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2.
Hastings Cent Rep ; 50(3): 79-80, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32596905

RESUMEN

The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, explicit, and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety-net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community-based care, and fully staff hospitals and clinics on nights and weekends.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Asignación de Recursos para la Atención de Salud/ética , Neumonía Viral/epidemiología , Nivel de Atención/ética , Betacoronavirus , COVID-19 , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/ética , Disparidades en Atención de Salud/organización & administración , Humanos , Pandemias , Admisión y Programación de Personal/ética , Admisión y Programación de Personal/organización & administración , SARS-CoV-2 , Nivel de Atención/organización & administración , Telemedicina/ética , Telemedicina/organización & administración
3.
J Med Ethics ; 46(7): 436-440, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32409625

RESUMEN

As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are 'fit for reallocation' have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Asignación de Recursos para la Atención de Salud/ética , Personal de Salud/ética , Personal de Salud/organización & administración , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Betacoronavirus , COVID-19 , Asignación de Recursos para la Atención de Salud/organización & administración , Humanos , Evaluación de Necesidades/ética , Evaluación de Necesidades/organización & administración , Pandemias , Admisión y Programación de Personal/ética , Admisión y Programación de Personal/organización & administración , Rol Profesional , Factores de Riesgo , SARS-CoV-2 , Voluntarios
6.
J Med Ethics ; 44(9): 593-598, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29703860

RESUMEN

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials (CRTs) of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed?


Asunto(s)
Ética en Investigación , Internado y Residencia/organización & administración , Admisión y Programación de Personal/ética , Ensayos Clínicos Controlados Aleatorios como Asunto/ética , Comités de Ética en Investigación/ética , Humanos , Consentimiento Informado/ética , Internado y Residencia/ética , Internado y Residencia/normas , Proyectos de Investigación , Investigadores/ética , Sujetos de Investigación/psicología , Medición de Riesgo
7.
Vet Surg ; 47(3): 327-332, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29457248

RESUMEN

To ensure patient safety and protect the well-being of interns and residents, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in 2003 limiting the working hours of physician trainees. Although many supported the goals of the ACGME, institutions struggled to restructure their programs and hire staff required by this unfunded mandate. Numerous studies have analyzed the effects of duty hours restrictions on patient outcomes and physician training over the past 15 years. Most agree that duty hours restrictions improved well-being of house officers, but these improvements came at the expense of continuity, and patient hand-offs led to medical errors. Effects on resident training are program specific, with duty hours restrictions having the most deleterious effects on surgical disciplines. Because veterinary specialists assume a similar role in providing 24-hour patient care, interns and residents face work-related stress as a result of extended working hours, on-call duty, and an increasingly complex caseload. The North Carolina State Veterinary Hospital is staffed by approximately 100 house officers representing almost every veterinary specialty group. We surveyed departing house officers regarding their quality of life and training experience. Sixty-six percent of interns and residents reported that they do not have time to take care of personal needs, and 57%-62% felt neutral or dissatisfied with their mental and physical well-being. Most trainees believed that decreased duty hours would improve learning, but 42% believed that decreased caseload would be detrimental to training. Veterinary educators must consider post-DVM veterinary training guidelines that maintain patient care with a good learning environment for interns and residents.


Asunto(s)
Educación en Veterinaria , Internado y Residencia , Admisión y Programación de Personal , Tolerancia al Trabajo Programado , Acreditación , Educación en Veterinaria/ética , Humanos , Internado y Residencia/ética , North Carolina , Admisión y Programación de Personal/ética , Calidad de Vida , Encuestas y Cuestionarios , Medicina Veterinaria/ética
8.
Nurse Educ Today ; 56: 1-5, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28599196

RESUMEN

This paper addresses the issue of substandard care and its effects on healthcare practice. It explores some recent concerns about the problem in nursing, its potential effects on students, how it can be conceptualised and what action needs to be, by both nurses and educators to prevent it. Recent healthcare scandals have tarnished the public image of nursing, and are also likely to influence nursing students' images, expectations and experiences of nursing. While much attention has been paid to the examination of such lapses in care, and potential corrective actions, little attention has been paid to the potential or actual effect on nursing students in practice. While good resources and staffing levels are crucial to ensuring optimal nursing care, developing and encouraging nursing students' awareness of and openness about personal behaviours, reflecting critically on practice reflection and strengthening nurse educators' collaborative links with healthcare practice can all serve to positively influence care deficits.


