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Organizational ethics in urgent transfers of severely disabled people to intensive care units - a qualitative study.
Le Fort, Marc; Demeure Dit Latte, Dominique; Perrouin-Verbe, Brigitte; Ville, Isabelle.
Afiliación
  • Le Fort M; Nantes Université, Centre Hospitalier Universitaire de Nantes, Service universitaire de Médecine Physique et de Réadaptation neurologique, Hôpital Saint-Jacques, Nantes, France.
  • Demeure Dit Latte D; Institut national de la santé et de la recherche médicale (INSERM-CERMES3), Ecole des hautes études en sciences sociales (EHESS-PHS), Paris, France.
  • Perrouin-Verbe B; Nantes Université, Centre Hospitalier Universitaire de Nantes, Service de Réanimation chirurgicale, Hôtel-Dieu, Nantes, France.
  • Ville I; Nantes Université, Centre Hospitalier Universitaire de Nantes, Service universitaire de Médecine Physique et de Réadaptation neurologique, Hôpital Saint-Jacques, Nantes, France.
Disabil Rehabil ; 45(23): 3852-3860, 2023 11.
Article en En | MEDLINE | ID: mdl-36369957
ABSTRACT

PURPOSE:

Urgent transfers of severely impaired patients with chronic neurological disability (PwND) from a neurological physical and rehabilitation medicine (nPRM) to an intensive care unit (ICU) or an emergency room (ER) served as the basis for this study. We hypothesized that human and structural factors interfered with but were not directly related to the acute context.

METHODS:

We decided to use a qualitative methodology, based on in-depth interviews with 16 ICU/ER physicians. We used mixed bottom-up and top-down methods. We interpreted our data using a thematic approach based on the key principles of grounded theory, which were modified with consideration of the literature.

RESULTS:

Three main domains emerged. The impact of the clinical setting notably implied the patient's clinical typology between the acute event and the chronic background, but also bed availability. Key elements of the telephone negotiation were confidence and perceived usefulness of the transfer. Finally, the otherness of some categories of patients, transferred with more difficulty, involved those with cognitive impairment.

CONCLUSIONS:

The existence of healthcare pathways for many years has created an organizational culture between departments of nPRM and ICUs. But urgent transfers also imply organizational ethics, as a balance should be struck between utility and equity. IMPLICATIONS FOR REHABILITATIONStructural and human factors interfere in urgent transfers, involving the settings within health pathways, the key elements of negotiation to get confidence and a perceived utility of transfer, and certain categories of people, especially those with cognitive impairment.Transfers that imply negotiation between practitioners from physical and rehabilitation medicine and intensive care unit departments, lead to a need of organizational ethics, as a balance should be struck between the principles of utility and equity.The development of facilitating tools such as a commitment charter is of paramount importance as it can support ethical decision-making.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Ética Institucional / Unidades de Cuidados Intensivos Tipo de estudio: Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: Disabil Rehabil Asunto de la revista: REABILITACAO Año: 2023 Tipo del documento: Article País de afiliación: Francia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Ética Institucional / Unidades de Cuidados Intensivos Tipo de estudio: Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: Disabil Rehabil Asunto de la revista: REABILITACAO Año: 2023 Tipo del documento: Article País de afiliación: Francia