A survey of the allocation of scarce resources in Türkiye during the COVID-19 pandemic: Which criteria did healthcare professionals prioritize?

COVID-19 caused an imbalance between medical resources and the number of patients in Türkiye like in many countries. There was not pandemic-triage system, and this situation led to decision making based on experience, intuition, and judgment of allocation of scarce resources. The research explains the guiding criteria that healthcare professionals used to prioritize the distribution of scarce medical resources during the COVID-19 pandemic. The criteria preferred by 928 healthcare professionals were evaluated when preventive measures for COVID-19 were reduced and so the number of cases increased rapidly. The results indicate that Turkish healthcare professionals largely support the utilitarian approach, which focuses on medical benefit in pandemic. The main problem was that some criteria not approved in COVID-19 triage guidelines were considered important by healthcare professionals. These criteria, which cause discrimination by preventing the provision of fair and equal medical care to patients, are a prominent issue in the study.

Paediatric oncology patients' definitions of a good physician and good nurse.

BACKGROUND: It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults. OBJECTIVE: The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients. RESEARCH DESIGN: In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT: Eighteen children hospitalised due to cancer in paediatric oncology and haematology clinics of a university hospital in Turkey. ETHICAL CONSIDERATIONS: Permission to conduct the study was obtained from the Institution's Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality. FINDINGS: The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics. CONCLUSION: Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan.

Respectful care of human dignity: how is it perceived by patients and nurses?

OBJECTIVE: Dignified care protects the patient's rights and provides appropriate ethical care while improving the quality of nursing care. In this context, the opinions of nurses and patients who receive nursing care about dignified care are important. The aim of this study was to explore the opinions and experiences of Turkish patients and nurses about respectful care of human dignity. METHODS: This descriptive cross-sectional study was conducted in Turkey. Participants were inpatients at cardiology, neurology and neurosurgery clinics and nurses working in these clinics. The data for the study were collected from face-to-face interviews using questionnaires. The percentages of characteristics and preferences of the participants were calculated, and the results were analysed using statistical tests. RESULTS: A total of 150 patients and 78 nurses participated in the study. The patients stated that the protection of their rights was the most important factor for dignified nursing care. The nurses stated that being careful to not expose the patients' body and being respectful of the patients' privacy were important in dignified nursing care. The age of the patient, duration of the disease, number of hospitalisations and length of time the nurses had been working at the clinic caused significant changes in the factors considered important in dignified care. CONCLUSIONS: Our findings provide a perspective on dignified care in the Turkish healthcare setting. There were some differences between patients and nurses in the factors considered important for dignified care. The discussion with patients and nurses related to care and practices that protect or detract from human dignity can provide insights to ethics.

Attributes of a good nurse.

BACKGROUND: The opinions of students regarding the attributes of a good nurse can make a major contribution to the planning and the conducting of professional education. There are few studies which aim at identifying the qualifications of a good nurse from the perspectives of nursing students. OBJECTIVES: To determine the opinions of first- and fourth-year nursing students concerning the 'attributes of a good nurse', and whether and how their views change depending on their year of study. RESEARCH DESIGN: Descriptive research. Participants and research context: This study was conducted in the nursing department of a vocational school of health in the 2010/2011 academic year. The study participants consisted of first-year and intern students. A survey form was used to identify characteristics of participants, and students were asked the following open-ended question about their opinions related to the attributes of a good nurse. Ethical considerations: The permission was taken from the school administration. Informed consent was obtained, and anonymity was ensured for participating students. FINDINGS: A total of 120 students participated in this study. Most frequently expressed attributes were 'professional competence' in first-year and 'responsibility' in fourth-year students. While first-year students placed a greater emphasis on the attributes of 'geniality', 'patience', 'calmness', 'love of nursing', 'loyalty to nursing' and 'not attaching importance to material values', fourth-year students emphasized the attributes of 'empathy', 'honesty', 'responsibility' and 'scientific curiosity' significantly more. DISCUSSION AND CONCLUSION: Fourth-year students placed a greater emphasis on the attributes which the students are expected to acquire through a nursing program and clinical experience. However, they mentioned the attributes related to a good nurse-patient relationship and communication significantly less. Appropriate ethical training methods and good role models can help students acquire attributes that are important for the nursing profession and combine them with the attributes they already have.