Asunto(s)
Actitud del Personal de Salud , Prácticas Clínicas/ética , Docentes de Enfermería/ética , Estudiantes de Enfermería/psicología , Bachillerato en Enfermería , Humanos , Admisión y Programación de Personal/ética , Admisión y Programación de Personal/normas
11.
Artículo en Alemán | MEDLINE | ID: mdl-27878330

RESUMEN

Volunteering in the hospice movement has had a profound impact on generating awareness of hospice work and palliative care in the context of supporting dying persons and their relatives as well as on integrating respective services in the existing health care system. This paper focuses on two specific questions: First, it asks how society is changing with respect to dealing with dying and death, and more precisely with dying persons, which is recognizable by the integration of hospice work and palliative care in the healthcare system and related to the relevance of volunteering in the sense of a citizens' movement. Second, this paper asks what the specific roles of volunteers are as well as the possibilities and limits of voluntary practice in end-of-life care and accompaniment. To answer these questions, the pivotal objectives of the hospice movement - the transformation of the social awareness regarding dying and death, as well as the reorganization of "institutions of dying" - will first be outlined by reference to the concept of "good dying", a specific hospice attitude together with hospice culture and palliative competence. In a second step, the relevance of volunteering and the specific role of volunteers in the actual practice of hospice work and palliative care will be outlined alongside current indicators and recognizable alteration tendencies, before concluding with a discussion of the perspectives of hospices as a citizens' movement.


Asunto(s)
Cuidados Paliativos al Final de la Vida , Perfil Laboral , Cuidados Paliativos , Admisión y Programación de Personal/organización & administración , Cuidado Terminal , Voluntarios/psicología , Alemania , Cuidados Paliativos al Final de la Vida/ética , Cuidados Paliativos al Final de la Vida/psicología , Cuidados Paliativos/ética , Cuidados Paliativos/psicología , Admisión y Programación de Personal/ética , Cuidado Terminal/ética , Cuidado Terminal/psicología , Recursos Humanos
12.
Nurs Stand ; 29(21): 3, 2015 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-25605064

RESUMEN

Guidance on the number of nurses needed in A&E departments was issued last week by the National Institute for Health and Care Excellence (NICE). No nurse should have to look after more than four patients - and only two if their conditions are more serious. The guidance is out for consultation, but hospital managers would be well advised to take heed straightaway.


Asunto(s)
Consenso , Admisión y Programación de Personal/normas , Humanos , Seguridad del Paciente/normas , Admisión y Programación de Personal/ética , Medicina Estatal/economía , Reino Unido
13.
Nurs Stand ; 29(21): 7, 2015 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-25605065

RESUMEN

Proposed guidance on minimum staffing levels could help struggling A&Es, but should be viewed with caution, according to the RCN.


Asunto(s)
Gravedad del Paciente , Admisión y Programación de Personal/normas , Sociedades de Enfermería/organización & administración , Humanos , Seguridad del Paciente/normas , Admisión y Programación de Personal/ética , Reino Unido
14.
J Nurs Adm ; 44(12): 640-6, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25393140

RESUMEN

The experience of unaddressed moral distress can lead to nurse attrition and/or distancing from patients, compromising patient care. Nurses who are confident in their ethical decision making abilities and moral agency have the antidote to moral distress for themselves and their colleagues and can act as local or institutional ethics resources. We describe a grant-funded model education program designed to increase ethics competence throughout the institution.


Asunto(s)
Atención Ambulatoria/organización & administración , Agotamiento Profesional/prevención & control , Relaciones Interprofesionales/ética , Modelos Educacionales , Principios Morales , Reorganización del Personal , Adulto , Competencia Clínica , Conflicto Psicológico , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Admisión y Programación de Personal/ética , Estados Unidos
15.
Indian J Med Ethics ; 10(4): 259-63, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24152353

RESUMEN

The rapid spread of the novel influenza virus of H1N1 swine origin led to widespread fear, panic and unrest among the public and healthcare personnel. The pandemic not only tested the world's health preparedness, but also brought up new ethical issues which need to be addressed as soon as possible. This article highlights these issues and suggests ethical answers to the same. The main areas that require attention are the distribution of scarce resources, prioritisation of antiviral drugs and vaccines, obligations of healthcare workers, and adequate dissemination and proper communication of information related to the pandemic. It is of great importance to plan in advance how to confront these issues in an ethical manner. This is possible only if a comprehensive contingency plan is prepared with the involvement of and in consultation with all the stakeholders concerned.


