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An interactive educational workshop to improve end of life communication skills.

https://arctichealth.org/en/permalink/ahliterature153875
Source
J Contin Educ Health Prof. 2008;28(4):241-8; quiz 249-55
Publication Type
Article
Date
2008
Author
Brigette M Hales
Laura Hawryluck
Author Affiliation
Critical Care Secretariat, Ministry of Health and Long Term Care, Toronto, Ontario, Canada. brigette.hales@sunnybrook.ca
Source
J Contin Educ Health Prof. 2008;28(4):241-8; quiz 249-55
Date
2008
Language
English
Publication Type
Article
Keywords
Decision Making - ethics
Education - methods
Education, Continuing
Humans
Intensive Care Units
Interdisciplinary Communication
Ontario
Professional-Family Relations - ethics
Program Evaluation
Questionnaires
Terminal Care - ethics - legislation & jurisprudence
Abstract
An understanding of legal, ethical, and cultural concerns and an ability to communicate when faced with clinical dilemmas are integral to the end of life decision-making process. Yet teaching practicing clinicians these important skills in addressing conflict situations is not strongly emphasized.
A one-day interactive continuing education workshop was designed to improve interactions among multiprofessional intensive care unit (ICU) clinicians, their colleagues, and families in a range of end of life situations using standardized families and colleagues (SF/SCs). Workshop participants completed preworkshop and postworkshop evaluations. Data were analyzed using the McNemar test for paired categorical data to evaluate changes in comfort, knowledge, and skill.
The majority of evaluation respondents were nursing professionals, while only one physician (of two in attendance) responded. Statistically significant improvement was seen in all comfort levels, except when approaching cultural differences. Expectations were exceeded according to 76.2% of responses, while 82.4% rated SF/SCs "excellent" for improving communication skills and comfort levels with ethical and legal dilemmas. Peer discussions were highly valued in meeting educational objectives (95.2% good or excellent), and 95.2% rated achievement of personal learning objectives good or excellent. Qualitative data supported a high overall perception of success and achievement of educational objectives.
An interactive workshop can be a valuable educational intervention for building capacity and confidence in end of life communication skills and ethical and legal knowledge for health care providers; further physician involvement is required to extrapolate results to this population.
PubMed ID
19058258 View in PubMed
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Are end-of-life practices in Norway in line with ethics and law?

https://arctichealth.org/en/permalink/ahliterature263426
Source
Acta Anaesthesiol Scand. 2014 Oct;58(9):1146-50
Publication Type
Article
Date
Oct-2014
Author
R. Førde
O G Aasland
Source
Acta Anaesthesiol Scand. 2014 Oct;58(9):1146-50
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Attitude of Health Personnel
Euthanasia - ethics - legislation & jurisprudence - statistics & numerical data
Female
Humans
Life Support Care - ethics - legislation & jurisprudence - statistics & numerical data
Male
Middle Aged
Norway
Physicians - ethics - legislation & jurisprudence - statistics & numerical data
Questionnaires
Sex Distribution
Suicide, Assisted - ethics - legislation & jurisprudence - statistics & numerical data
Terminal Care - ethics - legislation & jurisprudence - statistics & numerical data
Abstract
End-of-life decisions, including limitation of life prolonging treatment, may be emotionally, ethically and legally challenging. Euthanasia and physician-assisted suicide (PAS) are illegal in Norway. A study from 2000 indicated that these practices occur infrequently in Norway.
In 2012, a postal questionnaire addressing experience with limitation of life-prolonging treatment for non-medical reasons was sent to a representative sample of 1792 members of the Norwegian Medical Association (7.7% of the total active doctor population of 22,500). The recipients were also asked whether they, during the last 12 months, had participated in euthanasia, PAS or the hastening of death of non-competent patients.
Seventy-one per?cent of the doctors responded. Forty-four per?cent of the respondents reported that they had terminated treatment at the family's request not knowing the patient's own wish, doctors below 50 and anaesthesiologists more often. Anaesthesiologists more often reported to have terminated life-prolonging treatment because of resource considerations. Six doctors reported having hastened the death of a patient the last 12 months, one by euthanasia, one by PAS and four had hastened death without patient request. Male doctors and doctors below 50 more frequently reported having hastened the death of a patient.
Forgoing life-prolonging treatment at the request of the family may be more frequent in Norway that the law permits. A very small minority of doctors has hastened the death of a patient, and most cases involved non-competent patients. Male doctors below 50 seem to have a more liberal end-of-life practice.
PubMed ID
25124467 View in PubMed
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Artificial intelligence: making decisions about artificial nutrition and hydration.

https://arctichealth.org/en/permalink/ahliterature178789
Source
J Nutr Health Aging. 2004;8(4):254-6
Publication Type
Article
Date
2004

