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2.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 76-78, jun. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1102743

RESUMO

Se refiere aquí una experiencia vivida en la convalecencia de una enfermedad por un cirujano cardíaco en un hospital con clientela cerrada, en una época en que no existían otros servicios en la ciudad y habiendo sido él mismo el "fundador" del Servicio, debiendo practicar cirugía de revascularización coronaria. La enfermedad, definitivamente, constituye una nueva dimensión de la sensibilidad, a veces carente de razonamiento según Broeckman, o al decir de Lolas Strepke "falla la teorización del rol de estar enfermo", y eso es lo que introduce a los médicos en el laberinto. Nos preguntamos finalmente: ¿Quién se ocupa del "cuidado del médico", o sea, del "cuidado del cuidador"? Se concluye que, por lo general, el médico, estando enfermo, no tiene imagen real de su propia enfermedad. Falta analizar los aspectos narcisistas psicológicos de los cirujanos. (AU)


What is reported here is an experience lived in the convalescence of a disease by a cardiac surgeon within a hospital of closed clientele, at a time when there were no other services in the city and having been himself the "founder" of that same service, having to practice coronary revascularization. Illness definitely constitutes a new dimension of sensitivity, sometimes lacking in reasoning according to Broeckman, or as Lolas Strepke says "the theorization on the role of being sick fails", and that is what makes physicians end up in a labyrinth. So finally, we ask ourselves, who deals with the "care of the doctor" or the "care of the caregiver"? It is concluded that generally the doctor, being sick, has no realistic image of his own illness. We lack an analysis of the psychological narcissistic aspects of surgeons. (AU)


Assuntos
Humanos , Masculino , Feminino , Temas Bioéticos , Cirurgiões/psicologia , Doença/psicologia , Cuidadores/psicologia , Erros Médicos/ética , Cirurgiões/ética , Presenteísmo/ética , Narcisismo
3.
Rev. bioét. derecho ; (48): 61-79, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192078

RESUMO

La Seguridad del Paciente se ha convertido en un reto y en una prioridad de todos los sistemas sanitarios. Se ha implantado políticas internacionales con el objetivo de reducir el número de incidentes relacionados con Seguridad del Paciente. Todavía son muchos los pacientes que sufren daños derivados de la atención sanitaria. Además, su impacto se extiende no solo a los familiares y allegados, sino también a los propios profesionales, a las instituciones sanitarias y todo ello con un coste económico y emocional con importantes consecuencias para todos los implicados. La mayoría de estudios realizados han ido dirigidos a conocer la epidemiología de los eventos adversos, a conocer sus causas y sus consecuencias. Se han promovido numerosas prácticas seguras con el objetivo de reducir los riesgos relacionados con la atención sanitaria. Recientemente han cobrado mayor relevancia aspectos relacionados con la actuación posterior a un evento adverso (EA). La gestión del riesgo implica entre otras acciones, la identificación, notificación y el análisis de los EA que señalen los fallos latentes en el sistema y la causa raíz con el objetivo último de establecer acciones de mejora y evitar su recurrencia. De forma paulatina estas estrategias se han ido incorporando en las políticas institucionales y mejorando con ello la cultura de seguridad. Pero todavía existen partes del proceso, que en nuestro ámbito se encuentran en su etapa más inicial, tales como el proceso de información sobre los EA a los pacientes y sus familiares y el soporte a los profesionales tras verse implicados en un EA. Todo ello debe construirse en un marco de confianza y credibilidad


Patient Safety has become a challenge and a priority of all healthcare systems. International policies have been implemented with the aim of reducing the number of incidents related to Patient Safety. There are still many patients who suffer damages derived from health care. In addition, its impact extends not only to family members and relatives, but also to the professionals themselves, to health institutions and all of this at an economic and emotional cost with important consequences for all those involved. Most studies have been directed to know the epidemiology of adverse events (AE), to know their causes and their consequences. Numerous safe practices have been promoted with the aim of reducing the risks related to health care. Recently, aspects related to post-AE performance have become more relevant. Risk management involves, among other actions, the identification, notification and analysis of the AE that point out latent failures in the system and the root cause with the ultimate goal of establishing improvement actions and avoiding their recurrence. Gradually these strategies have been incorporated into institutional policies and thereby improving the safety culture. But there are still parts of the process, which in our area are in their most initial stage, such as the process of informing about AE to patients and their families and the supoort to professionlas after being involved in an AE. All this must be built in a framework of trust and credibility


