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Nurs Inq ; 27(1): e12316, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31398774


Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late-stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day-to-day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms.

J Empir Res Hum Res Ethics ; : 1556264619872366, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31469349


Little is known about how research assistants (RAs) protect participants in vulnerable circumstances. Using a critical qualitative method informed by feminist ethics, we ran five focus groups with experienced RAs. We identified two themes: (a) expressing moral competencies (subthemes: recognizing power, privilege, and vulnerability; adapting processes and providing support; understanding the sources of moral competencies) and (b) negotiating and making transparent roles and responsibilities (subthemes: separating responsibilities as a clinician from those of an RA; critically reflecting on the shared responsibilities of principal investigators and RAs; and identifying the role of the Research Ethics Committee). Although RAs possess a variety of moral competencies and have an important role in protecting research participants in vulnerable circumstances, that role is largely unrecognized.

Nurs Ethics ; : 969733019848031, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122121


Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%). Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process.

Nurs Ethics ; : 969733019843634, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113269


BACKGROUND: The decision whether to initiate cardiopulmonary resuscitation may sometimes be ethically complex. While studies have addressed some of these issues, along with the role of nurses in cardiopulmonary resuscitation, most have not considered the importance of nurses acting as advocates for their patients with respect to cardiopulmonary resuscitation. RESEARCH OBJECTIVE: To explore what the nurse's advocacy role is in cardiopulmonary resuscitation from the perspective of patients, relatives, and health professionals in the Basque Country (Spain). RESEARCH DESIGN: An exploratory critical qualitative study was conducted from October 2015 to March 2016. Thematic analysis was used to analyse the data. PARTICIPANTS: Four discussion groups were held: one with patients and relatives (n = 8), two with nurses (n = 7 and n = 6, respectively), and one with physicians (n = 5). ETHICAL CONSIDERATIONS: Approval was obtained from the Basque Country Clinical Research Ethics Committee. FINDINGS: Three significant themes were identified: (a) accompanying patients during end of life in a context of medical dominance, (b) maintaining the pact of silence, and (c) yielding to legal uncertainty and concerns. DISCUSSION: The values and beliefs of the actors involved, as well as pre-established social and institutional rules reduced nurses' advocacy to that of intermediaries between the physician and the family within the hospital environment. On the contrary, in primary health care, nurses participated more actively within the interdisciplinary team. CONCLUSION: This study provides key information for the improvement and empowerment for ethical nursing practice in a cardiac arrest, and provides the perspective of patients and relatives, nurses and physicians.

Aten. prim. (Barc., Ed. impr.) ; 51(5): 269-277, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180875


Objetivo: Explorar la percepción acerca de la presencia de familiares durante la reanimación cardiopulmonar (RCP) en pacientes adultos, de los propios pacientes y familiares, enfermeras y médicos. Diseño: Se desarrolló un estudio cualitativo exploratorio y un análisis temático. Emplazamiento: Atención Primaria, Atención Hospitalaria y Servicio de Emergencias del Servicio Vasco de Salud. Participantes: La selección de los participantes se realizó a través de muestreo intencional. Se desarrollaron 4 grupos de discusión: uno de pacientes y familiares, 2 de enfermeras y uno de médicos. Método: Se realizó un análisis temático. Se utilizaron técnicas de triangulación entre investigadores e investigador-informante. Se utilizó el programa informático Open Code 4.1. Resultados: Se identificaron 3 categorías significativas: impacto de la actuación en la familia; peso de la responsabilidad ética y legal; poder, lugar donde sucede la parada y supuestos culturales. Conclusiones: La RCP es un constructo social influido por los valores de los contextos socioculturales específicos. En este estudio, los pacientes y familiares describieron temor y resistencia a presenciar la RCP. Por su parte, los profesionales sanitarios consideran que su decisión reviste complejidad, siendo necesario valorar cada caso de forma independiente e integrando a pacientes y familiares en la toma de decisiones. Como líneas de investigación futuras sería recomendable profundizar sobre la experiencia subjetiva de familiares que hayan presenciado la RCP y el impacto de los elementos contextuales y socioculturales en sus percepciones

Objective: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. Design: A qualitative exploratory study and thematic analysis were developed. Site: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. Participants.The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians. Method: Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used. Results: Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions. Conclusions: CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Acompanhantes Formais em Exames Físicos/normas , Reanimação Cardiopulmonar/normas , Parada Cardíaca/terapia , Tratamento de Emergência/normas , Temas Bioéticos/normas , Percepção Social , Medo , Atitude do Pessoal de Saúde , Pesquisa Qualitativa , Grupos Focais/métodos
Nurs Inq ; 26(1): e12269, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30412326