Attitudes of Quebec doctors toward sedation at the end of life: an exploratory study.

https://arctichealth.org/en/permalink/ahliterature148306
Source
Palliat Support Care. 2009 Sep;7(3):331-7
Publication Type
Article
Date
Sep-2009
Author
Danielle Blondeau
Serge Dumont
Louis Roy
Isabelle Martineau
Author Affiliation
Faculty of Nursing, Pavillon Ferdinand-Vandry, Université Laval, Québec, Canada. Danielle.Blondeau@fsi.ulaval.ca
Source
Palliat Support Care. 2009 Sep;7(3):331-7
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Awareness
Conscious Sedation - ethics - psychology
Cooperative Behavior
Decision Making - ethics
Ethics, Medical
Humans
Informed Consent - ethics - psychology
Interdisciplinary Communication
Palliative Care - ethics - psychology
Patient Care Team - ethics
Physician-Patient Relations - ethics
Professional-Family Relations - ethics
Quebec
Terminal Care - ethics - psychology
Abstract
The induction of sedation at the end of life is a much debated practice and not very documented. The goal of this study was to explore the practice from both a clinical and ethical point of view.
Data were collected through semistructured interviews with 19 Quebec physicians working in palliative care.
Doctors' first priority was their patients, not patients' families. Clinically, the therapeutic aim of sedation was strictly to relieve suffering on the part of the patient. Ethically, getting the patient's consent was imperative. The family's consent was only required in cases of incapacity. Generally, sedation and euthanasia were seen as two distinct practices.
There are still very few guidelines regarding end-of-life sedation in Québec, and its normative framework is more implicit than explicit. It should be noted that most of the respondents regarded sedation and euthanasia as two distinct practices.
PubMed ID
19788775 View in PubMed
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Attitudes to terminal patients' unorthodox therapy: Finnish doctors' responses to a case scenario.

https://arctichealth.org/en/permalink/ahliterature182750
Source
Support Care Cancer. 2004 Feb;12(2):132-6
Publication Type
Article
Date
Feb-2004
Author
Heikki Hinkka
Elise Kosunen
Ulla-Kaija Lammi
Riina Metsänoja
Pirkko Kellokumpu-Lehtinen
Author Affiliation
Kangasala Health Center, Herttualantie 28, 36200 Kangasala, Finland. hhinkka@sci.fi
Source
Support Care Cancer. 2004 Feb;12(2):132-6
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Attitude of Health Personnel
Complementary Therapies - ethics - psychology
Female
Finland
Humans
Logistic Models
Male
Middle Aged
Palliative Care - ethics - psychology
Physicians - ethics - psychology
Questionnaires
Terminal Care - ethics - psychology
Abstract
We carried out a postal survey of a sample of Finnish doctors ( n=1182) concerning their attitudes and ethical decisions in end-of-life care. A scenario was presented in which a patient with terminal cancer wished to obtain unorthodox treatment. Factors possibly influencing decision making such as general attitudes, life values and demographics were investigated. The response rate was 62%. The patient's plan to use unorthodox treatment was accepted by 54% of doctors. Gender or speciality did not influence the decision, but doctor's age was a significant factor ( P=0.0005). Doctors aged 35-49 years were more accepting; younger and older ones less accepting. Doctors who had clinical experience in terminal care were more compliant to the patient's plan ( P=0.034). A stepwise logistic regression analysis was used to create a model for explaining not accepting versus accepting the treatment with the background variables. Altogether eight independent significant variables were included in the final model of explaining a doctor's choice in the presented scenario. According to the model the patient's wish was more frequently accepted if the doctor was middle-aged, had clinical experience in terminal care, valued a high standard of living, considered terminal care satisfying, was less critical of health economics, considered advance directives helpful, had a high fear-of-death index score, and valued professional status less.
PubMed ID
14628213 View in PubMed
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[Beneficial with Kierkegaard in the palliative care?].

https://arctichealth.org/en/permalink/ahliterature137468
Source
Lakartidningen. 2010 Dec 8-14;107(49):3153-5
Publication Type
Article
Author
Niels Lynøe
Author Affiliation
Centrum för hälso- och sjukvårdsetik, Karolinska Institutet, Stockholm.
Source
Lakartidningen. 2010 Dec 8-14;107(49):3153-5
Language
Swedish
Publication Type
Article
Keywords
Attitude to Death
Denmark
Existentialism
History, 19th Century
Humans
Medicine in Literature
Palliative Care - ethics
Philosophy - history
Right to Die - ethics
Terminal Care - ethics
PubMed ID
21280352 View in PubMed
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Best interests at end of life: an updated review of decisions made by the Consent and Capacity Board of Ontario.

