v Focus groups were completed as preliminary work to prepare for a formative evaluation project to design a palliative care program in adult intensive care units (ICUs). Twenty-two ICU staff nurses from the medical ICU (n = 10), surgical ICU (n = 6), and neuroscience ICU (n = 6) participated in focus groups to elucidate nurses' viewpoints of caring for critically ill and dying patients in ICUs. Five major themes were identified in the analysis: (1) helping the patient through, (2) telling bad news, (3) grieving as a process, (4) family as the patient, and (5) the dying patient's effect on the nurse. Nurses also identified how palliative care was currently being used in the ICU. Findings support the need to build strong collegial relationships between members of the healthcare team in order to effectively support communication about end-of-life decision making in the ICU setting.C ritical illness and death are common features of American hospitals. Most deaths in the United States occur in institutional settings. More than 58% of deaths occur in hospitals, and 20% occur in nursing homes. 1 Most people (59%) who die in hospitals
The COVID-19 pandemic caused by SARS-CoV-2 is unprecedented in modern history. Its effects on social behavior and health care delivery have been dramatic. The resultant burden of disease and critical illness has outpaced the diagnostic, therapeutic, and health care professional resources of many clinics and hospitals. It continues to do so globally. The allocation of hospital beds and ventilators, personal protective equipment, investigational therapeutics, and other scarce resources has required difficult decisions. Clinical and surgical practices which are standard in normal times may not be standard or safe during the COVID-19 crisis. How can we best adapt as physicians and surgeons? What foundational ethical principles and systems of principle application can help guide our decision-making? Fortunately, a large body of work in medical ethics addresses these questions. Unfortunately, many surgeons and other health care professionals are probably not as familiar with these concepts. This brief communication is intended to provide a concise explanation of ethical considerations which readers may find helpful when addressing allocation of scarce resources and alterations in surgical care brought on by the current pandemic.
Most current dental ethics curricula use a deontological approach to biomedical and dental ethics that emphasizes adherence to duties and principles as properties that determine whether an act is ethical. But the actual ethical orientation of students is typically unknown. The purpose of the current study was to determine the ethical orientation of dental students in resolving clinical ethical dilemmas. First-year students from one school were invited to participate in an electronic survey that included eight vignettes featuring ethical conflicts common to the health care setting. The Multidimensional Ethics Scale was used to evaluate the students' ethical judgments of these conflicts. Students rated each vignette along 13 ethically relevant items using a 7-point scale. Nine of the thirteen items were analyzed because they represent the dominant ethical theories, including deontology. One hundred sixteen dental students successfully completed the survey. Of the analyzed items, those associated with deontology had comparatively weak associations with whether students judged the action to be ethical and whether students judged themselves likely to perform the action. Whether an action was judged to be caring had the strongest association with whether the action was judged to be ethical and whether students judged themselves likely to perform the action. These results suggest that adherence to duties or principles has weaker association with students' ethical judgments and behavior compared to caring, which was found to be more influential in their ethical judgments and behavior. Current dental school curricula with a primary focus on deontology may not adequately prepare students to maintain ethical attitudes and behavior in practice.
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