLS data. To address this gap in the literature, this qualitative study was designed to explore how staff perceive and experience RTLS, and how health care providers anticipate using RTLS data for professional practice and clinical decision making.Results: Interviews and focus groups were conducted with 31 health care professionals who work in a community hospital in Canada. There was variation between the participants in terms of the experience of being monitored, the intensity of emotions related to RTLS and being monitored, the degree to which RTLS influenced clinical decision making and reflection, and the perceptions of usefulness of RTLS data for  professional practice. Three key themes emerged from the data: (1) the experience of being monitored, (2) anticipating using the data and (3) claiming the data for professional practice.Conclusions: Supports are vital to the successful adoption of RTLS and to enable health care professionals to claim and use RTLS data for professional practice and clinical decision making. During the implementation and use of RTLS data, it is crucial to recognize that RTLS data only represent the time spent in a location, and not the professional or knowledge-based practice of health professionals. Further research is required to understand the leadership strategies to guide the use of RTLS data.

Industrial Conceptualization of Health Care Versus the Naturalistic Decision-Making Paradigm: Work as Imagined Versus Work as Done

2018 ◽  
Vol 12 (3) ◽  
pp. 222-226 ◽  
Author(s):  
Ken Catchpole ◽  
Myrtede Alfred
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Clinical Decision Support Systems ◽  
Clinical Work ◽  
Clinical Decision ◽  
Naturalistic Decision Making ◽  
Weak Part ◽  
Context Specific

Quality and safety concerns in health care over the past 20 years precipitated the need to move beyond the traditional view of health care as an artisanal process toward a sociotechnical systems view of performance. The adoption of industrial approaches placed a greater emphasis on standardization of processes and outcomes, often treating humans as the “weak” part of the system rather than valuing their role in holding together complex, opaque, and unpredictable clinical systems. Although some health care tasks can be modeled linearly, others are much more complex. Efforts to reduce variation in clinical reasoning through evidence-based practices have proven problematic by failing to provide a means for context-specific adaptation or to account for the complex and adaptive nature of clinical work. We argue that the current, highly empirical approach to clinical decision making reflects clinical reasoning “as imagined,” whereas the application of the naturalistic decision-making (NDM) paradigm can help reveal clinical reasoning “as done.” This approach will have benefits for improving the conditions for diagnosis; the design of acute, time-pressured clinical work; the identification of deteriorating patients; the development of clinical decision support systems; and many more clinical tasks. Health care seems ready to accept NDM approaches.

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