Ethical conflicts among physicians and nurses during the COVID-19 pandemic: A qualitative study.

RATIONALE, AIMS AND OBJECTIVES: The healthcare system and professionals working in the sector have experienced a high caseload during the coronavirus disease 2019 (COVID-19) pandemic. This has increased the potential for morally harmful events that violate professionals' moral codes and values. The aim of this study was to understand and explore experiences of new moral challenges emerging among physicians and nurses caring for individuals during the COVID-19 pandemic. METHOD: The consolidated criteria for reporting qualitative research (COREQ) checklist was used in this qualitative study based on Gadamer's phenomenology. Participants were selected using a convenience sampling method. Thirteen medicine and nursing graduates were interviewed in depth. The participants all worked on the frontline at the start of the COVID-19 pandemic. Data were gathered in two basic healthcare districts in Spain, encompassing both primary care and hospital care. RESULTS: Four main themes emerged from the data analysis: (1) Betrayal of moral and ethical values as a key source of suffering; (2) Ethical and moral sense of failure accompanying loss of meaning; (3) Lack of confidence in performance; (4) Self-demand and self-punishment as personal condemnation among healthcare workers. CONCLUSIONS: Health institutions must implement interventions for health professionals to help mitigate the consequences of experiencing complex ethical scenarios during the pandemic. In addition, they should promote training in moral and ethical deliberation and prepare them to make decisions of great ethical significance.

Professional quality of life, self-compassion, resilience, and empathy in healthcare professionals during COVID-19 crisis in Spain.

The coronavirus pandemic has exposed healthcare professionals to suffering and stressful working conditions. The aim of this study was to analyze professional quality of life among healthcare professionals and its relationship with empathy, resilience, and self-compassion during the COVID-19 crisis in Spain. A cross-sectional study was conducted with 506 healthcare professionals, who participated by completing an online questionnaire. A descriptive correlational analysis was performed. A multivariate regression analysis and a decision tree were used to identify the variables associated with professional quality of life. Empathy, resilience, and mindfulness were the main predictors of compassion fatigue, compassion satisfaction, and burnout, respectively.

Cuidados compasivos en el final de la vida: una cuestión ética / Compassionate care at the end of life: an ethical question

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Atención recibida al final de la vida en los servicios de urgencias desde la perspectiva de los cuidadores: estudio cualitativo / Care received at the end of life in emergency services from the perspective of caregivers: A qualitative study

Objetivo: Conocer las vivencias de los pacientes que se encontraban al final de la vida y fueron atendidos por los servicios de urgencias, mediante los discursos de sus cuidadores familiares que acompañaban al familiar en este tránsito asistencial. Método: Estudio de enfoque cualitativo, basado en el paradigma de la fenomenología hermenéutica. En total participaron 81 cuidadores familiares. Las técnicas que se utilizaron fueron la entrevista en profundidad y el grupo de discusión, con un total de 5 grupos de discusión y 41 entrevistas. El período de recopilación de los datos se realizó entre enero del 2013 y junio del 2014. Resultados: En la red de los discursos obtenida respecto a la «Atención Urgente», todos los códigos se aglutinan respecto a una única línea argumentativa: las deficiencias en la atención urgente. Entre ellos, hemos encontrado distintas dimensiones que se establecen en función de los diferentes tiempos de la atención, o los distintos aspectos determinantes de estas deficiencias: desorganización de la atención recibida, poca experiencia de los profesionales en las urgencias, aplicación de protocolos generales, en los servicios de urgencias, inadecuada atención en el trato recibido, demoras en la atención en urgencias. Conclusiones: En general, destacamos la insatisfacción de los familiares con respecto a la atención en los servicios de urgencias. Las necesidades que precisan este tipo de situaciones no están cubiertas desde estos servicios y son de baja calidad. Por tanto, es necesario reorientar los protocolos de atención de estos pacientes

