The experiences of pediatric nurses caring for children in a persistent vegetative state*

Montagnino, Barbara A.; Ethier, Angela M.

doi:10.1097/01.pcc.0000282172.11035.a6

Cited by 19 publications

(38 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A few studies have revealed how caring for these patients can lead to conflicting emotions, and widely diverging views on their appropriate medical care 46,47 . Thus the challenge of clinical diagnosis clearly indicates the need for education and dissemination of more precise clinical scales.…”

Section: Diagnostic Accuracy and The Need For Professional And Publicmentioning

confidence: 99%

Observations on the Ethical and Social Aspects of Disorders of Consciousness

Racine

Rodrigue

Bernat

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

Disorders of consciousness such as coma, the vegetative state (VS), and the minimally conscious state (MCS) are neurological syndromes that disturb awareness or both wakefulness and awareness. Medical advances and neurotechnology have increased the probability of survival for patients suffering from severe neurological injury. Although coma rarely persists more than a few weeks, some patients remain in a VS or a MCS for years. The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. Our goals here are to update the principal controversies surrounding disorders of consciousness and to discuss how scientific developments and social factors have lead to changes in the ethical landscape of these disorders. ABSTRACT:The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration -which had been considered "settled" by many in the medical, legal and ethical communities -have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.RÉSUMÉ: Observations sur les aspects éthiques et sociaux des troubles de la conscience. La prise en charge de patients inconscients chronique soulève des questions médicales, éthiques et sociales qui sont éprouvantes en ce qui concerne le diagnostic, le pronostic, la communication avec les membres de la famille et les décisions à prendre, dont le retrait des mesures de maintien en vie. Nous faisons une mise à jour des grandes controverses concernant les troubles de la conscience. Les controverses telles le retrait de la nutrition artificielle et de l'hydratation -qui étaient considérées comme résolues par plusieurs membres des communautés médicale, légale et éthique -ont refait surface sous la pression de groupes sociaux et d'autorités religieuses. Certaines notions au sujet du niveau de conscience et du pronostic de l'état végétatif et les patients minimalement conscients, qui étaient tenues pour acquises, sont remises en question à cause des progrès dans les soins cliniques découlant des techniques de recherche en neurosciences, particulièrement de l'imagerie fonc...

show abstract

Section: Diagnostic Accuracy and The Need For Professional And Publicmentioning

confidence: 99%

Observations on the Ethical and Social Aspects of Disorders of Consciousness

Racine

Rodrigue

Bernat

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

show abstract

“…A similar conflict was noted by both Montagnino (2007) and Kirk (2007), although they identified this situation within the nurse / family member relationship. Concurring, Brazil et al (2010) identified this contributing factor as emerging from patient autonomy in decision making.…”

Section: Staffingmentioning

confidence: 91%

“…The literature further reveals being powerless towards the other in the given situation, notably powerlessness over treatment decision making (Ferrell, 2006;Krishnasamy, 1999;Laabs, 2007;Montagnino & Ethier, 2007;Nordam et al, 2005;Wilkinson, 1989). In the ward situation, amongst patients and peers, the nurse risks becoming callous and bitter (Meaney, 2002a); cynical (Ohnishi et al, 2010); exasperated (Krishnasamy, 1999) and demonstrating shock and dismay (Hanna, 2005).…”

Section: Towards Others ("I Would Act…")mentioning

confidence: 99%

“…This last opinion also resonates in the observation within the context of midwifery; that the specific elements contributing to moral distress develop from a combination of our personal value systems and the nature of enculturation to the workers role (Hanna, 2005;Tiedje, 2000;Wilkinson, 1989). Whilst the workplace culture then influences moral distress, so too does a person's own cultural background (Montagnino & Ethier, 2007;Yam, Rossiter, & Cheung, 2001).…”

Section: Individualmentioning

confidence: 99%

“…In addition, the nurse needs to be able to not only communicate ethical dilemmas in a language accessible to medical staff (Krishnasamy, 1999), but also have the capacity to make ethical decisions in ethically challenging situations if moral distress is to be avoided (Malloy et al, 2009). This capacity to make ethical decisions extends to include treatment decision making (Montagnino & Ethier, 2007) with a strength of character to manage different opinions about treatment options between staff and family members (Green & Jeffers, 2006). Nurses may at times be viewed as risk averse, with Tiedje (2000) suggesting that the courage to take additional risks may be "the greatest challenge in moving from moral distress to moral action"(p40).…”

Section: Individualmentioning

confidence: 99%

See 2 more Smart Citations