Shared decision-making in maternity care in Saudi Arabia: A cross-sectional study.

BACKGROUND: Shared decision-making (SDM) in maternity care involves women actively in decisions, thereby reducing decisional conflicts and enhancing satisfaction with care. AIM: To investigate SDM and the factors associated with it, and its correlation with respect in maternity care in Saudi Arabia. METHODS: A comprehensive, nationwide online questionnaire-based study was conducted between January to May 2023, involving women aged 18 years and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. The Mothers' Autonomy in Decision-Making (MADM) scale and the Mothers of Respect Index (MORi) were used. Low to very low SDM was defined as a score of ≤ 24 on the MADM and low to very low respected was defined as a score of ≤ 49 on the MORi. RESULTS: A total of 505 women completed the survey. Low to very low SDM was reported by 137 (34.1 %, 95 confidence interval (CI), 29.6 % - 38.9 %) women. Factors significantly associated with low to very low SDM included seeing different obstetricians of different gender at each visit (adjusted odds ratio (AOR) 2.0, 95 % CI, 1.0 - 3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95 % CI, 1.2 - 5.6) and having an instrumental vaginal birth (AOR 6.67, 95 % CI, 1.6 - 28.1). There was a positive association between low to very SDM and feeling of low to very low respect ((χ2 = 83.8173, p < 0.001). CONCLUSION: More than one-third of women experienced low to very low SDM in maternity care. This should alert healthcare providers to the importance of continuity of care in Saudi Arabia.

Impairments of Human Dignity at the End of Life Quantitatively Assessed by Health Care Professionals: A Pilot Study From Germany.

BACKGROUND: Empirical investigations on health care professionals' (HCPs) perception of dignity have already spotted common themes in preserving dignity in end-of-life care. However, heterogenic assessment results of varying HCP groups exist. This pilot study wants to provide further evidence on HCPs' rating of dignity-impairing aspects based on a patient-centered concept, especially regarding different underlying job profiles and other professional characteristics. METHODS: In a quantitative study design, the rating of dignity-impairing factors in end-of-life care via an adapted version of the Patient Dignity Inventory (aPDI) was assessed. Participants of the relevant professional groups were recruited via convenience sampling from a region of Germany. RESULTS: From the final sample of participants, 229 questionnaires were analyzed. The overall importance of each dignity-impairing aspect in end-of-life care was considered to be very high by all different HCP groups. Nonetheless, ratings differed between professions: nursing staff had the highest ratings of importance compared to both physicians and individuals with multiple occupations. Participants with previous knowledge in bioethics also rated some aspects as more important compared to those without this feature. CONCLUSION: With the findings of this investigation, an insight of how professionals rate impairments of dignity at the end of life based on a patient-centered concept is given. Thus, a link between empirical research and medical ethics is added. Potential normative implications for HCPs in practice of a dignified care can be derived, consisting of actively addressing social topics as well as further stressing ethics as a fundamental subject in the training and continuing education.

"We rely on each other": A qualitative exploration of rural Eastern Region Native American experiences during the COVID-19 pandemic.

Background: Native American communities suffered disproportionately negative effects during the COVID-19 pandemic, yet no research has explored the experiences of rural Eastern Region Native Americans. Methods: Informed by the Native Reliance Model and Indigenous Standpoint Theory, we conducted a qualitative descriptive project in the Spring and Summer of 2022; data included semi-structured interviews and focus groups with 24 individuals representing five South Carolina tribal groups. Findings: Thematic analysis yielded four emergent themes: 1) "Let's just finish the Indians off": Pandemic distrust rooted in historical and contemporary Native American experiences; 2) "We have been misled": Making sense of conflicting public health information; 3) "I'm not giving it to some innocent person": COVID-19 mitigation behaviors as Native American cultural practice; and 4) "We put the plan in place": Self-advocacy and action as a source of Native American pride and responsibility. Interpretation: These participants demonstrated resiliency grounded in family and tribal ties, even in the face of personal losses, economic struggles, and healthcare barriers. To strike a balance between cultural traditions and public health recommendations, public health practitioners should 1) build partnerships with community leaders, elders, and tribal health authorities to facilitate the development of culturally respectful interventions that address specific health concerns in the context of historical traumas; and 2) implement alternative methods of communication and engagement to ensure equitable access to healthcare services in rural locations, such as collaborating with community organizations, deploying mobile health units, and utilizing traditional channels of communication within these communities.

How infants predict respect-based power.

