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1.
J Clin Ethics ; 30(4): 347-355, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31851626

RESUMEN

Most professional guidelines advocate family presence during resuscitation (FPDR). Many clinicians, however, are still reluctant to implement this recommendation. In this article I present the most comprehensive case for FPDR to date. I review the little that has been written about the ethics of FPDR, as well as the available empirical evidence. More importantly, I present and defend three arguments for FPDR: adherence to professional guidelines, benefit to patients and relatives, and patients' autonomy. I conclude with suggestions for future research.


Asunto(s)
Reanimación Cardiopulmonar/ética , Cuidados Críticos/ética , Familia , Relaciones Profesional-Familia/ética , Actitud del Personal de Salud , Reanimación Cardiopulmonar/psicología , Cuidados Críticos/psicología , Familia/psicología , Humanos , Guías de Práctica Clínica como Asunto
2.
Enferm. intensiva (Ed. impr.) ; 30(4): 163-169, oct.-dic. 2019. tab
Artículo en Español | IBECS | ID: ibc-184480

RESUMEN

La muerte de un niño en la Unidad de Cuidado Intensivo Pediátrico (UCIP) es difícil, la pérdida genera sentimientos de tristeza y dolor; en este estudio se destacan las diferentes estrategias de afrontamiento utilizadas por las enfermeras para manejar esta situación y poder fortalecerse para brindar cuidado al final de la vida. Objetivo Explorar las estrategias de afrontamiento utilizadas por las enfermeras en la UCIP frente a la muerte. Métodos: Estudio realizado en la ciudad de Manizales, Colombia, durante los meses de octubre, noviembre y diciembre. Se utilizó un enfoque cualitativo, fenomenológico hermenéutico. El método de muestreo fue intencional para la selección de las enfermeras participantes (n = 10) que trabajan en la UCIP; se realizaron entrevistas en profundidad para la construcción de la información y los datos se analizaron según los procedimientos propuestos por Cohen, Kahn y Steeves. Resultados: Las enfermeras utilizan estrategias de afrontamiento centradas en las emociones: inhiben los sentimientos frente al paciente y la familia, usan la comunicación y oración con el paciente, así como el acompañamiento para aliviar el sufrimiento de la familia. Conclusión: Las enfermeras de la UCIP desarrollan estrategias de afrontamiento frente a los cuidados al final de la vida utilizando recursos espirituales y de comunicación con la familia que necesita apoyo permanente, reflexionando ante la muerte y el acompañamiento del niño en su trascendencia


The death of a child in the Paediatric Intensive Care Unit (PICU) is difficult, the loss generates feelings of sadness and pain; this study highlights the different coping strategies used by nurses to manage this situation and find the strength to provide care at the end of life. Objective: Explore the strategies used by nurses in the PICU in coping with death. Methods: Study conducted in the city of Manizales, Colombia, during the months of October, November and December. A qualitative, hermeneutical phenomenological approach was used. The method of intentional sampling for the selection of participating nurses (n = 10) working in PICU, in-depth interviews were conducted for the construction of the information and the data were analyzed according to the procedures proposed by Cohen, Kahn and Steeves. Results: Nurses use coping strategies focused on emotions: they inhibit their feelings towards the patient and their family; they use communication and prayer with the patient, as well as accompaniment to alleviate the suffering of the family. Conclusion: UCIP nurses develop coping strategies for end-of-life care using spiritual resources and communication with the family who require ongoing support, reflecting on death and accompanying the child in its transcendence


Asunto(s)
Humanos , Niño , Unidades de Cuidado Intensivo Pediátrico , Adaptación Psicológica/fisiología , Cuidados Críticos/psicología , Enfermería de Cuidados Paliativos al Final de la Vida/métodos , Cuidados Paliativos al Final de la Vida/psicología , Comunicación
3.
Rev Lat Am Enfermagem ; 27: e3182, 2019.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-31596416

RESUMEN

OBJECTIVE: to evaluate job satisfaction and its relationship with the personal and professional characteristics of the nursing team. METHOD: a descriptive and cross-sectional study with 163 nursing workers from the intensive care units of a teaching hospital. For data collection, the Brazilian version of the Job Satisfaction Survey and a personal and professional characterization form were used. Data were analyzed using descriptive statistics, comparisons and correlations. RESULTS: the professionals demonstrated ambivalence for job satisfaction in a global way and concerning the communication domain. They were satisfied with the supervision, co-workers, and nature of work, while dissatisfied with other domains. There was a correlation between the intention to stay in the job and the majority of the Job Satisfaction Survey domains, except for co-workers and operating procedures, and a correlation between time working at the unit and at the institution with the domains pay, contingent rewards, and supervision. CONCLUSION: there was an ambivalence regarding job satisfaction and the variables intention of stay in the job and time working at the unit and at the institution were correlated with job satisfaction concerning the domains pay, contingent rewards, and supervision.


