end of life decision
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2022 ◽  
Author(s):  
Ilse H. Zaal‐Schuller ◽  
Rosa Geurtzen ◽  
Dick L. Willems ◽  
Mirjam A. Vos ◽  
Marije Hogeveen

2021 ◽  
Vol 162 (51) ◽  
pp. 2047-2054

Összefoglaló. Bevezetés: A haldoklást minden korban kulturális és vallási szabályok vették körül, melyek a mai napig hatnak a társadalomban. A 21. században számos beteg a kórházban, az intenzív osztályon fejezi be életét, ahol nem ritkán kerülhet sor életvégi döntés meghozatalára. Célkitűzés: Vizsgálatunk célja annak feltárása volt, milyen hatással van az orvosok és ápolók vallásossága a kezeléskorlátozással kapcsolatos döntésekre az intenzív osztályon. Módszer: Magyarországi intenzív osztályokon dolgozó orvosok és szakdolgozók körében végeztünk kérdőíves felmérést a vallás életvégi döntésekre gyakorolt hatásáról. 189 orvos és 105 ápoló által anonim módon kitöltött kérdőívet elemeztünk. Eredmények: Az intenzív osztályra történő betegfelvételre nem volt hatással a vallásosság, azonban a szabad ágyak száma a vallásos orvosokat erősebben befolyásolta, mint az ateista és választ nem adó orvosokat (<0,0001). A vallásukat gyakorló orvosok szignifikánsan jobban figyelembe vették a hozzátartozó kérését, mint az ateisták (p = 0,0002). A vallásos ápolók gyakrabban folytatnák a beteg kezelését a hozzátartozó kérése ellenére is, ha még látnának esélyt a gyógyulásra, mint a nem vallásosak. Következtetés: Vizsgálatunk alátámasztotta, hogy a világnézet befolyásolja az orvosokat és ápolókat az élet végéről hozott döntésekben. A kezeléskorlátozásról hozott döntés összetett, elengedhetetlen megismerni hozzá a beteg és családjának haldoklással kapcsolatos vallási szokásait, mivel jó életvégi döntés a világnézeti szempontok figyelembevétele nélkül nem hozható. Orv Hetil. 2021; 162(51): 2047–2054. Summary. Introduction: Death has always been surrounded by habits in all ages, influenced by cultural and religious differences. Many patients finish their lives at intensive care units where end-of-life decisions are the part of everyday practice in the 21th century. Objective: The goal of our study was to assess how the religious beliefs of physicians and nurses affect their decision on therapy restriction. Method: We have performed questionnaire-based enquiries among physicians and nurses working at intensive care units on how religion affects end-of-life decisions. We have analyzed the anonymous questionnaires filled out by 189 physicians and 105 nurses. Results: Our results have confirmed the hypothesis that religion affects decision making about therapy restriction. Patients’ admissions were not affected by religious beliefs, but the number of available patient beds influenced the religious physicians more than the atheists ones or the non-responders (<0.0001). Actively religious physicians complied significantly better with the relatives than atheists (p = 0.0002). Religious nurses would continue patient treatment even against the will of relatives more often than atheists if they see a chance for recovery. Conclusion: The study supports that religion influences physicians and nurses in their end-of-life decisions. Decisions on therapy restriction are complex; it is important to find out religious beliefs and perception of death among patients and families because good end-of-life decision cannot be made disregarding religious considerations. Orv Hetil. 2021; 162(51): 2047–2054.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 327-328
Author(s):  
Sherry Greenberg ◽  
Nancy Innella ◽  
Bryan Pilkington

Abstract This presentation highlights the development, implementation, and results of an educational session with undergraduate nursing students about end-of-life decision making. The purpose of this qualitative thematic analysis study was to explore student perspectives of end-of-life decision making following an education session. The aims were to 1) develop themes from student feedback on end-of-life decision making and 2) refine educational strategies to teach end-of-life decision making to nursing students. The study was conducted with 72 junior level baccalaureate nursing students enrolled in an undergraduate gerontological nursing course. An interactive lecture was developed, following short philosophical ethics readings, which brought the students up to date on the history of end-of-life discussions, key cases, and different frameworks to approach a cluster of ethical issues associated with end-of-life care. A debate pedagogical model was employed as an engaging activity in which students directly applied recently learned concepts. In the debate activity, students were divided into two teams. Each team was assigned a position, which was a specific response to the case question: Should practitioners assist in their patient’s committing suicide? Should practitioners offer medical aid in dying? Each team conferred, presented their position, responded to the arguments or reasons from the opposing position. The session ended with a debrief by the course instructors. In the first semester, 31 nursing students completed four open-ended questions following the class. Results included increased student confidence discussing end-of-life issues and identification of two concepts commonly referred to in end-of-life care discussions and in bioethics, autonomy and dignity.


