[Emerging ethical issues in clinical practice: a regional survey]. / Questioni etiche emergenti nella pratica clinica: risultati di un'indagine regionale.

. Emerging ethical issues in clinical practice: a regional survey. INTRODUCTION: In 2016, the Friuli Venezia Giulia Region established the Clinical Ethics Committees in every health agency of the Region. To initiate a proactive way of "doing ethics" giving voice to those who face clinical-ethical problems, a survey was carried out in six health agencies. AIM: To identify the most relevant ethical issues. METHODS: Survey through self-administered questionnaires, which explore: a) the ethical dimension of work in health care; b) situations of potential moral conflict; c) death and dying; (d) how ethical issues are handled and the role of ethic committees. RESULTS: 2.774 questionnaires were collected. Almost all respondents (97%) consider ethics an integral dimension of the health profession; 35% report a lack of education on bioethic issues. Behaviors that generated moral suffering (lack of respect of patients as persons 43%; aggressive medical treatment 29%). End-of-life ethical issues were the most controversial wellas the discharge of not self-sufficient patients without a social network. Restraints use was a source of conflict; receive education on; 60% of health professionals did receive education on death and dying death and dying; 51% felt inadequate in dealing with these issues. Only 8% referred to use ethical advice. CONCLUSIONS: Ethical Committees could play a role in fostering debate, proposing methods for detecting, describing and analysing ethical dilemmas, to supporting professionals in difficult clinical choices.

The experiences of patients electrically shocked by an implantable cardioverter defibrillator: Findings from a descriptive qualitative study.

BACKGROUND: To date, few studies have explored cases of implantable cardioverter defibrillator (ICD) shock delivery with the intent of understanding patients' educational and supportive needs. AIMS AND OBJECTIVES: To explore patient experiences as lived before, during and after one or more shocks. DESIGN: A descriptive qualitative study carried out between 2016 and 2017. METHODS: Semi-structured face-to-face audio-recorded interviews were performed and analysed using a content analysis methodology. RESULTS: A total of 50 patients (average age = 68.3 years; largely male = 49; 98%) were interviewed. Four themes emerged: (a) "Feeling surprised vs. alerted by the changes inside me"; (b) "Living an intense, mono-dimensional vs. living a multidimensional storm experience", (c) "Facing the event vs. being supported"; and (d) "Living a drama vs. being used to it". CONCLUSIONS: Findings suggest that ICD use can trigger negative physical and emotional effects in patients. Moreover, nurses should recognize patients' educational needs according to the stage of adaptation that each patient is experiencing with the aim of tailoring appropriate supportive interventions. RELEVANCE TO CLINICAL PRACTICE: Therefore, it is necessary to consider the psychological needs of patients by integrating these into clinical care at different levels (emergency department, hospital ward, home). Specific structured support aimed at helping patients overcome intense negative experiences is suggested, especially in the first stage of the adaptation process. Nurses should also ensure that appropriate education programmes with adequate follow-up interventions are offered to improve the experience of living with an ICD. In addition, patient-reported outcomes should be routinely collected from patients with an ICD.