Comparing assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool.

OBJECTIVE: To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool. METHODS: This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T. RESULTS: Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients' relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients' relatives were statistically significant. CONCLUSIONS: Our findings demonstrate those physicians, nurses and the patients' relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations.

The Nursing Students' Views About the Patient's Rights at the West Black Sea Universities in Turkey.

BACKGROUND: The members of healthcare team have an important role in implementation and protection of patient's rights. Contemporary nursing entails an ethical responsibility to advocate and protect the patients' rights. OBJECTIVES: This study was designed to evaluate how ready nursing students, at the end of their education, were to play the role of patient's rights advocates and to discuss ethics education in nursing. MATERIALS AND METHODS: This descriptive study was performed on nursing students at Black Sea Universities in the academic year 2010-2011. Data were collected using a structured questionnaire about students' attitudes regarding patients' rights including patient's rights regulations. The association between gender and students' attitudes was analyzed using Chi-square test. RESULTS: The mean age of the 238 participants was 22.11 ± 1.21 years and 82.8% of them were female. The majority of the nursing students held desirable attitudes toward patient information, truth telling, and protection of patients' privacy and medical records. However, the students' views about the rights of patients to refuse treatment, children's active participation in treatment, prioritization of the quality of life in treatment, and respect for the rights of dying patients were less satisfactory. CONCLUSIONS: The results of this study was concerning with regard to nursing students' readiness for duties such as patient's rights advocacy. Therefore, it proposes ethics education that covers both patient's rights and the obligations of nurses to defend these rights.

Preliminary Turkish study of psychiatric in-patients' competence to make treatment decisions.

INTRODUCTION: Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases. METHODS: This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). RESULTS: The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups. DISCUSSION: These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders.

[Informed consent in emergency medicine]. / Acil tip'ta aydinlatilmis onam.

Informed consent is a prerequisite for the ethical and legal validity of the emergency intervention in emergency medicine, since it protects the fiduciary relationship between the physician and patient; the principle of honesty that grounds this relationship; the principle of autonomy that necessitates right of self-determination; and the principle of respect for persons. Informed consent in emergency medicine, which is supposed to include the nature, benefits and risks of emergency medical intervention, differentiates with respect to definite groups of patients: (1) conscious patients, (2) unconscious patients, and (3) children and mature minors. In addition, informed consent differentiates between medical, psychological and even social circumstances of the patients, referred to as valid consent, expressed-explicit consent, blanket consent, presumed consent, tacit consent, proxy consent, and parental consent. There are a few exceptions in which emergency medical intervention is administered without informed consent. In addition to the exceptions of life-saving interventions, when a patient can not decide for herself/himself, intervention of the physician in the best interest of the patient or children is based on the "therapeutic privilege" of the physician. As an ethically defensible right, since therapeutic privilege may open a door to hard paternalistic approaches, in those situations, emergency physicians should be cautious not to violate a patient's autonomy.

Attitudes to end-of-life decisions in paediatric intensive care.

The aim of this study was to assess attitudes of intensive care nurses to selected ethical issues related to end-of-life decisions in paediatric intensive care units. A self-administered questionnaire was distributed in 2005 to intensive care nurses at two different scientific occasions in Turkey. Of the 155 intensive care nurse participants, 98% were women. Fifty-three percent of these had intensive care experience of more than four years. Most of the nurses failed to agree about withholding (65%) or withdrawing (60%) futile treatment. In addition, 68% agreed that intravenous nutrition must continue at all costs. In futile treatment cases, the nurses tended to leave the decision to parents or act maternalistically. The results showed that intensive care nurses could ignore essential ethical duties in end-of-life care. We suggest that it is necessary to educate Turkish intensive care nurses about ethical issues at the end of life.