La seguretat del pacient s'ha convertit en un repte i en una prioritat de tots els sistemes sanitaris. S'han implantat polítiques internacionals amb l'objectiu de reduir el nombre d'incidents relacionats amb la seguretat del pacient. Encara són molts els pacients que sofreixen danys derivats de l'atenció sanitària. A més, el seu impacte s'estén no només als familiars i afins, sinó també als propis professionals, a les institucions sanitàries i tot això amb un cost econòmic i emocional amb importants conseqüències per a tots els implicats. La majoria d'estudis realitzats han anat dirigits a conèixer l'epidemiologia dels esdeveniments adversos, a conèixer les seves causes i les seves conseqüències. S'han promogut nombroses pràctiques segures amb l'objectiu de reduir els riscos relacionats amb l'atenció sanitària. Recentment han cobrat major rellevància els aspectes relacionats amb l'actuació posterior a un EA (esdeveniment advers). La gestió del risc implica entre altres accions, la identificació, notificació i l'anàlisi dels EA que assenyalin les fallades latents en el sistema i la causa arrel de les mateixes amb l'objectiu últim d'establir accions de millora i evitar-ne la recurrència. De forma gradual, aquestes estratègies s'han anat incorporant en les polítiques institucionals millorant amb això la cultura de seguretat. Però encara existeixen parts del procés, que en el nostre àmbit es troben en la seva etapa més inicial, tals com el procés d'informació sobre els EA als pacients i els seus familiars i el suport als professionals després de veure's implicats en un EA. Tot això ha de construir-se en un marc de confiança i credibilitat


Assuntos
Humanos , Segurança do Paciente , Bioética , Cuidados Críticos/ética , Comunicação em Saúde/ética , Gestão de Riscos/ética , Responsabilidade pela Informação/ética , Erros Médicos/ética
6.
Nurs Ethics ; 27(2): 609-620, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31331231

RESUMO

BACKGROUND: Nursing errors endanger patient safety, and error reporting helps identify errors and system vulnerabilities. Nursing managers play a key role in preventing nursing errors by using leadership skills. One of the leadership approaches is ethical leadership. AIM: This study determined the level of ethical leadership from the nurses' perspective and its effect on nursing error and error reporting in teaching hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran. RESEARCH DESIGN: This was a cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: A total of 171 nurses working in medical-surgical wards were selected through random sampling. Data collection was carried out using "ethical leadership in nursing, nursing errors and error reporting" questionnaires. Data were analyzed with SPSS20 using descriptive and analytical statistics. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee for Medical Research. Ethical considerations such as completing informed consent form, ensuring confidentiality of information, explaining research objectives, and voluntary participation were observed in the present study. FINDINGS: The results showed that the level of nursing managers' ethical leadership was moderate from the nurses' point of view. The highest and the lowest levels were related to the power-sharing and task-oriented dimensions, respectively. There was a significant relationship between nursing managers' level of ethical leadership with error rates and error reporting. CONCLUSION: The development of ethical leadership approach in nursing managers reduces error rate and increases error reporting. Programs designed to promote such approach in nursing managers at all levels can help reduce the level of error rate and maintain patient safety.


Assuntos
Liderança , Erros Médicos/ética , Enfermeiras e Enfermeiros/psicologia , Gestão de Riscos/métodos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Erros Médicos/efeitos adversos , Erros Médicos/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Gestão de Riscos/ética , Gestão de Riscos/normas , Inquéritos e Questionários
7.
Kennedy Inst Ethics J ; 29(3): 187-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31656231

RESUMO

Medical error is the third-leading cause of death in the United States, but there has been little work done on the associated conceptual and normative questions. What is medical error? Is all medical error bad? The first section of this paper surveys the dominant conception of medical error-promulgated by the Institute of Medicine-and tries to understand whether error necessarily eventuates in adverse events. The second section challenges an asymmetry in the way that we think about error: For example, the received view would allow that undertesting could comprise medical error, whereas overtesting cannot. The third section considers the concept of moral luck and how it bears on our ascriptions of medical error.


