Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 309
Filtrar
2.
N Z Med J ; 132(1501): 10-20, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31465323

RESUMO

AIM: Professional supervision (PS), a collaborative relationship that promotes reflection on contextualised work-related issues for the benefit of ongoing learning and development and improved professional practice, is not well understood in the medical context. This study aimed to explore the attitudes and experiences of PS among doctors working in palliative care in New Zealand. METHOD: Eighty members of the Australia New Zealand Society of Palliative Medicine (ANZSPM) participated in a cross-sectional quantitative survey. RESULTS: Overall, PS was felt to be important, particularly by those currently participating in PS, for enhancing clinical functioning and supporting doctors' wellbeing. Barriers to undertaking PS included finding a supervisor, lack of funding and time, with the most significant factor being whether the workplace supported PS. Supervisees' responses showed PS to be a safe experience, addressing a wide range of issues, with a positive effect on personal coping. CONCLUSION: Despite identified barriers, New Zealand-based palliative care doctors reported PS to be important and beneficial both personally and professionally. Further consideration should include the impact of professional and organisational culture on uptake of PS, future research and acknowledgment that palliative medicine may be in a position to highlight the benefits of PS for the wider medical community.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Tutoria , Cuidados Paliativos , Equipe de Assistência ao Paciente , Papel do Médico , Estudos Transversais , Humanos , Modelos Organizacionais , Nova Zelândia , Organização e Administração , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/organização & administração , Relações Profissional-Paciente , Melhoria de Qualidade
4.
Cir Esp ; 97(4): 190-195, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30771999

RESUMO

The significance of technical skills and manual dexterity for surgeons is an indisputable fact. However, the systematic study of medical errors has revealed that a significant percentage of these errors are caused by factors related to non-technical skills. The review presented in this article intends to describe and explore the relevance of these non-technical skills, including: situational awareness, decision-making, leadership and communication. In conclusion, the authors propose that adequate importance needs to be given to these aptitudes to provide safe clinical care.


Assuntos
Competência Clínica/normas , Cirurgia Geral/educação , Erros Médicos/prevenção & controle , Conscientização/ética , Comunicação , Tomada de Decisões , Humanos , Liderança , Erros Médicos/estatística & dados numéricos , Equipe de Assistência ao Paciente/ética , Relações Médico-Paciente/ética
5.
Am J Hosp Palliat Care ; 36(4): 290-293, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30134736

RESUMO

CONTEXT:: Patients in medical intensive care units (MICUs) are medically complex. This complexity can lead to uncertainty about patient goals and prognosis. Ethical dilemmas arise when there is uncertainty about the clinically and ethically appropriate actions for managing seriously ill patients. Ethics and palliative care involvement may promote improved quality of care and reduced staff moral distress. PROJECT DESCRIPTION:: In this clinical project, a physician with ethics, palliative care, and geriatrics expertise attended morning rounds with the MICU team weekly. Data on the logistics and impact from the first 2 years of the project were collected. PROJECT LOGISTICS AND PRELIMINARY IMPACT:: Rounds lasted approximately 1.75 hours per week. The rounder was present for discussion of approximately 200 patients per year and made comments on nearly half of the patients. The comments were categorized as 25% ethics, 40% palliative care, 10% geriatrics, and 25% a combination or other topic. Attending physicians rated the project as helpful. The number of ethics and palliative care consults from the MICU increased in the first 2 years. Downstream impact has included a dietician reviewing Physician Orders for Life Sustaining Treatment forms with teams throughout the hospital and routine review of advance directives of newly admitted patients. DISCUSSION:: Weekly MICU rounding provides an opportunity to briefly teach staff and trainees about relevant ethics, palliative care, and geriatrics issues. It also provides a forum for discussion of ethically challenging cases. Considerations when starting a similar program are discussed.


Assuntos
Ética Clínica/educação , Unidades de Terapia Intensiva/ética , Estresse Ocupacional/epidemiologia , Cuidados Paliativos/ética , Equipe de Assistência ao Paciente/ética , Visitas com Preceptor/organização & administração , Estado Terminal/psicologia , Estado Terminal/terapia , Geriatria/educação , Geriatria/ética , Humanos , Cuidados Paliativos/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Fatores de Tempo
6.
HEC Forum ; 31(1): 75-83, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30074121

RESUMO

The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To solve the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience.


