ABSTRACT
This study was designed to determine the degree to which clinical genetics professionals are comfortable with grief and loss, whether discomfort with grief and loss is associated with clinician distress, and what factors predict comfort with grief and loss for the purpose of developing recommendations for support and training. We surveyed 300 clinical geneticists (MDs), genetic counselors (GCs) and genetic nurses randomly selected from their professional associations. Out of 225 eligible clinicians, 172 completed surveys (76% response rate). The vast majority of respondents have clinical interactions with patients and families who are experiencing grief, loss and/or death. However, nearly 20% of respondents reported that they did not feel 'comfortable in the presence of grief and loss'. Twenty-nine percent of respondents disagree or strongly disagree that they 'have been adequately trained to address issues of death, dying, grief/bereavement, and end of life care'. Reported discomfort with grief and loss was strongly correlated with clinician distress. Predictors of comfort with grief and loss included perceived adequacy of training, tolerance for uncertainty, significant personal experiences of loss and deriving meaning from patient care. In conclusion, as follows. A significant minority of clinical genetics professionals experience discomfort in the presence of grief and loss, and feel inadequately prepared for such experiences. Greater attention should be paid to training clinicians in how to deal with grief and loss, and supporting them through such difficult experiences in an effort to reduce their distress.
Subject(s)
Attitude of Health Personnel , Genetic Counseling/psychology , Genetics, Medical , Grief , Health Personnel/education , Social Support , Adult , Demography , Female , Health Personnel/psychology , Health Surveys , Humans , Life Change Events , Male , Middle AgedABSTRACT
The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.
Subject(s)
Attitude of Health Personnel , Ethics, Nursing , Nurse's Role , Nurses/psychology , Suicide, Assisted/legislation & jurisprudence , Beneficence , Codes of Ethics , Critical Care , Humans , Nurse-Patient Relations , Personal Autonomy , United StatesABSTRACT
Respecting the values and preferences of adolescents regarding treatment is an essential dimension of nursing practice. As public policy and societal thinking about the role of minors in healthcare decisions evolves, critical care nurses are in a pivotal position to provide leadership and guidance. Critical care nurses who care for adolescents should embrace the opportunity created by the PSDA to implement creative strategies for involving minors in decision making, seek improved methods of assessing decision-making capacity, and document the values and preferences of minors.
Subject(s)
Advance Directives , Critical Illness/nursing , Psychology, Adolescent , Adolescent , Advance Directives/legislation & jurisprudence , Comprehension , Critical Illness/psychology , Decision Making , Disclosure , Humans , Male , Minors , Nursing Assessment , Patient Advocacy/legislation & jurisprudence , Personal Autonomy , Withholding TreatmentABSTRACT
In order for nurses to be effective advocates, they must practice in an environment that fosters competency, collaboration, communication, and ethical values. This article addresses the meaning of advocacy, explores whether nurses can be effective advocates in complex practice environments, identifies barriers to advocacy, and suggests individual and systems approaches to support advocacy in critical care.
Subject(s)
Critical Care , Ethics, Nursing , Patient Advocacy , HumansABSTRACT
Technologic innovations such as extracorporeal membrane oxygenation generate a myriad of ethical concerns that complicate clinical treatment decisions. Nurses must engage in deliberate actions to raise the issues of balancing the benefits and burdens of the technology, access to therapy, informed consent, and allocation of scarce resources, in order to provide ECMO services in an ethically sound manner. Consumers and providers of ECMO services must continue to examine and debate these issues in a reasoned, deliberate fashion and construct the necessary procedural safeguards that will ensure beneficent and just delivery of these services.
Subject(s)
Decision Making , Ethics, Nursing , Extracorporeal Membrane Oxygenation/standards , Risk Assessment , Beneficence , Extracorporeal Membrane Oxygenation/nursing , Health Care Rationing/standards , Humans , Infant, Newborn , Informed Consent , Interdisciplinary Communication , Job Description , Moral Obligations , Parental Consent , Patient Selection , Resource Allocation , Therapeutic Human ExperimentationABSTRACT
The critical care environment is often described as contrary to the humane treatment of critically ill patients and their families. To diminish the negative effects of the environment and critical illness, specific strategies to foster more humane care are needed to create an environment where healing and recovery are possible.