Asunto(s)
Cuidados Críticos/psicología , Unidades de Cuidados Intensivos , Satisfacción en el Trabajo , Personal de Enfermería en Hospital/psicología , Adulto , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
4.
Z Gerontol Geriatr ; 52(Suppl 4): 243-248, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31602507

RESUMEN

The use of freedom-depriving measures (physical and medicinal restraints) in people with cognitive impairment or dementia in clinical care settings is of ongoing importance. At the same time, these coercive measures are not only heavily debated but also in most cases ethically questionable from the perspective of the ethics of human dignity. Usually, the ethical evaluation of freedom-depriving measures follows classical paradigms of medical ethics, such as the Principles of Biomedical Ethics by Beauchamp and Childress. To enrich the debate at this point, the ethical category of embodiment ("Leiblichkeit" ) is introduced and discussed after a short summary of the ethical problem at hand. The phenomenon of the living body that has received increasingly more attention in several sciences since the proclaimed "corporeal turn" enables new perspectives towards human dignity, freedom and deprivation of freedom: freedom-depriving measures do not take place in an invisible realm of ideas but are directly applied to the psychophysical unity that is the living body of a person. Thus, freedom-depriving measures are an intervention into the bodily autonomy of the human being and the personal freedom that is manifested in the living body. The concept of the living body ("Leib") that is applied here, signifies more than just a physical object and is especially apt to capture the (inter)subjective dimension that has to be taken into account here. Finally, it will have to be investigated whether the use of medicinal restraints represents an especially serious interference into the sphere of human embodiment. Once introduced into the debate on freedom-depriving measures in clinical care, the category of embodiment can warrant decisive new emphases.


Asunto(s)
Cuidados Críticos/ética , Demencia/terapia , Libertad , Derechos del Paciente/ética , Autonomía Personal , Respeto , Cuidados Críticos/psicología , Toma de Decisiones , Ética Médica , Humanos
5.
J Rehabil Med ; 51(8): 598-606, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31402389

RESUMEN

OBJECTIVES: To assess the feasibility of in-reach rehabilitation for critical care survivors following discharge from the intensive care unit. To determine whether additional in-reach rehabilitation reduces hospital length-of-stay and improves outcomes in critical care survivors, compared with usual therapy. PARTICIPANTS: A total of 66 consecutively-admitted critical care survivors with an intensive care unit stay ≥ 5 days were enrolled in the study. Of these, 62 were included in the analyses. METHODS: Pilot randomized control trial with blinded assessment at 6 and 12 months. The intervention group (n = 29) received in-reach rehabilitation in addition to usual ward therapy. The usual-care group (n = 33) received usual ward therapy. The primary outcome assessed was length-of-stay. Secondary outcomes included mobility, functional independence, psychological status and quality-of-life. RESULTS: The intervention group received more physiotherapy and occupational therapy sessions per week than the usual-care group (median = 8.2 vs 4.9, p < 0.001). Total length-of-stay was variable; while median values differed between the intervention and usual care groups (median 31 vs 41 days), this was not significant and the pilot study was not adequately powered (p = 0.57). No significant differences were observed in the secondary outcomes at hospital discharge, 6- or 12-month follow-ups. CONCLUSION: Provision of intensive early rehabilitation to intensive care unit survivors on the acute ward is feasible. A further trial is needed to draw conclusions on how this intervention affects length-of-stay and functional outcomes.