Assuntos
Comportamento Cooperativo , Eticistas , Equipe de Assistência ao Paciente/tendências , Humanos , Modelos Biológicos , Equipe de Assistência ao Paciente/ética , Assistência Centrada no Paciente/ética , Assistência Centrada no Paciente/métodos , Papel Profissional
7.
J Plast Reconstr Aesthet Surg ; 72(2): 173-180, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30279107

RESUMO

AIM: We herein describe the establishment of the Helsinki Vascularized Composite Allotransplantation (VCA) program and its execution in the first two face transplant cases. METHODS & PATIENTS: The Helsinki VCA program initially required the fulfillment of legal, hospital, financial, and ethical requirements. Thereafter, the assembling of a multidisciplinary team commenced. A team of Plastic, maxillofacial and ENT surgeons comprise the facial VCA team. The protocol involves collaboration with the Solid Organ Transplant (SOT) team, transplant immunology, immunosuppression, microbiology, psychiatric evaluation, well-defined VCA indications and informed consent. Between 2011 and 2017 two patients were selected for transplantation. Both patients had a severe composite facial deformity involving the maxilla and mandible following earlier ballistic injury. RESULTS: Patient 1 was a 35 year-old male who underwent successful near total face transplantation in February 2016 and at 30 months he has a good aesthetic outcome with symmetrical restoration of the central face and good sensory and symmetrical motor functional outcomes. Patient 2 was a 58 year-old male who underwent full face transplantation in March 2018 and at 5 months he has recovered without major problems. CONCLUSION: A successful facial VCA program requires a well-prepared research protocol, experts from multiple specialties and careful patient selection. The establishment of the Helsinki VCA program required long and thorough planning and resulted in the first two Nordic face transplantation cases. This protocol now forms the platform (as a proof of concept) for other types of vascularized composite allotransplantations.


Assuntos
Transplante de Face , Equipe de Assistência ao Paciente/organização & administração , Adulto , Algoritmos , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/legislação & jurisprudência , Resultado do Tratamento
8.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30563878

RESUMO

We present the case of a 19-month-old boy with complex congenital heart disease. His single father is skeptical of traditional medicine and does not offer the social support needed to make heart transplantation successful for his son. After the father demonstrates commitment to transplant success and provides enhanced social support, doctors place the child on a Berlin Heart (a biventricular assist device) as a bridge to transplantation and list him for transplant. When the child is matched to a donor heart, the father refuses transplantation, despite that it is the child's only chance for survival. His doctors report the case to child protective services, but they decline to take protective custody. The father then changes his mind and asks that the child be put back on the waiting list for transplant. By this time, the social supports the father implemented are no longer in place. This case raises a number of issues. First, should courts order heart transplantation when doctors believe that it is in the child's best interest and parents do not consent? Second, once parents refuse a transplant, can they change their minds? Third, if there are uncertainties regarding whether the child has the social support to make transplantation successful, should the child be relisted? Finally, should a child who is not currently a transplant candidate but who may become one in the future be supported with ventricular assist devices?


Assuntos
Relações Pai-Filho , Cardiopatias Congênitas/diagnóstico , Transplante de Coração/ética , Coração Auxiliar/ética , Apoio Social , Listas de Espera , Cardiopatias Congênitas/psicologia , Cardiopatias Congênitas/cirurgia , Transplante de Coração/psicologia , Coração Auxiliar/psicologia , Humanos , Lactente , Masculino , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/tendências
9.
Med Health Care Philos ; 22(2): 231-238, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30194513

RESUMO

Neonatal professionals encounter many ethical challenges especially when it comes to interventions at the limit of viability (weeks 22-25 of gestation). At times, these challenges make the moral dilemmas in neonatology tragic and they require a particular set of intellectual and moral virtues. Intellectual virtues of episteme and phronesis, together with moral virtues of courage, compassion, keeping fidelity to trust, and integrity were highlighted as key virtues of the neonatal professional. Recognition of the role of ethics requires a recognition that answering the obvious question (what shall we do?) does not always suffice. Acknowledging the tragic question (is any of the alternatives open to us free from serious moral wrongdoing) and recognizing the ethical dilemmas, where the lines between right and wrong are blurred, leads to actions taken towards establishing ethics frameworks to support decision-making. In neonatology units, such organizational support can help in allowing the team members to recognize the ethical dilemmas, avoid moral distress, and improve team cohesion and the quality of care provided. Only when the organizational structure allows ethical dilemmas to be recognized, adequate decisions can be made.