Objective: To discover the experiences of end-of-life patients attended by the emergency services, through the discourse of the family caregivers who accompanied the family member in this care transit. Method: A qualitative approach study, based on the paradigm of hermeneutical phenomenology. In total, 81 family caregivers participated. The techniques used were the in-depth interview and the discussion group, with a total of 5 discussion groups and 41 interviews. The period of data collection was carried out between January 2013 and June 2014. Results: In the network of discourses obtained with respect to "Urgent Care", all the codes were grouped in relation to a single argumentative line: deficiencies in urgent care. Among them, we found different dimensions that are established depending on the different times of care, or the different determinant aspects of these deficiencies: disorganization of the care received, lack of experience of the professionals in emergencies, application of general protocols in the emergency services, inadequate care in the treatment received, delays in emergency care. Conclusions: In general, we highlight the dissatisfaction of the family members with respect to the care received from the emergency services. The needs of these types of situation are not covered from these services and are of low quality. Therefore, it is necessary to reorient the care protocols for these patients

Care received at the end of life in emergency services from the perspective of caregivers: A qualitative study. / Atención recibida al final de la vida en los servicios de urgencias desde la perspectiva de los cuidadores: estudio cualitativo.

OBJECTIVE: To discover the experiences of end-of-life patients attended by the emergency services, through the discourse of the family caregivers who accompanied the family member in this care transit. METHOD: A qualitative approach study, based on the paradigm of hermeneutical phenomenology. In total, 81 family caregivers participated. The techniques used were the in-depth interview and the discussion group, with a total of 5 discussion groups and 41 interviews. The period of data collection was carried out between January 2013 and June 2014. RESULTS: In the network of discourses obtained with respect to "Urgent Care", all the codes were grouped in relation to a single argumentative line: deficiencies in urgent care. Among them, we found different dimensions that are established depending on the different times of care, or the different determinant aspects of these deficiencies: disorganization of the care received, lack of experience of the professionals in emergencies, application of general protocols in the emergency services, inadequate care in the treatment received, delays in emergency care. CONCLUSIONS: In general, we highlight the dissatisfaction of the family members with respect to the care received from the emergency services. The needs of these types of situation are not covered from these services and are of low quality. Therefore, it is necessary to reorient the care protocols for these patients.

La información sanitaria en el proceso de la muerte: ¿a quién corresponde? / Giving information in the end-of-life-process. Whose responsibility?

ANTECEDENTES: Uno de los conflictos éticos más frecuentes y generadores de sufrimiento en la atención sanitaria es la información a pacientes y familias en el final de la vida. OBJETIVO: El objetivo de este trabajo es explorar e interpretar la visión de la enfermería respecto a la información sanitaria proporcionada a las personas en el proceso de la muerte. MÉTODO: Esta investigación se enmarca en el paradigma cualitativo y utiliza el método fenomenológico-hermenéutico interpretativo. El escenario de la investigación lo han conformado los Centros Sanitarios del Servicio Andaluz de Salud en Huelva y su provincia, siendo las personas informantes profesionales vinculados a los hospitales y Centros de Salud correspondientes. La información se ha obtenido a través de las técnicas de grupo nominal, grupo de discusión y la entrevista. RESULTADOS: En el ámbito de los cuidados paliativos no existe unanimidad entre los profesionales respecto a la conveniencia o no de facilitar información veraz a la persona enferma, siendo una de las dificultades importantes el miedo de los propios profesionales a hacer daño y a que esto se traduzca en una situación de inseguridad jurídica. La información se evidencia como una responsabilidad de enfermería que debe ser abordada en equipo

BACKGROUND: One of the most common ethical conflicts in health care and one which generates considerable suffering is whether or not to give clinical information to patients and their families at the end-of-life stage. AIM: The objective of this paper is to examine and interpret the giving of health information to people in the process of dying from the Nursing perspective. METHOD: This study is defined within the qualitative paradigm, and uses the interpretative hermeneutic-phenomenological method. The study setting is Andalusia Health Service health care centres in the city and province of Huelva, and carried out by health care professionals who work in Andalusia Health Service clinics and hospitals. Data have been gathered from contributions in a nominal group, discussion group, and interviews. RESULTS: There is no consensus among palliative care professionals about whether it is helpful to provide the dying patient with accurate information. One of main difficulties cited by health care professionals was the fear of harming the patient, which in turn might have legal consequences. Supplying information to the patient is seen as a Nursing responsibility that must be managed as a team