Research has shown that infants represent legitimate leadership and predict continued obedience to authority, but which cues they use to do so remains unknown. Across eight pre-registered experiments varying the cue provided, we tested if Norwegian 21-month-olds (N=128) expected three protagonists to obey a character even in her absence. We assessed whether bowing for the character, receiving a tribute from or conferring a benefit to the protagonists, imposing a cost on them (forcefully taking a resource or hitting them), or relative physical size were used as cues to generate the expectation of continued obedience that marks legitimate leadership. Whereas bowing sufficed in generating such an expectation, we found positive Bayesian evidence that all the other cues did not. Norwegian infants unlikely have witnessed bowing in their everyday life. Hence, bowing/prostration as cue for continued obedience may form part of an early-developing capacity to represent leadership built by evolution.

Development and Validation of a questionnaire on human dignity in nursing cares: an exploratory sequential mixed study.

Objective: The current study aimed to develop and validate of human dignity questionnaire in nursing care. Methods: The present research is a sequential exploratory mixed method study. The questionnaire was developed and validated in three phases: (1) the concept of human dignity was defined through conventional content analysis qualitative approach, (2) early items of questionnaire was generated according to findings of the first phase, (3) validation of the questionnaire was evaluated using face, content and construct validity as well as reliability. The study was conducted with the participation of 13 nurses in the qualitative section and 203 nurses in the quantitative section in teaching hospitals affiliated to Jahrom University of Medical Sciences (Iran). Results: In the qualitative section, the definition and dimensions of the concept of human dignity in nursing care were discovered. In the quantitative section, the initial pool of items for the questionnaire of human dignity in nursing care was formed using the results of the qualitative section of the study and review of texts and related questionnaires. In factor analysis, four subscales including: respectful communication, equality of patient human value, preservation of privacy and patient-centered care were extracted by Eigen value above one. Internal consistency and stability of the questionnaire were calculated as 0.85 and 0.80, respectively, indicating an excellent reliability. Conclusion: The 20-item developed questionnaire is valid and reliable for measurement of human dignity questionnaire in nursing cares.

The bottom-up approach in multigenerational family therapy: The child as the family guide.

In therapy, the child is mainly seen as a problem to be labeled or as a victim of various forms of abuse. The idea of the child as a therapeutic resource is the central point of my article where children's symptoms are quickly reframed and get a relational meaning in the family. Once the relational competence of the child is appreciated and his voice is heard, the child becomes a special guide to explore the emotional world of his family, and the genogram can provide a wonderful platform to start this therapeutic journey. Using a multigenerational lens, I describe how to explore family development with a "bottom-up approach." Intergenerational questions can be asked to the child and with his help relevant family events can emerge and broken bonds repaired. The therapeutic results I expect are the resolution of children's problems and family transformation.

Nursing peer feedback: Optimizing our relationships with human resources and collective bargaining organizations.

Nursing leaders have recognized the need for consistent mechanisms to promote and sustain nursing professionalism. Peer-to-peer feedback and peer review are widely effective for nurse professionalism and self-regulation, patient care outcomes, and retention. Unprofessional behavior has been noted as widespread in health care and the effects on patients, clinicians, and organizations have been well-documented. Approximately 10% of the registered nurses in the United States belong to a collective bargaining unit (CBU) or union. This article will describe how a peer feedback program to address unprofessional behavior was implemented in a Magnet nursing practice with CBU representation.

'Against Medical Advice' Discharges After Respiratory-Related Hospitalizations: Strategies for Respectful Care.

Against medical advice (AMA) discharges are practically and emotionally challenging for both patients and clinicians. Moreover, they are common after admissions for respiratory conditions such as COPD and asthma, and they are associated with poor outcomes. Despite the challenges presented by AMA discharges, clinicians rarely receive formal education and have limited guidance on how to approach these discharges. Often, the approach to AMA discharges prioritizes designating the discharge as "AMA," whereas effective coordination of discharge care receives less attention. Such an approach can lead to stigmatization of patients and low-quality care. Although evidence for best practices in AMA discharges remains lacking, we propose a set of strategies to improve care in AMA discharges by focusing on respect, in which clinicians treat patients as equals and honor differing values. We describe five strategies, including (1) preventing an AMA discharge; (2) conducting a patient-centered and truthful discussion of risk; (3) providing harm-reducing discharge care; (4) minimizing stigma and bias; (5) educating trainees. Through a case of a patient discharging AMA after a COPD exacerbation, we highlight how these strategies can be applied to common issues in respiratory-related hospitalizations, such as prescribing inhalers and managing oxygen requirements. We argue that, by using these strategies, clinicians can deliver respectful and higher-quality care to an often-marginalized population of patients with respiratory disease.

Nancy S. Jecker, Zohar Lederman, and Anita Ho reply.