Assuntos
Tomada de Decisões/ética , Empatia , Princípios Morais , Neonatologia/ética , Idade Gestacional , Humanos , Unidades de Terapia Intensiva Neonatal/ética , Equipe de Assistência ao Paciente/ética , Filosofia Médica
10.
Med Health Care Philos ; 22(1): 41-52, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29740744

RESUMO

In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle's notion of phronesis and Sartre's definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician's situation.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica/normas , Equipe de Assistência ao Paciente/ética , Relações Médico-Paciente/ética , Adaptação Psicológica , Humanos , Equipe de Assistência ao Paciente/normas , Autonomia Pessoal , Relações Profissional-Paciente/ética , Pesquisa Qualitativa , Valores Sociais
11.
Belo Horizonte; s.n; 2019. 181 p. ilus.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-1007509

RESUMO

A transferência de cuidado (handoff ou handover) consiste na transferência da responsabilidade do cuidado do paciente, ou grupo de pacientes, para outra pessoa ou grupo de profissionais, de forma temporária ou definitiva. O objetivo do presente estudo foi analisar a transferência de cuidado de pacientes no cotidiano de profissionais de saúde de um pronto-socorro e sua influência na qualidade assistencial. Trata-se de um estudo de caso de natureza qualitativa, que utilizou o referencial do cotidiano de Michel de Certeau, em especial, os conceitos de tática e estratégia, realizado em um pronto-socorro de um hospital público de grande porte, localizado na cidade de Belo Horizonte, Minas Gerais. Participaram da pesquisa 30 profissionais, entre médicos, enfermeiros, técnicos de enfermagem, maqueiros, assistente social, psicólogo e cirurgião-dentista do pronto-socorro (PS), diretamente envolvidos no handover. A coleta de dados foi realizada, por meio de entrevistas individuais com roteiro semiestruturado, observação e análise documental. Utilizou-se o critério de saturação dos dados, para encerrar as entrevistas que foram gravadas, transcritas e submetidas à Análise de Conteúdo Temática. Os dados foram coletados, após a aprovação do projeto pelo Comitê de Ética da UFMG (COEP/UFMG) e Comitê de Ética e Pesquisa do hospital sob os pareceres nº 1.519.784 e nº 1.559.717, respectivamente e assinatura do Termo de Consentimento Livre e Esclarecido (TCLE) pelos participantes. Os resultados foram organizados em cinco categorias temáticas: "Compreendendo a visão dos profissionais de um pronto-socorro sobre a transferência de cuidado de pacientes: múltiplos olhares";" Comunicação efetiva: estratégias e táticas vivenciadas no cotidiano dos profissionais"; "Fatores que interferem no trabalho em equipe e comunicação nos momentos de handover"; "O trabalho em equipe no cotidiano dos profissionais e reflexos no handover"; "Cuidado centrado no paciente e família". Os dados revelaram aspectos do cotidiano do PS, assim como o perfil dos entrevistados, sujeitos que, além das normas instituídas, utilizam táticas para superar dificuldades e mostram comprometimento com a assistência. O handover é compreendido de maneiras distintas pelos profissionais e apresenta-se mais ligado à transferência de informações, mas existe, também, uma preocupação para que ocorra transferência de responsabilidade e continuidade do cuidado. Foram identificadas estratégias, para definir o fluxo de atendimento e normatizar o handover, tendo destaques o protocolo de Manchester, prontuário eletrônico, Situação-Background- Avaliação-Recomendação (SBAR) e passômetro, assim como táticas (o fazer real) reveladas pelos profissionais. Habilidades leves, como assertividade, escuta e negociação, configuram-se como táticas para aumentar a efetividade da comunicação. O enfermeiro aparece como peça-chave para o trabalho da equipe multiprofissional e organização do handover. Identificaram-se fatores relacionados ao ambiente, estrutura, processos e indivíduos, que interferem na comunicação e trabalho em equipe nos momentos de handover. O trabalho em equipe no PS é percebido mais como agrupamento do que integração, prejudicando o handover. O cuidado é realizado, de acordo com normas e definições dos profissionais, com base na realidade do hospital e menos nas necessidades do paciente e sua família, o que compromete o handover e segurança do paciente neste cenário.(AU)