Asunto(s)
Cuidados Críticos/psicología , Unidades de Cuidados Intensivos/normas , Rehabilitación/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Sobrevivientes , Resultado del Tratamiento , Adulto Joven
6.
JAMA ; 322(3): 216-228, 2019 07 16.
Artículo en Inglés | MEDLINE | ID: mdl-31310297

RESUMEN

Importance: The effects of intensive care unit (ICU) visiting hours remain uncertain. Objective: To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium. Design, Setting and Participants: Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants were recruited from April 2017 to June 2018, with follow-up until July 2018. Interventions: Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation. Main Outcomes and Measures: Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU. Secondary outcomes included ICU-acquired infections for patients; symptoms of anxiety and depression assessed using the HADS (range, 0 [best] to 21 [worst]) for family members; and burnout for ICU staff (Maslach Burnout Inventory). Results: Among 1685 patients, 1295 family members, and 826 clinicians enrolled, 1685 patients (100%) (mean age, 58.5 years; 47.2% women), 1060 family members (81.8%) (mean age, 45.2 years; 70.3% women), and 737 clinicians (89.2%) (mean age, 35.5 years; 72.9% women) completed the trial. The mean daily duration of visits was significantly higher with flexible visitation (4.8 vs 1.4 hours; adjusted difference, 3.4 hours [95% CI, 2.8 to 3.9]; P < .001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, -1.7% [95% CI, -6.1% to 2.7%]; P = .44). Among 9 prespecified secondary outcomes, 6 did not differ significantly between flexible and restricted visitation, including ICU-acquired infections (3.7% vs 4.5%; adjusted difference, -0.8% [95% CI, -2.1% to 1.0%]; P = .38) and staff burnout (22.0% vs 24.8%; adjusted difference, -3.8% [95% CI, -4.8% to 12.5%]; P = .36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, -1.6 [95% CI, -2.3 to -0.9]; P < .001) and depression scores (4.0 vs 5.0; adjusted difference, -1.2 [95% CI, -2.0 to -0.4]; P = .003) were significantly better with flexible visitation. Conclusions and Relevance: Among patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium. Trial Registration: ClinicalTrials.gov Identifier: NCT02932358.


Asunto(s)
Delirio/prevención & control , Familia/psicología , Unidades de Cuidados Intensivos/organización & administración , Visitas a Pacientes , Ansiedad , Brasil , Agotamiento Profesional , Cuidados Críticos/psicología , Estudios Cruzados , Depresión , Femenino , Educación en Salud , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Tiempo
7.
JAMA ; 322(3): 229-239, 2019 07 16.
Artículo en Inglés | MEDLINE | ID: mdl-31310299

RESUMEN

Importance: Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. Objectives: To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. Design, Setting, and Participants: Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. Interventions: Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. Main Outcomes and Measures: The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. Results: Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. Conclusions and Relevance: Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02519725.


Asunto(s)
Cuidados Críticos/psicología , Unidades de Cuidados Intensivos , Respiración Artificial/psicología , Trastornos por Estrés Postraumático/prevención & control , Anciano , Familia/psicología , Femenino , Personal de Salud/psicología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Registros
9.
Int J Surg ; 68: 20-26, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31185311

RESUMEN

BACKGROUND: Communication skills may be an important skill for the front-line emergency physicians. AIM: This study aimed to investigate the effect of training in a SHARE communication course by emergency physicians on patient notification and signing of do-not-resuscitate (DNR) orders for critical patients in the emergency room. DESIGN: From a total of 29 attending physicians in the emergency department, 19 physicians had been trained in the SHARE communication course. An observation form designed based on the SHARE training was completed by two observers who noted the communication process between physicians and patients and family members during patient notification and signing a DNR order. To assess the influence of physicians trained in a SHARE communication course on the signing of DNR orders, a propensity score-matched population was created to reduce the potential selection bias of patients and family members. SETTING: Level 1 trauma medical center in southern Taiwan. RESULTS: There were 145 individuals enrolled in the study, of which 93 signed the DNR order, and 52 did not sign it. Analysis from 23 matched pairs from this population revealed that significantly more family members would sign a DNR order if the physician had been trained in the SHARE communication course than when they did not receive this training (78.3% vs. 39.1%, respectively, p = 0.017). The overall score of the observation form for physicians was higher in those individuals who had signed a DNR order than in those who did not sign it (29.48 ±â€¯3.72 vs. 26.13 ±â€¯3.52, respectively, p = 0.003), especially when the physician had chosen a quiet environment (1.35 ±â€¯0.65 vs. 0.87 ±â€¯0.69, respectively, p = 0.020), understood the patient's wishes and confirmed them (1.78 ±â€¯0.42 vs. 1.30 ±â€¯0.70, respectively, p = 0.008), and expressed concern (1.48 ±â€¯0.79 vs. 0.96 ±â€¯0.77, respectively, p = 0.028). In addition, a feedback survey about the feelings experienced by these physicians during the process of patient notification did not reveal a significant difference during the communication with those who had or had not signed DNR orders. CONCLUSION: The training in a SHARE communication course can improve the communication skills of emergency physicians in patient notification and signing of DNR orders for critical patients.