Assuntos
Ética Médica , Erros Médicos/ética , Princípios Morais , Humanos , Estados Unidos
8.
J Med Ethics ; 45(12): 821-823, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31399496

RESUMO

Defined as patients who 'lack decision-making capacity and a surrogate decision-maker', the unrepresented (sometimes referred to as the 'unbefriended', 'isolated patients' and/or 'patients without surrogates') present a major quandary to clinicians and ethicists, especially in handling errors made in their care. A novel concern presented in the care of the unrepresented is how to address an error when there is seemingly no one to whom it can be disclosed. Given that the number of unrepresented Americans is expected to rise in the coming decades, and some fraction of them will experience a medical error, creating protocols that answer this troubling question is of the utmost importance. This paper attempts to begin that conversation, first arguing that the precarious position of unrepresented patients, particularly in regards to errors made in their care, demands their recognition as a vulnerable patient population. Next, it asserts that the ethical obligation to disclose error still exists for the unrepresented because the moral status of error does not change with the presence or absence of surrogate decision-makers. Finally, this paper concludes that in outwardly acknowledging wrongdoing, a clinician or team leader can alleviate significant moral distress, satisfy the standards of a genuine apology, and validate the inherent and equivalent moral worth of the unrepresented patient.


Assuntos
Erros Médicos/ética , Revelação da Verdade/ética , Populações Vulneráveis , Tomada de Decisões/ética , Humanos , Competência Mental
9.
Indian J Med Ethics ; 4(3): 242-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378718

RESUMO

Bioethics is not taught as a subject discipline in the undergraduate and postgraduate curriculum in Pakistan. Recently, medical colleges have introduced the behavioural sciences in the undergraduate curriculum, but this has its own limitations, as students are not examined at the end of course work, as in other subjects, which they have to clear in order to get promoted.


Assuntos
Atitude , Bioética/educação , Educação Médica/ética , Hospitais Públicos , Humanos , Consentimento Livre e Esclarecido/ética , Imperícia , Erros Médicos/ética , Paquistão , Relações Médico-Paciente/ética , Relatório de Pesquisa
10.
AMA J Ethics ; 21(7): E553-558, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31333169

RESUMO

Disclosure of harmful mistakes to patients and their families can be daunting for physicians, who tend to weigh their ethical obligations to inform against possible underlying fears of retaliation, perceived incompetence, or shame. When a patient is both incompetent and unrepresented, documentation, disclosure, and rectification of errors are particularly important to consider.


Assuntos
Ética Médica , Erros Médicos/ética , Direitos do Paciente , Médicos/ética , Revelação da Verdade , Idoso de 80 Anos ou mais , Documentação , Humanos , Masculino , Gestão de Riscos
11.
Asian Nurs Res (Korean Soc Nurs Sci) ; 13(3): 200-208, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173923

RESUMO

PURPOSE: The purpose of this study was to determine nurses' perceptions of the disclosure of patient safety incidents (DPSI), which is known to be effective in reducing medical litigation and improving the credibility of medical professionals. METHODS: Three focus group discussions were conducted with 20 nurses using semistructured guidelines. Transcribed content including a record of the progress of the focus group discussions and researchers' notes were analyzed using directed content analysis. RESULTS: Most participants thought that DPSI is necessary because of its effectiveness and for ethical justification. However, participants held varied opinions regarding the primary responsibility of DPSI. Participants agreed on the necessity of explaining the incident and expressing sympathy, apologizing, and promising appropriate compensation that are chief components of DPSI. However, they were concerned that it implies a definitive medical error. A closed organizational culture, fear of deteriorating relationships with patients, and concerns about additional work burdens were suggested as barriers to DPSI. However, the establishment of DPSI guidelines and improving the hospital organization culture were raised as facilitators of DPSI. CONCLUSION: Most nurse participants acknowledged the need for DPSI. To promote DPSI, it is necessary to develop guidelines for DPSI and provide the appropriate training. Improving the hospital organization culture is also critical to facilitate DPSI.


