RESUMO
BACKGROUND:: Whistle-blowing is an ethical activity that tries to end wrongdoing. Wrongdoing in healthcare varies from inappropriate behaviour to illegal action. Whistle-blowing can have negative consequences for the whistle-blower, often in the form of bullying or retribution. Despite the wrongdoing and negative tone of whistle-blowing, there is limited literature exploring them in healthcare. OBJECTIVE:: The aim was to describe possible wrongdoing in Finnish healthcare and to examine whistle-blowing processes described on the basis of the existing literature in healthcare as perceived by healthcare professionals. RESEARCH DESIGN:: The study was a cross-sectional descriptive survey. The data were collected using the electronic questionnaire Whistle-blowing in Health Care and analysed statistically. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 397 Finnish healthcare professionals participated, 278 of whom had either suspected or observed wrongdoing in healthcare, which established the data for this article. ETHICAL CONSIDERATIONS:: Ethical approval was obtained from the Ethics Committee of the University (20/2015). Permission to conduct the study was received according to the organisation's policies. FINDINGS:: Wrongdoing occurs in healthcare, as 96% of the participants had suspected and 94% had observed wrongdoing. Regarding the frequency, wrongdoing was suspected (57%) and observed (52%) more than once a month. Organisation-related wrongdoing was the most common type of wrongdoing (suspected 70%, observed 66%). In total, two whistle-blowing processes were confirmed in healthcare: (1) from suspicion to consequences occurred to 27%, and (2) from observation to consequences occurred to 37% of the participants. DISCUSSION AND CONCLUSION:: Wrongdoing occurs in healthcare quite frequently. Whistle-blowing processes were described based on the existing literature, but two separate processes were confirmed by the empirical data. More research is needed on wrongdoing and whistle-blowing on it in healthcare.
Assuntos
Atenção à Saúde/métodos , Denúncia de Irregularidades/ética , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos Transversais , Atenção à Saúde/ética , Atenção à Saúde/normas , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde/ética , Avaliação de Processos em Cuidados de Saúde/normas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Our objective was to assess informed consent procedures for intravenous tissue plasminogen activator in acute stroke among New York State (NYS) Department of Health (DOH) designated stroke centers. METHODS: A 13-question survey stratified by 0- to 3-hour and 3.0- to 4.5-hour treatment windows was used to determine the type of consent or if no consent was required. RESULTS: Of the 117 hospitals, 111 responded (95%). All 111 hospitals provided treatment within the 3-hour window, whereas 97 (87%) provided treatment beyond the 3-hour window (P < .001). For hospitals that did provide treatment, there was a difference between the percentages of hospitals requiring consent (verbal or written) within 3 hours (82%) and beyond 3 hours (92%) (P = .04). Of the hospitals requiring consent, there was a difference in the type of consent: 31 of 91 (34%) required written consent within the 3-hour window, whereas 57 of 89 (64%) required written consent beyond the 3-hour window (P < .001). Within both treatment windows, 98% accepted a health-care proxy or surrogate in lieu of the patient. Of the hospitals with less than 500 beds, 11 of 81 (14%) did not require consent within the 3-hour treatment window, compared to hospitals with 500 or more beds where 9 of 30 (30%) did not require consent within the 3-hour treatment window (P < .05). Beyond the 3-hour treatment window, hospitals with more than 500 beds required written consent-2-fold increase "compared to less than 3 hour window" (P < .05). Fifty-five percent of the hospitals were academic, whereas 45% were nonacademic. Academic status was not related to the type of consent in either window. CONCLUSIONS: Significant variability exists in the types of informed consent based on hospital bed size and treatment windows across NYS DOH designated stroke centers.
Assuntos
Fibrinolíticos/administração & dosagem , Hospitais/ética , Consentimento Livre e Esclarecido/ética , Avaliação de Processos em Cuidados de Saúde/ética , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/ética , Ativador de Plasminogênio Tecidual/administração & dosagem , Termos de Consentimento/ética , Pesquisas sobre Atenção à Saúde , Disparidades em Assistência à Saúde/ética , Número de Leitos em Hospital , Humanos , Infusões Intravenosas , New York , Padrões de Prática Médica/ética , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Tempo para o Tratamento , Resultado do TratamentoAssuntos
Tomada de Decisões , Ética em Enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Profissionais de Enfermagem/psicologia , Ambulatório Hospitalar/ética , Avaliação de Processos em Cuidados de Saúde/ética , Mobilidade Ocupacional , Etiópia , Planejamento Hospitalar , Humanos , Agências Internacionais , Profissionais de Enfermagem/ética , Supervisão de Enfermagem/ética , Designação de PessoalRESUMO
In the United States, economic, racial, ethnic, geographic, and other disparities exist in access to fertility treatment and in treatment outcomes. This opinion examines the factors that contribute to these disparities and proposes actions to address them.