Asunto(s)
Comunicación , Cuidados Críticos/psicología , Educación Médica/métodos , Médicos/psicología , Órdenes de Resucitación/psicología , Adulto , Estudios Transversales , Servicio de Urgencia en Hospital , Familia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rol del Médico/psicología , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios , Taiwán , Enseñanza
10.
Rev Infirm ; 68(252): 30-31, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31208596

RESUMEN

The hospital is a healthcare setting in which staff often manage acute health situations. Patients, families and healthcare professionals constantly interact, often against a background of emergencies and anxiety. In such contexts, communication plays an important role in establishing a compassionate relationship. Does humour have a place in this relationship? If so, in what form and what are the benefits for the teams and the patients?


Asunto(s)
Cuerpo Médico de Hospitales/psicología , Relaciones Profesional-Familia , Relaciones Profesional-Paciente , Ingenio y Humor como Asunto , Ansiedad , Comunicación , Cuidados Críticos/psicología , Empatía , Humanos
11.
J Clin Nurs ; 28(21-22): 3991-4003, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31241805

RESUMEN

AIMS AND OBJECTIVES: To explore aspects that promote and challenge long-term ICU patients' inner strength and willpower. BACKGROUND: Considerable research has been devoted to ICU patients' experiences; however, research on long-term ICU patients is limited. Studies in a health-promoting perspective focusing on long-term ICU patients' inner strength and willpower are scarce. DESIGN: A qualitative, hermeneutic-phenomenological approach, using in-depth interviews. METHODS: Seventeen long-term Norwegian ICU patients were interviewed once, at 6-18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Data S1). RESULTS: The lived experience of the phenomenon "inner strength and willpower" and what promotes and challenges this phenomenon in long-term ICU patients were represented by four main themes and nine subthemes. Promoting aspects comprised of two main themes and five subthemes: (a) "No doubt about coming back to life" with subthemes; "Strong connectedness to life; feeling alive and present," "Meaning and purpose; feeling valuable to somebody." (b) "How to ignite and maintain the spark of life," with the subthemes: "Practical solutions, coping skills from previous life experiences," "Provocative and inspiring experiences" and "Vivid dream experiences that ignite the willpower." Two main categories and four subcategories represented challenging aspects: (a) Exhaustion, weakness and discomfort; subthemes; "Physical challenges" and "Mental discomfort" and (b) "Tiring delusions," subthemes; "Living in the worst horror movie" and "Feeling trapped." CONCLUSION: This study expands on previous studies by providing insights about what promotes and challenges long-term ICU patients' inner strength and willpower during their recovery trajectory. RELEVANCE TO CLINICAL PRACTICE: Insights into the variety of long-term ICU patients' experiences during the recovery trajectory are important for ICU nurses to support and facilitate ICU patients' inner strength and willpower.


Asunto(s)
Adaptación Psicológica , Cuidados Críticos/psicología , Adulto , Anciano , Enfermedad Crítica/enfermería , Enfermedad Crítica/psicología , Femenino , Hermenéutica , Humanos , Masculino , Persona de Mediana Edad , Noruega , Investigación Cualitativa , Estudios Retrospectivos
12.
J Adv Nurs ; 75(8): 1792-1804, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31037742

RESUMEN

AIM: With increasing age and chronicity in populations, the need to reduce the costs of care while enhancing quality and hospital avoidance, is important. Nurse-led co-ordination is one such model of care that supports this approach. The aim of this research was to assess the impact that newly appointed Navigators have on service provision; social and economic impact; nurses' professional quality of life and compassion fatigue; and analysis of the change that has occurred to models of care and service delivery. DESIGN: A concurrent mixed-method approach was selected to address the research aims. METHODS: The research project was funded in July 2018 and will conclude in December 2020. Several cohorts will be studied including; patients assigned to a navigator, patients not assigned to a navigator, family members of patients assigned a navigator; and a sample sized estimated at 140 navigators. DISCUSSION: This study provides a comprehensive international longitudinal and mixed method framework for evaluating the impact of nurse navigators on quality of care outcomes for patients with chronic conditions. IMPACT-WHAT PROBLEM WILL THE STUDY ADDRESS?: Even with specialty focused co-ordinated care, patients get lost in the system, increasing the incidence of non-compliance and exacerbation of condition. Navigators work with patients across service boundaries allowing for care that is patient responsive, and permitting variables in clinical, social and practical elements of care to be addressed in a timely manner. This novel nurse-led approach, supports hospital avoidance and patient self-management, while encouraging expansion and opportunity for the nursing and midwifery workforce.