This letter replies to the letter "Colonial and Neocolonial Barriers to Companion Digital Humans in Africa," by Luís Cordeiro-Rodrigues, in the same, May-June 2024, issue of the Hastings Center Report.

Learning from the multidisciplinary team: advancing patient care through collaboration.

Training for doctors, and other healthcare workers, has traditionally focussed on developing the knowledge and technical skills relevant to individual specialties. There has been an assumption that once trained in this way, we will be able to work easily and effectively in teams with other professionals. Multidisciplinary working is now a normal pattern of healthcare delivery and teamwork is taught as part of current curricula. Interdisciplinary learning is becoming more common, with medical students, nursing students and other professions allied to medicine learning together during their training. Healthcare staff who are already qualified have not had the benefit of being taught the particular skills needed to work well as part of diverse teams, nor given the skills to identify and overcome barriers to effective teamwork. We all need to develop these skills to help our patients get the best care from the teams looking after them.

Lived Experience of Human T-cell Leukemia Virus type-1 -Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP): A Phenomenology Study.

Background: Human T-cell Leukemia Virus type-1 (HTLV-1) -associated myelopathy causes sufferers to experience changes in several aspects of their lives. Gaining a deeper understanding of these changes can help healthcare professionals improve care, enhance strategic decision-making, meet expectations, and manage patients effectively. However, there is no information about the experience and problems of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis in Iran. Therefore, this study aimed to explain the lived experience of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. Methods: This qualitative study used hermeneutic phenomenology in 2022 in Mashhad, Iran. Participants were selected using purposeful sampling. Data were collected through 21 semi-structured in-depth interviews with 20 eligible patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. The data were analyzed in MAXQDA/2020 using the six stages proposed by Van Manen. Results: The main concept of "Reduced self-sufficiency and social dignity" emerged from the narratives of the patients, which included three main categories "Disruption of desirable personal and social life", "reduced perception of role competencies", and "obligatory unpleasant lifestyle changes". Conclusion: HTLV-1-associated myelopathy/tropical spastic paraparesis slowly makes patients feel insufficient and causes a sense of degradation in dignity. The disease can fundamentally change personal and social life. Thus, due to its incurability and progressiveness, palliative care should be provided to them to live with dignity.

An online survey of women's views of respectful and disrespectful pregnancy and early labour care in the Czech Republic.

OBJECTIVE: To ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour. DESIGN: Ethical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses. SETTING: The Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. MEASUREMENTS AND FINDINGS: Descriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had 'checking' visits from the midwife in labour. KEY CONCLUSIONS: Findings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent. IMPLICATIONS FOR PRACTICE: The examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.

Patient and relative experiences of the ReSPECT process in the community: an interview-based study.

BACKGROUND: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was launched in the UK in 2016. ReSPECT is designed to facilitate meaningful discussions between healthcare professionals, patients, and their relatives about preferences for treatment in future emergencies; however, no study has investigated patients' and relatives' experiences of ReSPECT in the community. OBJECTIVES: To explore how patients and relatives in community settings experience the ReSPECT process and engage with the completed form. METHODS: Patients who had a ReSPECT form were identified through general practice surgeries in three areas in England; either patients or their relatives (where patients lacked capacity) were recruited. Semi-structured interviews were conducted, focusing on the participants' understandings and experiences of the ReSPECT process and form. Data were analysed using inductive thematic analysis. RESULTS: Thirteen interviews took place (six with patients, four with relatives, three with patient and relative pairs). Four themes were developed: (1) ReSPECT records a patient's wishes, but is entangled in wider relationships; (2) healthcare professionals' framings of ReSPECT influence patients' and relatives' experiences; (3) patients and relatives perceive ReSPECT as a do-not-resuscitate or end-of-life form; (4) patients' and relatives' relationships with the ReSPECT form as a material object vary widely. Patients valued the opportunity to express their wishes and conceptualised ReSPECT as a process of caring for themselves and for their family members' emotional wellbeing. Participants who described their ReSPECT experiences positively said healthcare professionals clearly explained the ReSPECT process and form, allocated sufficient time for an open discussion of patients' preferences, and provided empathetic explanations of treatment recommendations. In cases where participants said healthcare professionals did not provide clear explanations or did not engage them in a conversation, experiences ranged from confusion about the form and how it would be used to lingering feelings of worry, upset, or being burdened with responsibility. CONCLUSIONS: When ReSPECT conversations involved an open discussion of patients' preferences, clear information about the ReSPECT process, and empathetic explanations of treatment recommendations, working with a healthcare professional to co-develop a record of treatment preferences and recommendations could be an empowering experience, providing patients and relatives with peace of mind.

Antecedents of rapport and its mediating role on relational cohesion in patient-physician interaction.

