ABSTRACT
This study was designed to determine the degree to which clinical genetics professionals are comfortable with grief and loss, whether discomfort with grief and loss is associated with clinician distress, and what factors predict comfort with grief and loss for the purpose of developing recommendations for support and training. We surveyed 300 clinical geneticists (MDs), genetic counselors (GCs) and genetic nurses randomly selected from their professional associations. Out of 225 eligible clinicians, 172 completed surveys (76% response rate). The vast majority of respondents have clinical interactions with patients and families who are experiencing grief, loss and/or death. However, nearly 20% of respondents reported that they did not feel 'comfortable in the presence of grief and loss'. Twenty-nine percent of respondents disagree or strongly disagree that they 'have been adequately trained to address issues of death, dying, grief/bereavement, and end of life care'. Reported discomfort with grief and loss was strongly correlated with clinician distress. Predictors of comfort with grief and loss included perceived adequacy of training, tolerance for uncertainty, significant personal experiences of loss and deriving meaning from patient care. In conclusion, as follows. A significant minority of clinical genetics professionals experience discomfort in the presence of grief and loss, and feel inadequately prepared for such experiences. Greater attention should be paid to training clinicians in how to deal with grief and loss, and supporting them through such difficult experiences in an effort to reduce their distress.
Subject(s)
Attitude of Health Personnel , Genetic Counseling/psychology , Genetics, Medical , Grief , Health Personnel/education , Social Support , Adult , Demography , Female , Health Personnel/psychology , Health Surveys , Humans , Life Change Events , Male , Middle AgedABSTRACT
As nurses begin to develop the sensitivities and skills necessary to preserve the integrity of clinical care and professional life, they must recognize the legitimacy of their perspectives and the value and consequences they have for the well-being of patient and family care. Nurses have much to contribute to the development of ethical practice environments for patients, families, multidisciplinary team members, and themselves. The frenzied, and at times anesthetized, culture of clinical settings can mitigate against the kind of deliberate reflection that is necessary if nurses are to act with ethical integrity. Knowing the rules of the road for end-of-life care and being attentive to common warning signs and addressing them proactively, enables nurses to provide patients and families with the highest quality care at the end of life.
Subject(s)
Ethics, Nursing , Quality of Health Care , Terminal Care/standards , HumansABSTRACT
Our healthcare system is fundamentally flawed in the ability to provide quality end-of-life care. The provision of quality end-of-life care involves a complex interaction of personal, professional, and societal values and practices. Attention to each dimension of end-of-life care is essential to improve the care of the dying patient and his/her family. Given the complexity of this problem, this article focuses on the critical care environment and the aspect of organizational culture and specific strategies for improvement. Several inter-related components of an environment which may foster ethical thinking, decision-making, and behaviors are discussed including organizational culture, individual agency, collaboration, and educational resources. Every member of the healthcare team has the responsibility to be a catalyst for creating a critical care environment where ethical practice is expected and rewarded rather than punished and suppressed. As a healthcare team, our ultimate goal is to provide healing and humane end-of-life care for all patients and families.
Subject(s)
Ethics, Medical , Health Facility Environment , Intensive Care Units/organization & administration , Quality of Health Care , Terminal Care/standards , Cooperative Behavior , Decision Making, Organizational , Family/psychology , Humans , Organizational Culture , Patient Care Team , United StatesABSTRACT
The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.
Subject(s)
Attitude of Health Personnel , Ethics, Nursing , Nurse's Role , Nurses/psychology , Suicide, Assisted/legislation & jurisprudence , Beneficence , Codes of Ethics , Critical Care , Humans , Nurse-Patient Relations , Personal Autonomy , United StatesSubject(s)
Ethics, Medical , Health Care Rationing , Intensive Care Units , Patient Transfer , Humans , Intensive Care Units/organization & administration , Lung Diseases, Obstructive/complications , Male , Nurse-Patient Relations , Organizational Policy , Patient Advocacy , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/nursing , Respiratory Insufficiency/therapyABSTRACT
Pediatric nurses often struggle to define their advocacy role with patients and their families. Nursing is based on the therapeutic use of self and caring. An unclear therapeutic relationship can undermine nurses' advocacy efforts. Nurses are encouraged but often not guided about staying within the parameters that define a professional and therapeutic relationship between the nurses and the patient/family. Examining the impact of unclear boundaries on the patient/family relationship and the nurse's ability to serve as an advocate provides the basis for suggested constructive strategies for addressing the related issues.