Asunto(s)
Enfermedad Crónica/terapia , Cuidados Críticos/psicología , Familia/psicología , Rol de la Enfermera/psicología , Atención de Enfermería/organización & administración , Navegación de Pacientes/organización & administración , Calidad de Vida/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
13.
Rev Bras Ter Intensiva ; 31(2): 164-170, 2019 May 23.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31141084

RESUMEN

OBJECTIVES: To evaluate the satisfaction of patients admitted to the intensive care unit using a diary and analyze possible points for improving this instrument. METHODS: This was an observational, retrospective study, conducted between March 2014 and July 2017, in a multidisciplinary intensive care unit of a district hospital. The diary was implemented in patients sedated for 3 or more days. Three months after discharge, their satisfaction was assessed using a questionnaire. A patient who agreed with the 5 statements assessing the diary's help in clarifying the intensive care unit stay, in filling memory gaps, in recovery, in reassurance, and in the recommendation of this intervention was defined as satisfied. RESULTS: A total of 110 patients were included, of whom 55 answered the questionnaire. Of these, 36 (65.5%) were classified as satisfied. Each item had a positive response in more than 74% of cases. A total of 60% of the participants suggested increasing the number of photographs. No significant differences were found in the subgroup analysis (age, sex, duration of sedation and ventilation, length of diary keeping, severity on admission, or delirium, depression, or anxiety in the intensive care unit). CONCLUSIONS: Most patients were satisfied with the diary but suggested an increase in the number of photographs.


Asunto(s)
Cuidados Críticos/psicología , Prioridad del Paciente , Satisfacción del Paciente , Adulto , Anciano , Ansiedad/epidemiología , Delirio/epidemiología , Depresión/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y Cuestionarios
15.
J Clin Nurs ; 28(17-18): 3210-3221, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31017337

RESUMEN

AIM: To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. BACKGROUND: The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such as the proximity to death and the pressure of work. DESIGN: A constructivist grounded theory approach with constant comparative analysis. METHODS: As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis, an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS: The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding, and the data presented reveal the challenges that nurses experience along the way. CONCLUSION: The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. RELEVANCE TO CLINICAL PRACTICE: Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially, this limits nurses' ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds have contributed further to occupational stress in this care setting.


Asunto(s)
Enfermería de Cuidados Críticos/métodos , Cuidados Críticos/psicología , Supervivencia , Adulto , Familia/psicología , Femenino , Teoría Fundamentada , Humanos , Masculino , Investigación Cualitativa
17.
Enferm. glob ; 18(54): 79-93, abr. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-183478

RESUMEN

Objetivo: Analizar los niveles preliminares de estrés, Burnout y depresión entre los auxiliares y técnicos de enfermería que trabajan en las unidades de cuidados intensivos de algunos servicios hospitalarios privados.Método: Estudio de enfoque cuantitativo-analítico y transversal, en 3 servicios hospitalarios privados y en 4 unidades de terapia intensiva. El instrumento de recolección de datos se compuso de 5 cuestionarios validados: perfil socioeconómico y demográfico, sintomatología del estrés en Bacarro, Escala de Estrés en el Trabajo, Cuestionario de JBeili, versión brasileña inspirada en el Maslach Burnout Inventory (versión HSS - Human Services Survey) el Inventario de Depresión de Beck, todos los datos fueron tratados a través de la estadística analítica.Resultados: Fueron abordados 72 auxiliares y técnicos de enfermería, donde la mayoría era del sexo femenino (52,8%), técnicos en enfermería (95,8%), entre 31 a 35 años (27,8%), casados (54,2%) y con 2 o más vínculos de trabajo (62,5%). En la fase inicial del síndrome de Burnout (68,1%) y con cuadro disfórico-depresivo (45,4%) en Bacarro, con estrés leve (66,7%) en la escala de estrés en el trabajo, en la fase inicial del síndrome de Burnout (68,1%) y con cuadro disfórico-depresivo (45,8%).Conclusión: Las unidades de cuidados intensivos son ambientes insalubres, potencialmente tensiogénicos y con elevada tasa de absentismo. Los participantes del estudio mantienen doble jornada de trabajo, en su mayoría mujeres y con hijos, presentando escores preocupantes de estrés, Burnout y depresión