2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Arif Imam Hidayat ◽  
Waraporn Kongsuwan ◽  
Kittikorn Nilmanat ◽  
Adiratna Sekar Siwi ◽  
Galih Noor Alivian

<p class="paragraph" align="center">ABSTRACT</p><p class="paragraph"><strong>Objectives</strong>: This study examines the significance of Muslim nurses' lived experiences in the Intensive Care Unit (ICU) when it comes to End-of-Life (EOL) decisions (ICU)</p><p class="paragraph"><strong>Methods</strong>: The research was carried out at an intensive care unit (ICU) of a government hospital in Central Java, Indonesia. Fourteen nurses were chosen as participants after meeting the inclusion criteria: Muslims with at least three years of experience in the ICU and experienced to involved in end of life decision making process in an ICU. Data were gathered using in-depth interview. The result the transcribed and analyzed by using van Manen’s hermeneutic phenomenological approach. Trustworthiness was established following Lincoln and Guba's criteria.</p><p class="paragraph"><strong>Results: </strong>Four theme themes emerged from nurses' engagement in EOL decision-making. Feeling dilemma, being in uncertain time, receiving overwhelming role, and evading the process. Van Manen's four lived world of body, time, relation, and space are reflected in these subjects.</p><p class="paragraph"><strong>Conclusion</strong>: The purpose of this study was to illustrate the meaning of Muslim nurses' EOL decision-making in the ICU and to affect nursing policy addressing EOL decision-making education in ICU settings.</p>


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Tsung-Chien Lu ◽  
Eric H Chou ◽  
CHIH-HUNG WANG ◽  
Amir Mostafavi ◽  
Mario Tovar ◽  
...  

Introduction: There are only scarce models developed for stratifying the risk of cardiac arrest from COVID-19 patients presenting to the ED with suspected pneumonia. By using the machine learning (ML) approach, we aimed to develop and validate the ML models to predict in-hospital cardiac arrest (IHCA) in patients admitted from the ED. Hypothesis: We hypothesized that ML approach can serve as a valuable tool in identifying patients at risk of IHCA in a timely fashion. Methods: We included the COVID-19 patients admitted from the EDs of five hospitals in Texas between March and November 2020. All adult (≥ 18 years) patients were included if they had positive RT-PCR for SARS-CoV-2 and also received CXR examination for suspected pneumonia. Patients’ demographic, past medical history, vital signs at ED triage, CXR findings, and laboratory results were retrieved from the EMR system. The primary outcome (IHCA) was identified via a resuscitation code. Patients presented as OHCA or without any blood testing were excluded. Nonrandom splitting strategy based on different location was used to divide the dataset into the training (one urban and two suburban hospitals) and testing cohort (one urban and one suburban hospital) at around 2-to-1 ratio. Three supervised ML models were trained and performances were evaluated and compared with the National Early Warning Score (NEWS) by the area under the receiver operating characteristic curve (AUC). Results: We included 1,485 records for analysis. Of them, 190 (12.8%) developed IHCA. Of the constructed ML models, Random Forest outperformed the others with the best AUC result (0.930, 95% CI: 0.896-0.958), followed by Gradient Boosting (0.929, 95% CI: 0.891-0.959) and Extra Trees classifier (0.909, 95% CI: 0.875-0.943). All constructed ML models performed significantly better than by using the NEWS scoring system (AUC: 0.787, 95% CI: 0.725-0.840). The top six important features selected were age, oxygen saturation at triage, and lab data of APTT, lactic acid, and LDH. Conclusions: The ML approach showed excellent discriminatory performance to identify IHCA for patients with COVID-19 and suspected pneumonia. It has the potential to save more life or provide end-of-life decision making if successfully implemented in the EMR system.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hille Voss ◽  
April Loxton ◽  
Julie Anderson ◽  
Joanne Watson