Many studies have examined clinical and institutional moral problems in the practice of nurses that have led to the experience of moral distress. The causes and implications of moral distress in nurses, however, have not been understood in terms of their implications from the perspective of virtue ethics. This paper analyzes how nurses reach for the telos of their practice, within a context of moral distress. A qualitative case study was carried out in a private hospital in Brazil. Observation and semi-semistructured interviews were conducted with 13 nurse participants. With the aid of ATLAS.ti software, the data were analyzed by using thematic content analysis using virtue ethics to theorize the findings. These nurses experienced a loss of their nursing identity as they encountered an ambiguous telos and the domination of institutional values. In their reach for the telos of their practice, nurses found an environment permeated by ethical challenges, which not only created moral distress but also created professional invisibility, a phenomenon referred to as 'invisibility of the self'.

Ética em Enfermagem , Enfermeiras e Enfermeiros/psicologia , Estresse Psicológico/etiologia , Adulto , Brasil , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Estresse Psicológico/psicologia
Aten Primaria ; 51(5): 269-277, 2019 05.
Artigo em Espanhol | MEDLINE | ID: mdl-29571750


OBJECTIVE: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. DESIGN: A qualitative exploratory study and thematic analysis were developed. SITE: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. PARTICIPANTS: The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians. METHOD: Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used. RESULTS: Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions. CONCLUSIONS: CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives.

Texto & contexto enferm ; 28: e20180157, 2019.
Artigo em Inglês | LILACS-Express | ID: biblio-1043485


ABSTRACT Objective: to analyze how intensive care nurses practice patient advocacy in view of the need for hospitalization by court order to an intensive care due to bed unviability. Method: analytical exploratory qualitative research. Data were obtained through interviews with 42 nurses, selected via snowball sampling, between January and December 2016. The interviews were analyzed using elements of the Discursive Textual Analysis. Results: two categories emerged: 1) Between obedience to the law and the ethical-moral duty of the intensive care nurse; 2) The position of nurses in the practice of patient advocacy for patients requiring intensive care beds. Conclusions: intensive care nurses exercise sensitivity and moral duty of the care process when defending their patients by informing them of their rights, guiding, acting and talking to and on behalf of patients and their families, valuing care free of judgment and harm to the patient hospitalized by court order.

RESUMEN Objetivo: analizar cómo los enfermeros de cuidados intensivos practican la defensa del paciente en vista de la necesidad de hospitalización por orden judicial a cuidados intensivos debido a la inviabilidad de la cama. Método: investigación exploratoria, analítica cualitativa. Los datos se obtuvieron a través de entrevistas con 42 enfermeros, seleccionados mediante muestreo de bola de nieve, entre enero y diciembre de 2016. Las entrevistas se analizaron utilizando elementos del Análisis textual discursivo. Resultados: surgieron dos categorías: 1) Entre la obediencia a la ley y el deber ético-moral del enfermero de cuidados intensivos; 2) La posición de los enfermeros en la práctica de la defensa del paciente para pacientes que requieren camas de cuidados intensivos. Conclusiones: los enfermeros de cuidados intensivos ejercen la sensibilidad y el deber moral del proceso de atención cuando defienden a sus pacientes informándoles sobre sus derechos, guiándoles, actuando y hablando con y en nombre de los pacientes y sus familias, valorando la atención libre de juicio y daños al paciente hospitalizado por orden judicial.

RESUMO Objetivo: analisar como enfermeiros intensivistas têm exercido a advocacia do paciente diante da necessidade de internação em unidade de terapia intensiva por ordem judicial, perante in/viabilidade de leito. Método: pesquisa qualitativa exploratória, analítica. Os dados foram obtidos através da realização de entrevistas com 42 enfermeiros, selecionados mediante amostragem por bola de neve, entre janeiro e dezembro de 2016. As entrevistas foram analisadas mediante elementos da Análise Textual Discursiva. Resultados: emergiram duas categorias: 1) Entre a obediência à lei e o dever ético-moral do enfermeiro intensivista e; 2) A posição dos enfermeiros no exercício da advocacia do paciente que necessita de leito na terapia intensiva. Conclusões: enfermeiros intensivistas exercem a sensibilidade e dever moral do processo de cuidar quando defendem seus pacientes informando-os sobre seus direitos, orientando, agindo e falando sobre e em nome dos pacientes e seus familiares, prezando por um cuidado livre de julgamentos e prejuízos ao paciente que interna através da ordem judicial.

Can J Cardiol ; 34(7): 850-862, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29960614


Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.

Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios , Telemedicina/métodos , Sinais Vitais/fisiologia , Humanos
Clin Nurs Res ; : 1054773818791085, 2018 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-30051734


The aim of this scoping review is to synthesize the academic and gray literature on the use of immediate staff debriefing following seclusion or restraint events in inpatient mental health settings. Multiple electronic databases were searched to identify literature on the topic of immediate staff debriefing. The analysis identified several core components of immediate staff debriefing: terminology, type, critical reflection, iterative process, training, documentation, and monitoring. While these components were regarded as vital to the implementation of debriefing, they remain inconsistently described in the literature. Immediate staff debriefing is an important intervention not only to prevent future episodes of seclusion and restraint use, but as a forum for staff to support each other emotionally and psychologically after a potentially distressing event. The core components identified in this review should be incorporated into the organization's policies, practice guidelines, and training modules to ensure consistent conceptualization and implementation of the debriefing process.

Enferm. foco (Brasília) ; 9(1): 31-35, abr. 2018.
Artigo em Português | BDENF - Enfermagem | ID: bde-33681


Objetivo: Analisar a prática profissional de enfermeiros em um hospital privado acreditado, sob o prisma da ética da virtude. Metodologia: Estudo de caso qualitativo, realizado em um Hospital Privado “Acreditado com Excelência” em Minas Gerais. Os participantes foram 13 enfermeiros. A coleta de dados foi realizada mediante entrevista individual seguindo roteiro semiestruturado e observação e submetidos à Análise Temática de Conteúdo. Resultados: Foram identificadas contradições entre os valores que norteiam a organização do trabalho na instituição, cujo enfoque é a acreditação e os valores dos enfermeiros, os quais são voltados para o cuidado. Conclusão: A contradição encontrada distancia o enfermeiro de sua prática, colocando-o em confronto com a sua profissão, provocando sofrimento moral. (AU)

Objective: To analyze the professional practice of nurses in an accredited private hospital, under the prism of virtue ethics. Methodology: Case study with a qualitative approach performed in a Private Hospital “Excelent in Accreditation” in Minas Gerais. The participants were 13 nurses. The data collection was performed through an individual interview following a semistructured script and observation and, submitted to the Thematic Content Analysis. Results: Contradictions were identified among the values that guide the organization of work in the institution, whose enforcement is the accreditation and values of nurses, which are focused on care. Conclusion: The contradiction found distances the nurses from their practice, putting them in confrontation with their profession, provoking the moral suffering. (AU)

Objetivo: Analizar la práctica profesional de enfermeros en un hospital privado acreditado, bajo el prisma de la ética de la virtud. Metodología: Estudio de caso cualitativo realizado en un Hospital Privado “Acreditado con Excelencia” en Minas Gerais. Participaron del estudio 13 enfermeros. La recolección de datos fue realizada mediante entrevista individual siguiendo itinerario semiestructurado y observación y sometidos al Análisis Temático de Contenido. Resultados: Se identificaron contradicciones entre los valores que orientan la organización del trabajo en la institución, cuyo ahorque es la acreditación y los valores de los enfermeros, los cuales se dirigen al cuidado. Conclusión: La contradicción encontró distancia al enfermero de su práctica, colocándolo en confrontación con su profesion, provocando el sufrimiento moral. (AU)

Humanos , Masculino , Feminino , Enfermagem , Transtornos de Estresse Pós-Traumáticos , Ética em Enfermagem , Acreditação Hospitalar , Prática Privada de Enfermagem
Nurs Ethics ; 25(3): 324-334, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-27220717


BACKGROUND: Explicating nurses' moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. RESEARCH OBJECTIVES: The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy. RESEARCH DESIGN: The Registered Nurse Journal, a bimonthly publication of the Registered Nurses' Association of Ontario, Canada, features a regular column entitled, 'In the End … What Nursing Means to Me …' These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethical considerations: Ethics approval was not required because the narratives are publicly available. FINDINGS: Two narrative types were identified that represent the moral identities of nurses as expressed through their work: (1) making a difference in the lives of individuals and communities and (2) holding the identities of vulnerable individuals. DISCUSSION: Nurses' moral identities became evident when they could see improvement in the health of patients or communities or when they could maintain the identity of their patients despite the disruptive forces of illness and hospitalization. In reciprocal fashion, the responses of their patients, including expressions of gratitude, served to hold the moral identities of these nurses. CONCLUSION: Ultimately, the sustainability of nurses' moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer.

Princípios Morais , Narração , Enfermeiras e Enfermeiros/psicologia , Atitude do Pessoal de Saúde , Feminismo , Humanos , Satisfação no Emprego , Ontário , Pesquisa Qualitativa
Nurs Inq ; 25(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28580614


Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much-needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision-making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision-making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self-determination.

