ABSTRACT
Traditionally, physicians and parents made decisions about children's health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children - of diverse levels of cognitive development - are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children's 'best interest'. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.
Subject(s)
Child Advocacy , Decision Making , Patient Participation , Personal Autonomy , Terminal Care , Child , Ethics, Nursing , Humans , Parents/psychology , Treatment RefusalABSTRACT
The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates.
Subject(s)
Decision Making , Influenza, Human/prevention & control , Nursing Homes , Nursing Staff , Vaccination/statistics & numerical data , Adult , Conflict, Psychological , Cross-Sectional Studies , Facility Regulation and Control , Female , Health Care Surveys , Humans , Long-Term Care , Male , Middle Aged , North AmericaABSTRACT
Influenza seriously impacts the health and well-being of individuals and communities and has significant implications for the health care system. Despite known benefits of influenza vaccination, inoculation rates among health care providers remain low. Close proximity to patients, the potential to act as an infection vector and their role in patient education has focussed attention on how health care professionals make personal vaccination decisions. This commentary explores the inherent complexity of vaccination decision-making and offers suggestions for a multiple intervention approach to address health care providers' vaccination uptake needs. Directions for future research are also discussed.