Asunto(s)
Control de Enfermedades Transmisibles , Planificación en Desastres , Ética Médica , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Pandemias , Adolescente , Niño , Preescolar , Femenino , Asignación de Recursos para la Atención de Salud/ética , Humanos , India/epidemiología , Lactante , Gripe Humana/prevención & control , Vacunación Masiva/ética , Admisión y Programación de Personal/ética , Embarazo , Adulto Joven
16.
Prehosp Disaster Med ; 28(5): 488-97, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23890578

RESUMEN

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.


Asunto(s)
Servicios Médicos de Urgencia/ética , Guías como Asunto , Ambulancias/ética , Consenso , Humanos , Inutilidad Médica/ética , Seguridad del Paciente , Admisión y Programación de Personal/ética , Negativa al Tratamiento/ética , Factores de Tiempo , Transporte de Pacientes/ética , Transporte de Pacientes/métodos , Estados Unidos
18.
Semin Thorac Cardiovasc Surg ; 24(3): 166-75, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23200071

RESUMEN

Sleep deprivation and fatigue have long been linked with accidents in high-risk industries and serious errors in the medical profession, but their effects on surgical performance are less well understood. This article outlines the important functions that human sleep serves and describes the neurobehavioral effects of wakefulness extension and mental fatigue that are relevant to surgical performance, including attentional failure, risk taking, and decision-making bias. Methods used to explore the effects of sleep deprivation and fatigue on surgical performance, from laboratory studies to outcomes data, are discussed; the findings are summarized; and important deficiencies in the literature are highlighted. Future strategies to mitigate performance decline, such as novel assessment tools and countermeasures with proven efficacy, are presented, and their deployment is discussed in the context of key ethical principles.


Asunto(s)
Competencia Clínica , Fatiga Mental/etiología , Admisión y Programación de Personal , Privación de Sueño/etiología , Procedimientos Quirúrgicos Operativos/educación , Carga de Trabajo , Atención , Conducta de Elección , Cognición , Educación de Postgrado en Medicina , Humanos , Internado y Residencia , Fatiga Mental/prevención & control , Fatiga Mental/psicología , Destreza Motora , Seguridad del Paciente , Admisión y Programación de Personal/ética , Medición de Riesgo , Factores de Riesgo , Asunción de Riesgos , Privación de Sueño/prevención & control , Privación de Sueño/psicología , Procedimientos Quirúrgicos Operativos/ética , Factores de Tiempo
20.
Am J Surg ; 201(1): 16-23, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21167361

RESUMEN

BACKGROUND: the aim of this study was to explore professional values, value conflicts, and assessments of the Accreditation Council for Graduate Medical Education's duty-hour restrictions. METHODS: questionnaires distributed at 15 general surgery programs yielded a response rate of 82% (286 faculty members and 306 residents). Eighteen items were examined via mean differences, percentages in agreement, and significance tests. Follow-up interviews with 110 participants were explored for main themes. RESULTS: residents and faculty members differed slightly with respect to core values but substantially as to whether the restrictions conflict with core values or compromise care. The average resident-faculty member gap for those 13 items was 35 percentage points. Interview evidence indicates consensus over professional values, a gulf between individualistic and team orientations, frequent moral dilemmas, and concerns about the assumption of responsibility by residents and "real-world" training. CONCLUSIONS: the divide between residents and faculty members over conflicts between the restrictions, core values, and patient care poses a significant issue and represents a challenge in educating the next generation of surgeons.


Asunto(s)
Ética Médica , Docentes Médicos , Cirugía General/ética , Internado y Residencia/ética , Atención al Paciente/ética , Admisión y Programación de Personal/ética , Actitud del Personal de Salud , Conflicto Psicológico , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Factores de Tiempo
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