The transference of care (handoff or handover) consists in temporarily or permanently transferring the responsibility of the patient care to another person or group of professionals. The objective of this study was to analyze the transfer of patient care in the daily life of healthcare professionals of an emergency room and its influence on the quality of care. This is a case study of a qualitative nature, referenced on the daily life of Michel de Certeau's, especially regarding the concepts of tactics and strategy. We conducted the study in an emergency room of a large public hospital, located in the municipality of Belo Horizonte, Minas Gerais, Brazil. Thirty professionals of the emergency room among physicians, nurses, nursing technicians, stretcher bearer, social workers, psychologists, and dental surgeons (PS) directly involved in the transfer of patient care partook of the study. We collected the data through individual interviews using a semi-structured script, observation, and documentary analysis. We used the data saturation criterion to close the interviews recorded, transcribed, and submitted to the Thematic Content Analysis. The data collection occurred after the approval of the project by the Ethics Committee of the UFMG (COEP/UFMG) and the Committee of Ethics and Research of the hospital under the decision no 1,519,784 and 1,559,717, respectively. The participants signed the Term of Free and Clarified Consent (TFCC). The results were organized in five thematic categories: "Understanding the perspective of the professionals of an emergency room on the transfer of patient care: multiple perspectives"; "Effective communication: strategies and tactics experienced in the daily life of the professionals"; "Factors that interfere in teamwork and communication during a handover"; "Teamwork in the daily life of the professionals and reflexes on the handover"; "Care centered on the patient and family". The data revealed aspects of the daily life of the ER, as well as the profile of the interviewees, subjects who, besides the established norms, use tactics to overcome difficulties and show commitment to the assistance. The handover is understood in different ways by the professionals and is more closely connected to the transfer of information. However, there is also a concern for the transfer of responsibilities and care continuity. We identified strategies to define the flow of care and standardize the handover, highlighting the Manchester protocol, electronic medical record, Situation- Background-Assessment-Recommendation (SBAR), and passometer, as well as tactics (the real acting) revealed by the professionals. Mild skills such as assertiveness, listening, and negotiation are shown as tactics to increase the effectiveness of communication. The nurse appears as a critical piece for the work of the multiprofessional team and handover organization. We identified factors related to the environment, structure, processes, and individuals that interfere in the communication and teamwork during the handover. Teamwork in the ER is perceived more as a grouping than integration, impairing the handover. Care is performed according to the standards and definitions of the professionals based more on the hospital´s reality and less on the needs of the patients and their family, which compromises patient handover and the safety of this setting.(AU)


Assuntos
Humanos , Equipe de Assistência ao Paciente/ética , Serviços Médicos de Emergência/ética , Relações Interprofissionais , Inquéritos e Questionários , Dissertação Acadêmica
12.
Soins ; 63(830): 16-19, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30449464

RESUMO

Experienced on a personal and psychological level, work related stress nevertheless has social causes. New forms of management demand from staff an ever greater personal investment, but the growing intensification of the work often makes the missions they are given impossible to fulfil. This results in a feeling of having failed and of not being up to the job, which are in turn sources of suffering and stress.


Assuntos
Estresse Ocupacional , Fatores Sociológicos , Estresse Psicológico , Códigos de Ética , Assédio não Sexual/ética , Assédio não Sexual/psicologia , Assédio não Sexual/estatística & dados numéricos , Humanos , Relações Interprofissionais/ética , Satisfação no Emprego , Recursos Humanos de Enfermagem/ética , Recursos Humanos de Enfermagem/psicologia , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/etiologia , Estresse Ocupacional/prevenção & controle , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle
13.
Swiss Med Wkly ; 148: w14663, 2018 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-30428121

RESUMO

The number of people with dementia in Switzerland is currently around 150,000. The prevalence of this condition rises steeply after the age of 65. As a result of demographic changes, the number of people affected in Switzerland is thus expected to increase markedly over the coming decades. The course of dementia ­ which frequently occurs in combination with chronic somatic and/or mental disorders (multimorbidity) ­ is often protracted and is difficult to predict. Cognitive impairments mean that self-determination and alleviation of symptoms are more difficult to achieve in everyday practice. People with severe dementia generally lack capacity, and decisions then have to be made by representatives on the basis of the patient's previously expressed or presumed wishes. The management and care of patients may be complicated by disease-related behavioural disturbances. The public, as well as the individuals affected, are fearful of the loss of independence and possible changes in personality associated with progressive dementia; in addition, people are often afraid of becoming a burden on their relatives or society. Against this background, difficult decisions and significant ethical conflicts are not unusual ­ all the more so since life with dementia runs counter to guiding values, such as independence, productivity and rationality, which are central to our society. The aim of these guidelines is to offer practical guidance for dealing with ethical conflict situations relating to the care and treatment of people with dementia. Specific issues are addressed which may ultimately arise for all those involved in dementia care, irrespective of the setting (domestic, hospital, residential) and professional group. Which of these ethical issues is the most salient will depend largely on the stage of the condition. Once the condition has been diagnosed, management should be based on the principles that are also applicable, for example, in palliative care: a focus on quality of life, equality of care, interprofessional collaboration and continuity, open and appropriate communication, support for decision-making processes, anticipation, a multidimensional approach, and involvement of those close to the patient. These guidelines were prepared in cooperation with the Swiss Society of Gerontology (SGG SSG) as part of the National Dementia Strategy 2014­2019 (subproject 5.1: "Establishment of ethical guidelines").