Abstract Background Due to developments in health and social care, people with profound intellectual and multiple disability (PIMD) are living longer than ever before, meaning they are increasingly experiencing life-threatening health conditions requiring palliative care. Little is known about providing end-of-life care for people with PIMD. The aim of this study was to explore health practitioners’ perspectives and practices relating to end-of-life decision-making and planning for people with PIMD. Methods Seven in-depth semi-structured interviews were conducted with health practitioners employed in a range of hospital and community services throughout Melbourne, Australia. Questions were designed to gather information about their experience, perceptions, and attitudes relating to people with PIMD during and at the end of their life. Each interview, ranging from 40 to 60 min in length, was audio recorded and transcribed. Inductive thematic analysis was used to analyse the data. Results Four main themes emerged: limited participation, bias, dignity, and quality of death. Health practitioners indicated that people with PIMD are frequently excluded from participating in decision-making related to end-of-life care. Participants discussed reasons for this exclusion including challenges with communication and cognition. Participants reported a need for additional support and guidance in providing care for people with PIMD at the end of life. Professional and family bias played a role in end-of-life decision-making for people with PIMD. Participants reported a disproportional focus by palliative care practitioners on physical as opposed to emotional and spiritual well-being for patients with PIMD at the end of life. Finally, participants reported that people with PIMD generally did not die in specialised palliative care settings, but in segregated supported living environments. Conclusions Due to negative perceptions of a person with PIMD’s decision-making capacity, people with PIMD are likely to be assessed as unable to express choice and preference regarding end-of-life care and are offered limited opportunity to be involved in their own end-of-life care. This research provides guidance for the development of training and professional development relating to people with PIMD at the end of life. It is hoped that this will increase the accessibility of end-of-life services for people with PIMD, ensuring that a respectful and dignified death can be a reality for all humankind regardless of disability.


Author(s):  
Julie Benbenishty ◽  
Freda DeKeyser Ganz ◽  
Matthew H. Anstey ◽  
Francisco Jose Barbosa-Camacho ◽  
Maria Grazia Bocci ◽  
...  

2021 ◽  
Vol 83 (4) ◽  
pp. 1767-1773
Author(s):  
Heather Ma ◽  
Rachel E. Kiekhofer ◽  
Sarah M. Hooper ◽  
Sarah Dulaney ◽  
Katherine L. Possin ◽  
...  

Background: Advance care planning has been shown to improve end of life decision-making for people with dementia. However, the impact of goals of care conversations between people with dementia and their caregivers has not been characterized. Objective: In this study, we evaluate the association between goals of care conversations and advance care planning outcomes. Methods: Retrospective advance care planning measures were collected via a questionnaire administered to 166 caregivers after the death of the person with dementia for whom they provided care. Results: At time of death, the majority of decedents with dementia had advance directives, health care agents, and previous goals of care conversations with their caregiver. Goals of care conversations were significantly associated with the perceived usefulness of advance directives, the perceived adherence to advance directives, and decedent dying at their desired place of death, but not with disagreements around end-of-life care. Conclusion: Our findings suggest that goals of care conversations are an important component of advance care planning. These findings support the development of interventions that facilitate such conversations between people with dementia and their caregivers.


2021 ◽  
pp. 001139212110485
Author(s):  
Bernhard Weicht ◽  
Bernhard Forchtner

Autonomy and independence have become crucial elements of end-of-life decision making. Opinions on the latter are, however, strongly contested in public discourses. This contribution analyses arguments in favour of and against a Dutch civil society initiative which promotes the extension of the legislation on euthanasia. The authors investigate Dutch newspapers associated with three groups: religious, liberal and humanist perspectives, and do so by utilising quantitative and qualitative elements from a discourse-analytical perspective, raising the following questions: Which stances can be identified? How do different parties position themselves with regard to a ‘completed life’ and a ‘good death’? To what extent do these positions create demarcations between ‘us’ and ‘them’? The authors show that the debate developed along the lines of three key topoi: the topos of autonomy, the topos of human worth and the topos of embeddedness. The authors thereby identify how the different discursive positions define different visions of dying as ‘legitimate’ and as a proper end to a completed life.


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