El significado de morir dignamente desde la perspectiva de las personas cuidadoras: estudio fenomenológico / The meaning of dying with dignity from caregivers perspective: a phenomenological study

OBJETIVO: Explorar el significado de morir con dignidad desde la experiencia vivida por los testigos directos que han acompañado este proceso en personas fallecidas en Andalucía. MÉTODO: Estudio fenomenológico multicéntrico en el que se han analizado los discursos obtenidos en los grupos de discusión de 5 provincias andaluzas con la participación de 40 personas. El análisis de los datos se ha realizado a través de la propuesta de Van Manem.como herramienta informática hemos utilizado el programa Atlas Ti 7.0. RESULTADOS: El acompañamiento de los seres queridos se erige como elemento clave en la percepción de una muerte digna. También se destaca según orden de prioridad: el alivio del sufrimiento, el buen trato profesional, la capacidad de decidir y la posibilidad de expresar la dimensión espiritual. La cumplimentación de voluntades vitales anticipadas apenas es mencionada. CONCLUSIÓN: Se confirman como elementos esenciales los definidos en la Ley 2/2010, de morir con dignidad (sin sufrimiento, en compañía, respetando deseos, y posibilitando la despedida y el sentido trascendente del proceso de morir). Las personas cuidadoras en el final de la vida priorizan los aspectos psicosociales, destacando la necesidad de acompañamiento, la despedida de los seres queridos y el buen trato profesional sobre los aspectos físicos. La promoción de la Ley de Muerte Digna y Voluntades Vitales Anticipadas se encuentra aún en desarrollo

OBJECTIVE: To explore the meaning of dying with dignity from the perspective of the direct witnesses who have accompanied this process in dying people from Andalusia. METHOD: Phenomenological study conducted in different centres, which including analysing the transcriptions of the dialogues from discussion groups with 40 participants in five provinces in Southern Spain. The data was analysed using the Van Manen proposal and Atlas Ti 7.0 program was applied as a software tool. RESULTS: Being in the company of loved ones is noted as a key element in the perception of a dignified death. The following elements, according to a priority order, were also pointed out: relief of suffering, a good professional care, decision making ability, and the opportunity to consider their spiritual dimension. Achievement of their Living Wills is hardly mentioned. CONCLUSIONS: The essential elements defined in the Death with Dignity Law, 2/2010 are confirmed as being true (without suffering, with company, respecting living wills, having possibilities of the farewell, and the transcendental meaning of the death process). Caregivers, at the end of life, give priority to psychological aspects, underlying the need of company, a farewell of the loved ones, and a good professional care on the physical aspects. The promotion of the dignified Death Law and Living Wills are still being developed

[The meaning of dying with dignity from caregivers perspective: a phenomenological study]. / El significado de morir dignamente desde la perspectiva de las personas cuidadoras: estudio fenomenológico.

OBJECTIVE: To explore the meaning of dying with dignity from the perspective of the direct witnesses who have accompanied this process in dying people from Andalusia. METHOD: Phenomenological study conducted in different centres, which including analysing the transcriptions of the dialogues from discussion groups with 40 participants in five provinces in Southern Spain. The data was analysed using the Van Manen proposal and Atlas Ti 7.0 program was applied as a software tool. RESULTS: Being in the company of loved ones is noted as a key element in the perception of a dignified death. The following elements, according to a priority order, were also pointed out: relief of suffering, a good professional care, decision making ability, and the opportunity to consider their spiritual dimension. Achievement of their Living Wills is hardly mentioned. CONCLUSION: The essential elements defined in the Death with Dignity Law, 2/2010 are confirmed as being true (without suffering, with company, respecting living wills, having possibilities of the farewell, and the transcendental meaning of the death process). Caregivers, at the end of life, give priority to psychological aspects, underlying the need of company, a farewell of the loved ones, and a good professional care on the physical aspects. The promotion of the dignified Death Law and Living Wills are still being developed.