Objetivo: Analisar os níveis preliminares de estresse, Burnout e depressão entre os auxiliares e técnicos de enfermagem que trabalham nas unidades de terapia intensiva de alguns serviços hospitalares privados.Método: Estudo de abordagem quantitativo-analítica e transversal, em 3 serviços hospitalares privados e em 4 unidades de terapia intensiva. O instrumento de coleta dos dados foi composto de 5 questionários validados: perfil socioeconômico e demográfico, sintomatologia do estresse em Bacarro, Escala de Estresse no Trabalho, Questionário de JBeili, versão brasileira inspirada no Maslach Burnout Inventory (versão HSS - Human Services Survey) e o Inventário de Depressão de Beck, todos dados foram tratados através da estatística analítica. Resultados: Foram abordados 72 auxiliares e técnicos de enfermagem, onde a maioria era do sexo feminino (52,8%), técnicos em enfermagem (95,8%), entre 31 a 35 anos (27,8%), casados (54,2%) e com 2 ou mais vínculos empregatícios (62,5%). Classificados com estresse moderado (70,8%) em Bacarro, com estresse leve (66,7%) na escala de estresse no trabalho, na fase inicial da síndrome de Burnout (68,1%) e com quadro disfórico-depressivo (45,8%).Conclusão: As unidades de terapia intensiva são ambientes insalubres, potencialmente tensiogênicos e com elevada taxa de absenteísmo. Os participantes do estudo mantêm dupla jornada de trabalho, em sua maioria mulheres e com filhos, apresentando escores elevados de estresse, Burnout e depressão


Objective: To analyze the preliminary levels of stress, Burnout and depression among nursing assistants and technicians working at intensive care units of some private hospital services.Method: A quantitative-analytical and cross-sectional study in three private hospital services and in four intensive care units. The data collection instrument consisted of five validated questionnaires: socioeconomic and demographic profile, stress symptomatology in Bacarro, Work Stress Scale, JBeili Questionnaire, Brazilian version inspired by the Maslach Burnout Inventory (HSS - Human Services Survey) and the Beck Depression Inventory, all data were treated using analytical statistics.Results: The study included 72 nursing assistants and technicians, the majority was female (52.8%), nursing technician (95.8%), aged 31-35 years old (27.8%), married (54,2%) and with two or more employments (62.5%). They were classified with moderate stress (70.8%) in Bacarro, with mild stress (66.7%) on the work stress scale, in initial phase of Burnout syndrome (68.1%) and with dysphoric-depressive symptoms (45,8%).Conclusion: Intensive care units are potentially tensiogenic unhealthy environments and with high absenteeism rates. The study participants keep double working hours, mostly women and with children, presenting high scores of stress, Burnout and depression


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Cuidados Críticos/psicología , Atención de Enfermería/psicología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/epidemiología , Depresión/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Enfermería de Cuidados Críticos/estadística & datos numéricos , Factores de Riesgo , Condiciones de Trabajo
20.
Am J Bioeth ; 19(3): 21-28, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30896352

RESUMEN

If a doctor is trying to decide whether or not to provide a medical treatment, does it matter ethically whether that treatment has already been started? Health professionals sometimes find it harder to stop a treatment (withdraw) than to refrain from starting the treatment (withhold). But does that feeling correspond to an ethical difference? In this article, we defend equivalence-the view that withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. We argue that preference for withholding over withdrawal could represent a form of cognitive bias-withdrawal aversion. Nevertheless, we consider whether there could be circumstances in which there is a moral difference. We identify four examples of conditional nonequivalence. Finally, we reflect on the moral significance of diverging intuitions and the implications for policy. We propose a set of practical strategies for helping to reduce bias in end-of-life decision making, including the equivalence test.


Asunto(s)
Toma de Decisiones Clínicas/ética , Cuidados Críticos/ética , Cuidados Críticos/psicología , Ética Médica , Personal de Salud/psicología , Privación de Tratamiento/ética , Humanos , Principios Morales , Privación de Tratamiento/legislación & jurisprudencia
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