Conflicts between healthcare professionals and families of a multi-ethnic patient population during critical care: an ethnographic study

Keer, Rose-Lima Van; Deschepper, Reginald; Francké, Anneke L.; Huyghens, Luc; Bilsen, Johan

doi:10.1186/s13054-015-1158-4

Cited by 66 publications

(85 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The organisation of daily meetings is now an integral component of good clinical practice (34) and is associated with less frequent conflict (35), particularly when patients and families are of different ethnic backgrounds (36). The exact modalities of such meetings remain to be defined within each individual ICU.…”

Section: How Is the Collegial Process Initiated?mentioning

confidence: 99%

What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

View full text Add to dashboard Cite

The decision to limit or withdraw life-support treatment is an integral part of the job of a physician working in the intensive care unit, and of the approach to care. However, this decision is influenced by a number of factors. It is widely accepted that a medical decision that will ultimate lead to end-of-life in the intensive care unit (ICU) must be shared between all those involved in the care process, and should give precedence to the patient's wishes (either directly expressed by the patient or in written form, such as advance directives), and taking into account the opinion of the patient's family, including the surrogate if the patient is no longer capable of expressing themselves. A number of questions still remain unanswered regarding how decisions to limit or withdraw treatment are taken in daily practice, especially when this decision can be anticipated. We discuss here the collegial procedure for decision-making, in particular in the context of recent French legislation on end-of-life issues. We describe how collegial decision-making procedures should be carried out, and what points are covered in shared discussions regarding decisions to limit or withdraw life-sustaining therapies.

show abstract

Section: How Is the Collegial Process Initiated?mentioning

confidence: 99%

What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

View full text Add to dashboard Cite

show abstract

“…This has led to improved transparency, thereby reducing the risk of individual decisions that would burden a single ICU physician with moral weight that is too heavy to bear due to the risk of making the wrong decision [see article by JP Quenot on collegial decision making in this issue (3)]. Conflicts within the ICU, either between healthcare workers, or between the healthcare team and the patient or family, often stem from poor, not to say absent communication (16,17). The time devoted to communication, to explain care procedures, prognosis and likely outcome, probably represents a much larger proportion than the time allocated to actual therapeutic care, which is shared out between the different healthcare professionals in the unit.…”

Section: Ethical Questions During the Icu Staymentioning

confidence: 99%

What are the ethical dimensions in the profession of intensive care specialist?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

View full text Add to dashboard Cite

Two essential components of the profession of a medical doctor are the constant review of the patient's therapeutic project, and collaboration between healthcare professionals. The profession of intensive care unit (ICU) physician goes further in terms of responsibility, vis-à-vis the intensive treatments dispensed to the patients, and the physician's responsibilities towards the patient's family and the caregiving team, also bearing in mind that ICU care is costly in terms of human and financial resources. In this review, we address the profession of ICU physician from the perspective of the ethical questions that arise constantly, focusing on the timeframe of the reflection process. Firstly, admission to the ICU must be anticipated. The concept of advance care planning is a suitable tool for this, and in case of non-admission to the ICU, does not by any means constitute an abandonment of the patient, because palliative care can also be anticipated, with a view to avoiding suffering for the patient and their family. Next, during an ICU stay, while the technical aspects undoubtedly characterise the ICU best at the start of the patient's stay, the process of reflection rapidly becomes preponderant, and involves the analysis of often complex situations with a view to defining the level of therapeutic engagement and optimizing the care dispensed to the patient. Last, a further ethical issue concerns the decision to re-admit (or not) a patient to the ICU. This decision can be made, for example, in the framework of a systematic, formalised, structured, multidisciplinary meeting at the end of an ICU stay, using a similar procedure to that implemented for decisions relating to withholding or withdrawal of lifesustaining therapies. The profession of ICU physician is not simply a question of prolonging or sustaining life, but is also fraught with ethical questions about how best to employ their competences. In this regard, it is essential to foster interdisciplinary collaboration, and emphasise the need for ICU physicians to be involved in the development of therapeutic projects, particularly when the disease in question is likely to be complicated by acute situations that may require admission of the patient to the ICU.

show abstract

“…The existing literature focuses primarily on the problem of nursephysician conflict, and nurse-family conflict, and emphasizes coping mechanisms for nurses rather than improving patient care [11,15]. Several Studies conducted in other countries e.g.…”

Section: Problem Statementmentioning

confidence: 99%

Sociodemographic Factors Influencing the Experience of Ethical Dilemmas Among Nurses in Critical Care Unit of Kenyatta National Hospital

Mutinda¹

2017

AJNS

View full text Add to dashboard Cite

Abstract:Ethical issues have emerged in the recent years as a major component of health care for the critically ill patients, who are vulnerable and totally depend on nurse working in the critical care unit. The perception and magnitude of ethical dilemmas faced by nurses working in critical care unit of Kenyatta National Hospital (KNH) as well as the sociodemographic factors influencing this experience had not been determined. This exploratory survey was conducted on 123 nurses working in three critical care areas of the Kenyatta National Hospital. The research aimed to identify the ethical dilemmas by nurses working in Critical Care Units of the Kenyatta National Hospital in their everyday practice and the socio-demographic factors influencing the experience. Personnel records showed the nurses had varying socio-demographic characteristics which were found to influence the experience of dilemmas. Data were collected using questionnaires which were distributed to the123 nurses working in the critical care areas. The participants were selected using stratified random sampling method. Data was cleaned and analyzed using SPSS. Chi square test was used to assess the relationship between variables. The following were identified as the emerging ethical issues: end-of-life decisions (prolonging the dying process, withholding treatment, DNR orders and patients' religious values), Patient care issues (unsafe nurse-patient ratios, allocation of scarce medical resources, breaches of patients' privacy, ignoring patients' autonomy, dealing with incompetent colleagues, discriminatory treatment of patients, patient/ relatives uninformed about the patient's prognosis) and human rights issues (advance directives, informed consent, rights of pediatric patients and nursing of critically ill patients posing a risk to nurses). Various factors have been attributed to influencing the way one perceives ethical dilemmas. These include knowledge, age and gender among others. The study focused on the socio-demographic factors that significantly affected the experience of ethical dilemmas which included: age, professional qualification and level of knowledge of ethical issues. In conclusion this study shows that ethical dilemmas are an issue of concern among the nurses working in the critical care units of the KNH. The experience of ethical dilemmas is influenced by various socio-demographic factors.Keywords: Ethical Dilemmas, Critical Care Areas, Critical Care Nursing, Socio-demographic Factors BackgroundNurses are the largest group of healthcare providers serving in all the facilities providing health services. In Kenya they form 80% of the workforce as depicted in the Kenya national workforce and training analysis data (16). Nurses are deployed in nearly all the departments in the health care institutions to include the critical care units where they face various issues and are required to make decisions pertaining to patient care.Contemporary studies done in developed countries have consistently demonstrated that nurses working in cri...

show abstract

Conflicts between healthcare professionals and families of a multi-ethnic patient population during critical care: an ethnographic study

Cited by 66 publications

References 33 publications

What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care?

What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care?

What are the ethical dimensions in the profession of intensive care specialist?

Sociodemographic Factors Influencing the Experience of Ethical Dilemmas Among Nurses in Critical Care Unit of Kenyatta National Hospital

Contact Info

Product

Resources

About