Subject(s)
Critical Care/psychology , Holistic Health , Patient Advocacy , Family/psychology , Health Facility Environment , HumansABSTRACT
The unconsented use of placebo pain medicine raises numerous ethical and legal issues. Generally, the use of placebo for the assessment of pain is unjustified. Nurses who are asked to participate in placebo pain medication must be knowledgeable of the ethical and legal ramifications of their actions.
Subject(s)
Anemia, Sickle Cell/complications , Ethics, Nursing , Informed Consent/legislation & jurisprudence , Pain/drug therapy , Placebos , Adolescent , Disclosure , Humans , Intention , Male , Pain/etiology , Pain/nursing , Parental Consent , Risk Assessment , WhistleblowingABSTRACT
Caring for Baby K, an infant born with anencephaly, created moral distress and violated the integrity of some nurses. This article explores the nature of professional nurses' claims of violations of their integrity, argues for a broader moral framework for examining such dilemmas, and suggests strategies for addressing these issues in the clinical setting.
Subject(s)
Anencephaly/nursing , Dissent and Disputes , Ethics, Nursing , Group Processes , Nurse's Role , Patient Advocacy , Female , Humans , Infant, Newborn , Mothers , Nursing Staff, Hospital/psychology , Resource AllocationABSTRACT
Family-centered care (FCC) for critically ill or injured infants and children must be a priority for nurses and other health care professionals in the 1990s. Eight essential elements of FCC provide the basis for devising strategies for implementing FCC in the critical care setting.
Subject(s)
Critical Care , Family , Pediatric Nursing , Adult , Child , Child Development , Family/psychology , Female , Humans , Infant , Male , Nursing Assessment , Professional-Family RelationsABSTRACT
Generally, nurses have an ethical and legal obligation to provide treatment to persons with AIDS. When it is unclear whether nurses are morally required to provide treatment, they should engage in moral analysis, discuss their concerns with their colleagues and administrators, work within their institution's framework to resolve their concerns, seek legal counsel, or as a last resort consider working in another practice setting.
Subject(s)
Acquired Immunodeficiency Syndrome/nursing , Ethics, Nursing , Adolescent , Codes of Ethics , Humans , Jurisprudence , Male , Moral Obligations , Morals , Personal Autonomy , Social Justice , Social Responsibility , United StatesABSTRACT
Confronting unsafe practices in the workplace requires careful ethical and legal analysis and a supportive practice environment. Nurses should collaborate with their colleagues to create mechanisms to review and monitor clinical practices, investigate questionable occurrences, and collaborate with licensing boards to respond to infractions.
Subject(s)
Community Health Nursing/standards , Disclosure , Ethics, Nursing , Pediatric Nursing/standards , Whistleblowing , Child , Clinical Competence , Government Regulation , Home Care Services , Humans , Jurisprudence , Medication Errors , Moral Obligations , Professional Misconduct , Social Responsibility , United StatesABSTRACT
Critical care professionals may be faced with requests by parents to continue life-sustaining treatment despite professional recommendations to the contrary. Such cases raise complex moral, legal and social issues that require ongoing ethical dialogue in hopes of achieving a social consensus. Professional standards, a statutory framework, case law and the exercise of professional and parental responsibility will also play a role in this dialogue.
Subject(s)
Coma/therapy , Ethics, Nursing , Patient Advocacy/legislation & jurisprudence , Professional-Family Relations , Decision Making , Ethics Committees, Clinical , Humans , Infant , Male , Social Values , UncertaintyABSTRACT
Increasingly, nurses are being confronted with clinical situations that challenge their personal and professional integrity. For integrity to be preserved, safeguards must be developed and an environment that supports ethical practice fostered. Standards such as those promulgated by the JCAHO provide an important opportunity for nurses to create mechanisms to assure that diverse religious, cultural, and ethical beliefs of nurses are respected and upheld.
Subject(s)
Conflict, Psychological , Ethics, Nursing , Nursing Staff/psychology , Patient Advocacy , Female , Humans , Infant, Newborn , Joint Commission on Accreditation of Healthcare Organizations , Nursing Staff/legislation & jurisprudence , Social ValuesABSTRACT
In the context of health care decision making, the language of miracles is expressed by both parents and professionals. Without mutual understanding of the meaning of miracles, parents and professionals may experience conflict about treatment goals. Understanding the dynamics of appeals to miracles, examining caregiver responses, and employing strategies to assess parental knowledge, understanding the meaning of miracles and faith, and allowing for hope are essential for respectful and mutual accommodation.