Assuntos
Tomada de Decisões/ética , Demência/epidemiologia , Guias como Assunto , Equipe de Assistência ao Paciente/ética , Assistência à Saúde , Humanos , Qualidade de Vida , Suíça/epidemiologia
14.
Pediatrics ; 142(5)2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30315121

RESUMO

An infant with complex congenital heart disease suffers a prolonged cardiac arrest with minutes of anoxia. He is left with severe brain damage and profound neurologic impairment. He no longer responds to caregivers. Much of the time, he cries and grimaces as if in pain. He has required increasing sedation to control these symptoms. His parents live hours from the hospital and seldom visit. When their infant's situation is explained to them over the telephone, they request that doctors "do everything to keep him alive." His bedside caregivers report high levels of moral and psychological distress and frequently discuss J.S.'s "suffering." An ethics consultation is requested, asking whether it is permissible to withdraw life support despite the parents' request that therapy continue.


Assuntos
Cuidados para Prolongar a Vida/ética , Equipe de Assistência ao Paciente/ética , Doente Terminal/psicologia , Suspensão de Tratamento/ética , Cuidadores/psicologia , Tomada de Decisões/ética , Dissidências e Disputas , Humanos , Lactente , Masculino , Pais/psicologia , Estresse Psicológico
15.
J Adv Nurs ; 74(12): 2912-2921, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30019346

RESUMO

AIM: The aim of this research is to measure the impact that planned changes to nurse staffing and skill-mix have on patient, nurse, and organizational outcomes. BACKGROUND: It has been highlighted that there are several design limitations in studies that explore the relationship between nurse staffing and patient, nurse and organizational outcomes; not least that the vast majority of research in this area emanates from studies that are predominantly observational in design. There are limited studies that measure nurse, patient, organizational, and economic outcomes using a longitudinal design following a planned change in nurse staffing. DESIGN: The research will employ a longitudinal, multimethod approach to evaluate the impact that planned changes in nurse staffing and skill-mix have on wards in three pilot hospitals. METHODS: Administrative data collection will take place on a shift-by-shift basis prospectively over a three-year period including the measurement of nursing sensitive outcomes: cross-sectional patient experience data and nurse outcomes (nursing work, job satisfaction, burnout, missed care) will be collected at intervals prior to, during and after the implementation of planned changes in nurse staffing and skill-mix. Data will be analysed using interrupted time-series models, adjusted for key hospital, ward and patient-level factors. An economic costing of the changes will further investigate the resources required for the intervention that can then be aggregated to a national level for future roll-out plans. DISCUSSION: The study aims to provide evidence on the impact of planned changes to nurse staffing and skill-mix based on a systematic approach using a longitudinal design and to determine the extent to which the approach can be implemented at a national level.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Competência Clínica/normas , Protocolos Clínicos , Ética em Pesquisa , Humanos , Pesquisa Metodológica em Enfermagem/ética , Recursos Humanos de Enfermagem no Hospital/ética , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/organização & administração , Carga de Trabalho/estatística & dados numéricos
16.
Rev Bras Ter Intensiva ; 30(2): 226-232, 2018.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29995089

RESUMO

In an ethical dilemma, there is always an option that can be identified as the best one to be chosen. When it is impossible to adopt such option, the situation can lead professionals to experience moral distress. This review aims to define the issue of moral distress and propose coping strategies. Systematic searches in the MEDLINE/PubMed and SciELO databases were conducted using the keywords "moral distress" and "moral suffering" in articles published between 2000 and 2017. This review was non-exhaustive and contextual, with a focus on definitions, etiologies and methods of resolution for moral distress. In the daily practice of intensive care, moral distress was commonly related to the prolongation of patients' suffering and feelings of helplessness, as well as difficulties in communication among team members. Coping strategies for moral distress included organizational, personal and administrative actions. Actions such as workload management, mutual support among professionals and the development of techniques to cultivate open communication, reflection and questioning within the multidisciplinary team were identified. In clinical practice, health professionals need to be recognized as moral agents, and the development of moral courage was considered helpful to overcome ethical dilemmas and interprofessional conflicts. Both in pediatric and adult intensive care, professionals are challenged by questions about their practice, and they may experience moral distress. This suffering can be minimized and solved by understanding that the focus is always on the patient and acting with moral courage and good communication in an environment of mutual respect.


