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2.
Med Health Care Philos ; 24(2): 189-204, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1160870

ABSTRACT

The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality Enquiry (CEMQUE) and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in healthcare and social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating (self-)reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQUE model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: (i) the care receiver considered from their humanness, (ii) the caregiver considered from their solicitude, (iii) the care facility considered from its habitability and (iv) the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever.


Subject(s)
Attitude to Health , COVID-19/epidemiology , Quality of Health Care , Aged , Humans , Models, Organizational , Netherlands , Quality Assurance, Health Care/ethics , Quality of Health Care/ethics , Residential Facilities/ethics , Residential Facilities/organization & administration , Residential Facilities/standards
3.
Semergen ; 47(2): 122-130, 2021 Mar.
Article in Spanish | MEDLINE | ID: covidwho-997527

ABSTRACT

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Subject(s)
COVID-19/prevention & control , Health Care Rationing/ethics , Health Services Accessibility/ethics , Infection Control/methods , Primary Health Care/ethics , Telemedicine/ethics , COVID-19/epidemiology , Health Care Rationing/methods , Health Care Rationing/organization & administration , Health Services Accessibility/organization & administration , Health Services for the Aged/ethics , Health Services for the Aged/organization & administration , Humans , Infection Control/instrumentation , Infection Control/organization & administration , Pandemics , Personal Protective Equipment/supply & distribution , Primary Health Care/methods , Primary Health Care/organization & administration , Quality of Health Care/ethics , Quality of Health Care/organization & administration , Spain/epidemiology , Telemedicine/methods , Telemedicine/organization & administration
6.
Nurs Outlook ; 68(6): 838-844, 2020.
Article in English | MEDLINE | ID: covidwho-739077

ABSTRACT

Registered nurses are an essential workforce group across the globe. They use their expertise and skill sets every day in clinical practice to protect, promote, and advocate on behalf of patients and families under their care. In this article we discuss the physical, emotional, and moral stresses that nurses are experiencing in their day-to-day practice settings created by the novel coronavirus. We consider the demands placed on nurses by unexpected patient surges within hospital environments and inadequate personal protective equipment and other critical resources, challenging nurses' ability to meet their professional and ethical obligations. We also share our thoughts on supporting nurses and others now, and ideas for needed healing for both individuals and organizations as we move forward. Finally, we argue for the need for substantive reform of institutional processes and systems that can deliver quality care in the future when faced with another devastating humanitarian and public health crises.


Subject(s)
COVID-19/nursing , Nurses/psychology , Nursing Care/ethics , Nursing Care/psychology , Nursing Staff, Hospital/ethics , Nursing Staff, Hospital/psychology , Quality of Health Care/ethics , Adult , Coronavirus , Ethics, Nursing , Female , Humans , Male , Middle Aged , Occupational Stress , Pandemics , United States
7.
Cancer ; 126(17): 3896-3899, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-401377

ABSTRACT

The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision-making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS-CoV-2-positive patients with cancer.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Delivery of Health Care/ethics , Health Personnel/ethics , Neoplasms/complications , Pandemics/ethics , Pneumonia, Viral/complications , Quality of Health Care/ethics , Ambulatory Care/ethics , Ambulatory Care/organization & administration , COVID-19 , Clinical Decision-Making , Coronavirus Infections/virology , Delivery of Health Care/organization & administration , Health Personnel/organization & administration , Humans , Neoplasms/radiotherapy , Patient Safety , Pneumonia, Viral/virology , Quality of Health Care/organization & administration , SARS-CoV-2
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