Assuntos
Atitude do Pessoal de Saúde , Revelação/ética , Revelação/estatística & dados numéricos , Erros Médicos/ética , Erros Médicos/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Segurança do Paciente/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , República da Coreia
12.
Bioethics ; 33(8): 948-957, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31222898

RESUMO

Improving how health care providers respond to medical injury requires an understanding of patients' experiences. Although many injured patients strongly desire to be heard, research rarely involves them. Institutional review boards worry about harming participants by asking them to revisit traumatic events, and hospital staff worry about provoking lawsuits. Institutions' reluctance to approve this type of research has slowed progress toward responses to injuries that are better able to meet patients' needs. In 2015-2016, we were able to surmount these challenges and interview 92 injured patients and families in the USA and New Zealand. This article explores whether the ethical and medico-legal concerns are, in fact, well-founded. Consistent with research about trauma-research-related distress, our participants' accounts indicate that the pervasive fears about retraumatization are unfounded. Our experience also suggests that because being heard is an important (but often unmet) need for injured patients, talking provides psychological benefits and may decrease rather than increase the impetus to sue. Our article makes recommendations to institutional review boards and researchers. The benefits to responsibly conducted research with injured patients outweigh the risks to participants and institutions.


Assuntos
Pesquisa Biomédica/métodos , Erros Médicos/ética , Erros Médicos/legislação & jurisprudência , Direitos do Paciente/ética , Sujeitos da Pesquisa/psicologia , Sujeitos da Pesquisa/estatística & dados numéricos , Feminino , Humanos , Masculino , Nova Zelândia , Estados Unidos
13.
J Healthc Risk Manag ; 39(1): 19-27, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977243

RESUMO

BACKGROUND: Fostering a culture that empowers staff to speak up when concerned about the quality or safety of patient care is both an ethically1 and economically2 responsible endeavor. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak-Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. The objective of this effort was to advance patient safety in Keystone Center member organizations through widespread, measurable culture improvement. After extensive data collection and analysis, there was a discernable improvement in culture survey results across a 2-year period coinciding with the launch and sustainment of the award program. Furthermore, in an effort to demonstrate the power of speaking up among staff, the Keystone Center applied a cost-savings framework to the types of harm avoided. Results from the cost-savings analysis suggest that each instance of speaking up by staff saves patients, families, and health care organizations an average of more than $13,000. METHODS: Keystone Center Speak-Up! Award nominations were submitted through an electronic form that collects open, closed, and Likert-type question responses, producing a data array on type and severity of harm prevented, as well as the difficulty and magnitude of the decision to speak up. All data were then coded by harm type and subsequently applied to a tailored version of the cost-savings estimation framework used in the Great Lakes Partnership for Patients Hospital Improvement and Innovation Network. Safety culture was measured through the use of a survey instrument called the Safety, Communication, Operational Reliability, and Engagement (SCORE) instrument. RESULTS: The Keystone Center Speak-Up! Award program received 416 nominations across the 2-year study period, of which 62% (n = 258) were coded as a specific harm type. Adverse drug events (n = 153), imaging errors (n = 42), and specimen errors (n = 27) were the most common harm types prevented by speaking up. After applying the cost-savings framework to these data, it is estimated that for every instance of speaking up, approximately $13,000 in total expenses were avoided, which is in line with the findings from a report on the economic impact of medical errors sponsored by the Society of Actuaries.3 Furthermore, culture survey results improved by 6% between 2015 and 2017, coinciding with the Keystone Center Speak-Up! Award program. CONCLUSIONS: The Keystone Center Speak-Up! Award has proven to be a valuable tool in recognizing staff awareness and willingness to raise concerns about quality and safety in health care. Data analysis from this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. However, further research is required to adequately gauge the degree to which safety culture improvement is proportional to cost savings.


Assuntos
Pessoal de Saúde/psicologia , Erros Médicos/ética , Erros Médicos/prevenção & controle , Segurança do Paciente/economia , Segurança do Paciente/normas , Melhoria de Qualidade/ética , Melhoria de Qualidade/normas , Adulto , Atitude do Pessoal de Saúde , Comunicação , Feminino , Humanos , Masculino , Erros Médicos/economia , Erros Médicos/estatística & dados numéricos , Michigan , Pessoa de Meia-Idade , Melhoria de Qualidade/economia , Reprodutibilidade dos Testes , Inquéritos e Questionários
18.
J Med Ethics ; 45(2): 101-105, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30413557

RESUMO

Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions-such as guilt, regret and remorse-appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error.


Assuntos
Erros Médicos/ética , Humanos , Erros Médicos/psicologia , Segurança do Paciente , Responsabilidade Social , Revelação da Verdade/ética
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