Increasing competition in healthcare services, it is imperative that physicians and family-care practitioners seek ways to attract and retain patients. Building relationships with existing patients is one sure way to continued patronage and increased clientele. The purpose of this paper is to examine antecedents of rapport and its influence on perceived relationships in the context of patient-physician interaction. Study using cross-sectional survey method with structured questionnaire was used for data collection. Structural Equation Modeling was used for analyzing the data collected from 326 patients residing in Karnataka, India. The finding suggests that respect, responsibility and understanding have significant influence on relational cohesion with rapport acting as mediating variable. The results add to the empirical validity of the relationship among rapport, respect & relationship, as it is required to understand studied in Indian context. The finding provides new directions for both healthcare professionals and institutions in their endeavor of building relationships with their customers (Patients) by emphasizing the need for developing 'rapport' as an integral part of service interaction. Future research like longitudinal and experimental studies can provide more conclusive evidence regarding the influence of service behaviour on rapport.

Do Suicide Attempters Have a Right Not to Be Stabilized in an Emergency?

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients' level of decisional capacitation-among other relevant information-in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs-the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness.

How patients experience respect in healthcare: findings from a qualitative study among multicultural women living with HIV.

BACKGROUND: Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients' views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. METHODS: We analyzed 57 semi-structured interviews conducted at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant's language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about "respect." After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. RESULTS: Results from this study grouped into two overarching classifications: respect manifested in physicians' orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider's orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. CONCLUSIONS: Findings suggest a more robust conception of what 'respect for persons' entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery.

Exploring COVID-19 patient's dignity and satisfaction: A cross-sectional study.

AIM: With the outbreak of COVID-19 and associated challenges such as increased workload for health providers and shortage of equipment, it became more challenging to maintain patients' dignity and satisfaction. This study evaluated the patients' dignity and satisfaction with COVID-19 in Kashan, Iran, in 2021. DESIGN: A cross-sectional descriptive study. METHODS: In total, 385 patients recovered from COVID-19 were selected through sequential sampling method. Data were collected using demographic, patient dignity inventory, and patient satisfaction questionnaires. Data were analysed using descriptive analysis, independent t-test, ANOVA, and Spearman-Brown coefficient. RESULTS: The mean age of patients was 50.57. The mean scores of patients' dignity and satisfaction were 1.622 ± 0.653 and 3.851 ± 0.548 (out of 5), respectively. The dignity rating was associated with age, gender, education, underlying disease, and length of hospital stay (p < 0.05); but patient satisfaction was only associated with education (p = 0.002). The results indicated that dignity and satisfaction have a significant direct correlation (r = -0.23, p < 0.001). PATIENT OR PUBLIC CONTRIBUTION: This study was designed based on the research priorities and needs in the field of clinical research and patients were involved in conducting the study via participating in data collection.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties-A multicenter cross-sectional study.

OBJECTIVE: To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. RESULTS: The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. DISCUSSION: CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. CONCLUSION: The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

A strengths-based qualitative exploration of critical care nurses' reasons for remaining in critical care.

AIMS: Globally, the nursing shortage is a growing concern. Much of the research on retention of nurses focuses on the experience of those who left positions. In this study, we set out to listen to critical care nurses (CCRNs) who have chosen to remain in their positions to understand the factors retaining them in critical care. DESIGN: This interpretive descriptive study was guided by the following research question: 'what factors influence CCRN's decision to continue to work in critical care?' METHODS: Digitally recorded interviews and a focus group were conducted between July 2022 and January 2023 using a semi-structured, strengths-based interview guide with CCRNs from three critical care units at a tertiary hospital in a city in a central Canadian province. Transcribed interviews were analysed using open, axial and selective coding and constant comparative analysis. RESULTS: Twenty-two CCRNs participated in interviews and three in a focus group. The theme of Respect, demonstrated through the interconnected concepts of Working to Full Scope, Team, Rotations and Compensation was identified. Working to Full Scope was described as providing nursing care aligned with how each nurse envisions what nursing is. Being part of a Team led by strong nurse leaders that provides opportunities and supports the sharing of their perspectives was also found. Respect was also found to be demonstrated through Rotations that recognize that work is one part of these nurses' lives. Compensation that reflects the increased education, knowledge and skills required in critical care was the final concept of Respect. CONCLUSION: Organizations should focus their efforts across the identified concepts to demonstrate Respect for CCRNs and retain them. IMPLICATIONS FOR PRACTICE: The findings of this study provide ways to support the retention of CCRNs. IMPACT: This research will have an impact on nursing leaders by providing tangible ways to retain CCRNs. REPORTING METHOD: Reporting of this work was guided by the Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.