Subject(s)
Ethics, Nursing , Parents , Religion and Medicine , Resuscitation Orders , Attitude of Health Personnel , Child , Dissent and Disputes , Group Processes , Humans , Leukemia, Myeloid, Acute/therapy , Male , Parents/psychology , Pediatric Nursing , Withholding TreatmentABSTRACT
Blatant examples of breeches of confidentiality are less common in comparison to the daily indiscretions that occur by members of the health care team or support staff. Yet such breeches of confidentiality are rarely identified as ethical or legal problems and therefore remain unaddressed. To uphold their moral and legal obligation to protect private information, nurses must examine the nature of their obligations and devise strategies to create and maintain a culture that holds health care professionals accountable for their actions.
Subject(s)
Child Advocacy , Confidentiality , Disclosure , Ethics, Nursing , Parents , Patient Advocacy , Adolescent , Confidentiality/legislation & jurisprudence , Female , Humans , Minors , Pediatric Nursing/legislation & jurisprudence , Sexual Behavior , Social Responsibility , Truth Disclosure , United StatesABSTRACT
The need for critical care caregivers to complete their own grief work when a patient dies deserves special attention. Positive coping with grief and loss can be encouraged through formal programs and individual and group memorial services.
Subject(s)
Adaptation, Psychological , Death , Grief , Intensive Care Units, Pediatric , Nursing Staff, Hospital/psychology , Funeral Rites , Humans , Inservice Training/organization & administration , Nursing Staff, Hospital/educationABSTRACT
Pediatric nurses often struggle to define their advocacy role with patients and their families. Nursing is based on the therapeutic use of self and caring. An unclear therapeutic relationship can undermine nurses' advocacy efforts. Nurses are encouraged but often not guided about staying within the parameters that define a professional and therapeutic relationship between the nurses and the patient/family. Examining the impact of unclear boundaries on the patient/family relationship and the nurse's ability to serve as an advocate provides the basis for suggested constructive strategies for addressing the related issues.
Subject(s)
Child Advocacy , Nurse-Patient Relations , Patient Advocacy , Pediatric Nursing , Child , Dependency, Psychological , Friends , Humans , Male , Paternalism , Power, Psychological , Professional Misconduct , Professional-Family RelationsABSTRACT
Safe and timely administration of emergency medications and infusions is crucial when caring for critically ill neonates. A neonatal emergency medication sheet can enhance preparation, calculation, and administration of medications during emergency situations in neonatal intensive care units (NICUs).
Subject(s)
Drug Therapy/methods , Emergencies/nursing , Infant, Newborn, Diseases/drug therapy , Humans , Infant, Newborn , Infant, Newborn, Diseases/nursing , Nursing RecordsABSTRACT
Complex cases involving end-of-life care for infants with AIDS raise a variety of ethical and legal concerns. Health care providers should understand the issues involving proper treatment, including adequate relief of pain at the end of life, and a context for examining the suffering of caregivers.
Subject(s)
Acquired Immunodeficiency Syndrome/nursing , Ethics, Nursing , Pediatric Nursing/standards , Terminal Care/standards , Beneficence , Female , Humans , Infant , Pediatric Nursing/legislation & jurisprudence , Stress, Psychological , Terminal Care/legislation & jurisprudence , Therapeutic Human Experimentation , United States , Withholding TreatmentABSTRACT
As nurses begin to develop the sensitivities and skills necessary to preserve the integrity of clinical care and professional life, they must recognize the legitimacy of their perspectives and the value and consequences they have for the well-being of patient and family care. Nurses have much to contribute to the development of ethical practice environments for patients, families, multidisciplinary team members, and themselves. The frenzied, and at times anesthetized, culture of clinical settings can mitigate against the kind of deliberate reflection that is necessary if nurses are to act with ethical integrity. Knowing the rules of the road for end-of-life care and being attentive to common warning signs and addressing them proactively, enables nurses to provide patients and families with the highest quality care at the end of life.