Documentação/métodos , Autonomia Pessoal , Humanos , Pesquisa Qualitativa , Espanha
Hum Vaccin Immunother ; 14(2): 471-477, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29140749


OBJECTIVES: In 2012, Ontario pharmacists were granted immunization privileges to administer influenza vaccines to the public. This study explored the experiences and practices of pharmacist vaccinators and the impact of vaccination pain on their practice. METHODS: Semi-structured interviews were conducted with 12 pharmacists in the Greater Toronto Area. Transcribed interview data were coded and analyzed via thematic analysis. KEY FINDINGS: Data analysis revealed 4 main themes: 1) expanded scope of practice as an enhancement and challenge to relationships; 2) professional satisfaction and workload demands; 3) knowledge and attitudes regarding pain and fear; 4) practices regarding pain and fear management. Pharmacists reported satisfaction in their new role, despite the associated increased workload. Pharmacists felt that vaccination pain was not a key consideration when administering vaccines and that pain management was generally not necessary. Fear was identified as more important than pain and vaccinating children was challenging and time intensive. Pharmacists' main focus was on injection techniques in managing pain. CONCLUSION: These findings suggest that pharmacists are accepting of their role as vaccinators but more research is needed to examine impact on workload and pharmacist knowledge and perceptions of injection-related pain and fear.

Atitude do Pessoal de Saúde , Farmacêuticos , Vacinação , Serviços Comunitários de Farmácia , Humanos , Vacinas contra Influenza/administração & dosagem , Satisfação no Emprego , Ontário , Relações Profissional-Paciente
J Empir Res Hum Res Ethics ; 12(2): 107-116, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28421885


Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.

Análise Ética , Comitês de Ética em Pesquisa , Ética em Pesquisa , Consentimento Livre e Esclarecido/ética , Segurança do Paciente , Sujeitos da Pesquisa , Populações Vulneráveis , Feminismo , Humanos , Imaginação , Pesquisa Qualitativa , Pesquisadores , Medição de Risco , Pensamento
BMC Health Serv Res ; 17(1): 206, 2017 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-28292301


BACKGROUND: In an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such as pain. The purpose of this research study was to investigate whether therapeutic self-care ability explained variation in the frequency and types of adverse events experienced by home care clients. METHODS: A retrospective cohort design was used, utilizing secondary databases available for Ontario home care clients from the years 2010 to 2012. The data were derived from (1) Health Outcomes for Better Information and Care; (2) Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting System; and (4) Discharge Abstract Database. Descriptive analysis was used to identify the types and prevalence of adverse events experienced by home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care ability and the occurrence of adverse events in home care. RESULTS: The results indicated that low therapeutic self-care ability was associated with an increase in adverse events. In particular, logistic regression results indicated that low therapeutic self-care ability was associated with an increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication. CONCLUSIONS: This study advances the understanding about the role of therapeutic self-care ability in supporting the safety of home care clients. High levels of therapeutic self-care ability can be a protective factor against the occurrence of adverse events among home care clients. A clear understanding of the nature of the relationship between therapeutic self-care ability and adverse events helps to pinpoint the areas of home care service delivery required to improve clients' health and functioning. Such knowledge is vital for informing health care leaders about effective strategies that promote therapeutic self-care, as well as providing evidence for policy formulation in relation to risk mitigation in home care.

Serviços de Assistência Domiciliar/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Segurança do Paciente , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Atividades Cotidianas , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Ontário/epidemiologia , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Autocuidado/normas
Subst Abuse Treat Prev Policy ; 12(1): 12, 2017 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-28270218


BACKGROUND: People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics. METHODS: A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients' records and service reports were conducted. RESULTS: Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives' support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants' reports, revealing the fragility of trust and the focus on abstinence within this setting. CONCLUSION: The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of "fixing" has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.

Usuários de Drogas/psicologia , Redução do Dano , Pessoal de Saúde/psicologia , Serviços de Saúde Mental , Confiança/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
Nurs Inq ; 23(4): 283-289, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27791309


Sister (Sr.) Marie Simone Roach, of the Sisters of St. Martha of Antigonish, Nova Scotia, died at the Motherhouse on 2 July 2016 at the age of 93, leaving behind a rich legacy of theoretical and practical work in the areas of care, caring and nursing ethics. She was a humble soul whose deep and scholarly thinking thrust her onto the global nursing stage where she will forever be tied to a central concept in nursing, caring, through her Six Cs of Caring model. In Canada, she was the lead architect of the Canadian Nurses Association's first code of ethics, and her influence on revisions to it is still profound more than 35 years later. In this paper, four global scholars in nursing and ethics are invited to reflect on Sr. Simone's contribution to nursing and health-care, and we link her work to nursing and health-care going forward.

Competência Clínica/normas , Códigos de Ética , Cuidados de Enfermagem/normas , Canadá , Empatia , História do Século XX , História do Século XXI , Humanos , Virtudes