https://arctichealth.org/en/permalink/ahliterature118233
Source
J Crit Care. 2013 Feb;28(1):22-7
Publication Type
Conference/Meeting Material
Article
Date
Feb-2013
Author
Paula Chidwick
Robert Sibbald
Laura Hawryluck
Author Affiliation
William Osler Health System, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, University Health Network, University of Toronto. Paula.chidwick@williamoslerhs.ca
Source
J Crit Care. 2013 Feb;28(1):22-7
Date
Feb-2013
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Beneficence
Decision Making
Dissent and Disputes - legislation & jurisprudence
Governing Board
Humans
Negotiating
Ontario
Palliative Care - ethics - legislation & jurisprudence
Physician's Practice Patterns - ethics - legislation & jurisprudence
Terminal Care - ethics - legislation & jurisprudence
Third-Party Consent - ethics - legislation & jurisprudence
Withholding Treatment - ethics - legislation & jurisprudence
Abstract
To increase our understanding of the notion of "best interests" in end of life disagreements through an updated review of decisions made by the Consent and Capacity Board of Ontario. There was a significant increase (235%) in decisions from this tribunal between 2009 and 2011. "Best interests" test is used when no prior expressed wishes are known to the surrogate decision-makers.
Purposively sampled written decisions of the Consent and Capacity Board of Ontario between 2003 and 2011 that focused on the "best interests" of patients at the end of life. Interpretive content analysis was performed independently by 3 reviewers, and themes were identified by consensus.
We found substitute decision makers (SDMs) rely on an appeal to their own values or religion in their interpretation of best interests; physicians rely on clinical conditions; board emphasizes alignment with Health Care Consent Act. In the more recent cases, we found that SDMs report that patients value suffering; that SDMs have unrealistic hope for recovery and can communicate and get direction from the incapable patient; that SDMs need education on their role and responsibility as SDM; and that SDMs need time to provide consent, and that most proposed treatment plans that were sources of conflict included "palliative care."
Several lessons are drawn for the benefit of health care teams engaged in disagreements at end of life with SDMs over the best interests of patients.
PubMed ID
23228726 View in PubMed
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"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home.

https://arctichealth.org/en/permalink/ahliterature139178
Source
J Clin Ethics. 2010;21(3):201-11
Publication Type
Article
Date
2010
Author
Susan McClement
Michelle Lobchuk
Harvey Max Chochinov
Ruth Dean
Author Affiliation
Faculty of Nursing, University of Manitoba, Winnipeg. susan.mcclement@cancercare.mb.ca
Source
J Clin Ethics. 2010;21(3):201-11
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Attitude to Death
Canada
Female
Humans
Long-Term Care - ethics
Male
Middle Aged
Nurses' Aides - ethics - standards
Nursing Homes - manpower - standards
Terminal Care - ethics - standards
Abstract
Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.
Notes
Comment In: J Clin Ethics. 2010 Fall;21(3):179-8821089987
PubMed ID
21089989 View in PubMed
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[Caring for persons at the end of life in a curative care unit: privileges and heartbreaks].

https://arctichealth.org/en/permalink/ahliterature145841
Source
Can Oncol Nurs J. 2009;19(3):110-6
Publication Type
Article
Date
2009
Author
Marie-Laurence Fortin
Louise Bouchard
Author Affiliation
l''Hôpital Général Juif, 3755 chemin de la Côte Ste-Catherine, Montréal, Québec. mfortin@jgh.mcgill.ca
Source
Can Oncol Nurs J. 2009;19(3):110-6
Date
2009
Language
French
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Death
Burnout, Professional - psychology
Conflict (Psychology)
Empathy
Frustration
Grief
Hospital Units - ethics - organization & administration
Hospitals, University
Humanism
Humans
Nurse's Role - psychology
Nurse-Patient Relations - ethics
Nursing Methodology Research
Nursing Staff, Hospital - ethics - organization & administration - psychology
Organizational Culture
Philosophy, Nursing
Professional Autonomy
Qualitative Research
Quebec
Terminal Care - ethics - organization & administration - psychology
Thinking
Abstract
The objective of this study was to describe the experience of caring for individuals at the end of life by five nurses working in curative care units. Semi-structured interviews were conducted to gain a better understanding of the meaning nurses give to this experience. The analysis of results, based on Giorgi's phenomenological method (1997), highlighted a central meaning: it is a human experience fraught with paradoxes where the bedside nurse feels both privileged to be accompanying these individuals at the end of their lives and torn between the medical priority given to curative care and the lesser priority given to palliative care. This study offers relevant options for nurse managers wanting to improve these nurses' work environment and the quality of care for individuals at the end of life.
PubMed ID
20101940 View in PubMed
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76 records – page 1 of 8.