Background: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. Research question/aim: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in Botswana (referral, district, and primary). Ethical considerations: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained. Findings: Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved. Discussion: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff. Conclusion: Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment.
Like researchers, clinicians (i.e. nurses, physicians and other healthcare providers) face complex ethical issues in the delivery of patient care in Tanzania. However, there are few resources to aid those faced with making difficult ethical decisions in clinical practice. Healthcare practitioners must individually handle clinical ethics problems that arise within their respective clinics, hospitals or other settings, making decisions based on their own beliefs about what is morally right or wrong, when no ethics committee or ethics support system exists. This can lead to frustration, dissatisfaction and high turnover of the clinicians who are critical to the country's infrastructure and overall quality of healthcare. Healthcare ethics committees (HECs) are common within US hospital-based institutions, and assist clinicians, patients, families and others with difficult ethical problems that arise in patient care delivery. An analysis of data from 300 HEC chairpersons in the USA, for example, showed that the most successful functions reported by HEC members were patient, family, community and provider education and conflict mediation. [1] Additionally, the most frequent clinical issue that HEC chairpersons reported, and also the one best handled, was that of making end-of-life decisions (including 'do not resuscitate' , advance directives and withdrawing and withholding treatment), which remains a ubiquitous issue in many healthcare institutions. In their survey of 600 US general hospitals, Fox et al. [2] also identified reported goals of ethics consultations as intervening to protect patients' rights, addressing conflicts, discussing ethical issues with staff and providing moral support as needed, among other issues. Moreover, in a randomised trial of 551 patient cases in the USA in 2001, the majority (87%) of healthcare professionals, patients and families claimed that ethics consultations in the intensive care unit (ICU) were beneficial in alleviating conflict, and perceived as facilitative. [3] The majority of patients and surrogates also indicated that they would seek an ethics consultation again, and recommend it to others. This same study investigated the effects of ethics committees on duration of stay in the ICU, and on prolonged non-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
BackgroundPatients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community.ObjectiveTo assess practices and challenges of diabetic patients and healthcare providers’ participation in shared decision making at Muhimbili National Hospital in Dar es Salaam.MethodsThis study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili national hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software.ResultsThe study found that most participants participate in shared decision making. Few patients indicated partial participation in shared decision making. Decision aids were found important for execution of shared decision making but they are scarce. Likewise, the study found that beliefs and values, time and education level are barriers to shared decision making.ConclusionAlthough this study indicated that shared decision making is practiced at Muhimbili national hospital, further search in this area is needed to be done in other hospitals.
Like researchers, clinicians (i.e. nurses, physicians and other healthcare providers) face complex ethical issues in the delivery of patient care in Tanzania. However, there are few resources to aid those faced with making difficult ethical decisions in clinical practice. Healthcare practitioners must individually handle clinical ethics problems that arise within their respective clinics, hospitals or other settings, making decisions based on their own beliefs about what is morally right or wrong, when no ethics committee or ethics support system exists. This can lead to frustration, dissatisfaction and high turnover of the clinicians who are critical to the country's infrastructure and overall quality of healthcare. Healthcare ethics committees (HECs) are common within US hospital-based institutions, and assist clinicians, patients, families and others with difficult ethical problems that arise in patient care delivery. An analysis of data from 300 HEC chairpersons in the USA, for example, showed that the most successful functions reported by HEC members were patient, family, community and provider education and conflict mediation. [1] Additionally, the most frequent clinical issue that HEC chairpersons reported, and also the one best handled, was that of making end-of-life decisions (including 'do not resuscitate' , advance directives and withdrawing and withholding treatment), which remains a ubiquitous issue in many healthcare institutions. In their survey of 600 US general hospitals, Fox et al. [2] also identified reported goals of ethics consultations as intervening to protect patients' rights, addressing conflicts, discussing ethical issues with staff and providing moral support as needed, among other issues. Moreover, in a randomised trial of 551 patient cases in the USA in 2001, the majority (87%) of healthcare professionals, patients and families claimed that ethics consultations in the intensive care unit (ICU) were beneficial in alleviating conflict, and perceived as facilitative. [3] The majority of patients and surrogates also indicated that they would seek an ethics consultation again, and recommend it to others. This same study investigated the effects of ethics committees on duration of stay in the ICU, and on prolonged non-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making. Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.
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