Subject(s)
Child Advocacy , Nurse-Patient Relations , Patient Advocacy , Pediatric Nursing , Child , Dependency, Psychological , Friends , Humans , Male , Paternalism , Power, Psychological , Professional Misconduct , Professional-Family RelationsABSTRACT
In the context of health care decision making, the language of miracles is expressed by both parents and professionals. Without mutual understanding of the meaning of miracles, parents and professionals may experience conflict about treatment goals. Understanding the dynamics of appeals to miracles, examining caregiver responses, and employing strategies to assess parental knowledge, understanding the meaning of miracles and faith, and allowing for hope are essential for respectful and mutual accommodation.
Subject(s)
Ethics, Nursing , Parents , Religion and Medicine , Resuscitation Orders , Attitude of Health Personnel , Child , Dissent and Disputes , Group Processes , Humans , Leukemia, Myeloid, Acute/therapy , Male , Parents/psychology , Pediatric Nursing , Withholding TreatmentABSTRACT
Blatant examples of breeches of confidentiality are less common in comparison to the daily indiscretions that occur by members of the health care team or support staff. Yet such breeches of confidentiality are rarely identified as ethical or legal problems and therefore remain unaddressed. To uphold their moral and legal obligation to protect private information, nurses must examine the nature of their obligations and devise strategies to create and maintain a culture that holds health care professionals accountable for their actions.
Subject(s)
Child Advocacy , Confidentiality , Disclosure , Ethics, Nursing , Parents , Patient Advocacy , Adolescent , Confidentiality/legislation & jurisprudence , Female , Humans , Minors , Pediatric Nursing/legislation & jurisprudence , Sexual Behavior , Social Responsibility , Truth Disclosure , United StatesABSTRACT
Caring for Baby K, an infant born with anencephaly, created moral distress and violated the integrity of some nurses. This article explores the nature of professional nurses' claims of violations of their integrity, argues for a broader moral framework for examining such dilemmas, and suggests strategies for addressing these issues in the clinical setting.
Subject(s)
Anencephaly/nursing , Dissent and Disputes , Ethics, Nursing , Group Processes , Nurse's Role , Patient Advocacy , Female , Humans , Infant, Newborn , Mothers , Nursing Staff, Hospital/psychology , Resource AllocationABSTRACT
In order for nurses to be effective advocates, they must practice in an environment that fosters competency, collaboration, communication, and ethical values. This article addresses the meaning of advocacy, explores whether nurses can be effective advocates in complex practice environments, identifies barriers to advocacy, and suggests individual and systems approaches to support advocacy in critical care.
Subject(s)
Critical Care , Ethics, Nursing , Patient Advocacy , HumansABSTRACT
Increasingly, nurses are being confronted with clinical situations that challenge their personal and professional integrity. For integrity to be preserved, safeguards must be developed and an environment that supports ethical practice fostered. Standards such as those promulgated by the JCAHO provide an important opportunity for nurses to create mechanisms to assure that diverse religious, cultural, and ethical beliefs of nurses are respected and upheld.
Subject(s)
Conflict, Psychological , Ethics, Nursing , Nursing Staff/psychology , Patient Advocacy , Female , Humans , Infant, Newborn , Joint Commission on Accreditation of Healthcare Organizations , Nursing Staff/legislation & jurisprudence , Social ValuesSubject(s)
Dissent and Disputes , Ethics, Nursing , Euthanasia, Active , Euthanasia , Group Processes , Neuromuscular Blocking Agents/therapeutic use , Respiration, Artificial/nursing , Withholding Treatment , Advance Directives , Aged , Family , Female , Humans , Intention , Risk Assessment , Stress, Psychological , Terminology as TopicABSTRACT
The unconsented use of placebo pain medicine raises numerous ethical and legal issues. Generally, the use of placebo for the assessment of pain is unjustified. Nurses who are asked to participate in placebo pain medication must be knowledgeable of the ethical and legal ramifications of their actions.