Assuntos
Adaptação Psicológica , Tomada de Decisões/ética , Unidades de Terapia Intensiva/ética , Criança , Comunicação , Cuidados Críticos/ética , Cuidados Críticos/métodos , Ética Clínica , Humanos , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/organização & administração , Estresse Psicológico/psicologia
17.
Adv Emerg Nurs J ; 40(3): 214-225, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30059377

RESUMO

There is little research on the dynamics of the sexual assault response team (SART) members' interprofessional collaboration (IPC) practice. The study purposes were to (1) explore the perceptions of IPC among SART members; (2) evaluate the use of Perception of Interprofessional Collaboration Model Questionnaire with the SART; and (3) discuss the implications of the Interprofessional Core Competencies for emergency department nurses and sexual assault nurse examiners. This cross-sectional mixed-methods study (n = 49) was implemented using 4 SART teams in a mid-Atlantic state. There were no statistically significant differences in the subscales within the group level using analysis of variance but offered some valuable insight and content analysis. Emergency department nurses collaborate with different agencies and discipline within their working environment. Understanding the basics of IPC and the perception of IPC within the SART may open doors to further appreciate the dynamics of this team.


Assuntos
Comportamento Cooperativo , Enfermagem em Emergência/organização & administração , Comunicação Interdisciplinar , Relações Interprofissionais , Diagnóstico de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Delitos Sexuais , Estudos Transversais , Enfermagem em Emergência/ética , Ética em Enfermagem , Humanos , Relações Interprofissionais/ética , Liderança , Equipe de Assistência ao Paciente/ética , Resolução de Problemas , Apoio Social
18.
Methodist Debakey Cardiovasc J ; 14(2): 120-125, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29977468

RESUMO

Transplant medicine is fraught with clinical-ethical issues. It is not uncommon to have ethicists on transplant teams to help navigate ethically complex cases and ethical questions. Clinical ethicists work in hospitals and/or other healthcare institutions identifying and addressing value-laden conflict and ethical uncertainties. As ethicists, we set out to describe our process and involvement in cases involving extracorporeal membrane oxygenation (ECMO). Our work centers on monitoring and optimizing communication among clinicians, families, and patients, with the goals of (1) aligning patient/family understanding of the nature and purpose of ECMO while encouraging realistic expectations for possible outcomes, and (2) proactively mitigating the moral distress of providers involved in complex ECMO cases. We close with recommendations for how to measure the impact of ethicists' involvement in ECMO cases.


Assuntos
Tomada de Decisão Clínica/ética , Eticistas , Oxigenação por Membrana Extracorpórea/ética , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/ética , Síndrome do Desconforto Respiratório do Adulto/terapia , Idoso , Atitude do Pessoal de Saúde , Eticistas/psicologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/mortalidade , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Oxigenadores de Membrana , Equipe de Assistência ao Paciente/organização & administração , Seleção de Pacientes/ética , Papel Profissional , Relações Profissional-Família/ética , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Medição de Risco , Fatores de Risco , Assistência Terminal/ética , Suspensão de Tratamento/ética
20.
AMA J Ethics ; 20(5): 431-438, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29763389

RESUMO

Part of any trauma surgeon's job is communicating effectively in difficult, often time-limited, situations. The ability to effectively discuss topics like goals of care in these settings has a direct effect on patient care. Many factors contribute to the complexity of these conversations, including patient, physician, surrogate, and system-specific factors. In responding to the case of Mr. D and Dr. J, we attempt to outline and analyze some of the moral challenges and ethical questions that this professional responsibility poses to trauma surgeons and trainees.


Assuntos
Cirurgia Geral/educação , Cirurgia Geral/ética , Equipe de Assistência ao Paciente/ética , Cirurgiões/ética , Atitude do Pessoal de Saúde , Comunicação , Humanos , Relações Interpessoais , Papel do Médico , Relações Médico-Paciente , Responsabilidade Social , Cirurgiões/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA