| 1. |
- Axelsson, Lena, et al.
(author)
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Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives
- 2020
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In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:2, s. 419-432
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Journal article (peer-reviewed)abstract
- Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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| 2. |
- Bennesved, Anna, et al.
(author)
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Ambulance clinicians’ understanding of older patients’ self-determination : A vignette study
- 2023
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In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; , s. 1-13
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Journal article (peer-reviewed)abstract
- Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.
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| 3. |
- Bolmsjö, Ingrid, et al.
(author)
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Conflicts of interest: experiences of close relatives of patients suffering from amyotrophic lateral sclerosis.
- 2003
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 10:2, s. 186-198
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Journal article (peer-reviewed)abstract
- It is well known that close relatives of terminally ill patients endure great emotional stress. Many factors, such as existential concerns, contribute to the distress of these relatives. In this study, interviews were conducted to explore experiences concerning life restrictions, emotional distress, and limited support, in a group of close relatives of patients with amyotrophic lateral sclerosis (ALS). The purpose was to identify, illuminate and clarify ethical problems related to these experiences. The results indicate that close relatives of patients with ALS need someone to talk to, as well as more information about the disease and its process. Furthermore, the study illustrates how ethical problems are related to choices and conflicts, and that a process including shared decision making is often an ideal when trying to find a solution to ethical problems.
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| 4. |
- Bolmsjö, Ingrid, et al.
(author)
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Everyday ethical problems in dementia care: a teleological model.
- 2006
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 13:4, s. 340-359
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Journal article (peer-reviewed)abstract
- In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.
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| 5. |
- Bolmsjö, Ingrid, et al.
(author)
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Everyday ethics in the care of elderly people
- 2006
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 13:3, s. 249-263
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Journal article (peer-reviewed)abstract
- This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection.
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| 6. |
- Glasdam, Stinne, et al.
(author)
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Nurses’ refusals of patient involvement in their own palliative care
- 2020
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 27:8, s. 1618-1630
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Journal article (peer-reviewed)abstract
- Background:Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice.Aim:To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective.Method:A case study based on an anthropological field study among patients with advanced cancer in Denmark.Ethical considerations:Followed the principles of the Helsinki Declaration.Findings:Two cases illustrated situations where nurses refused patient involvement in their own case.Discussion:Focus on two ethical issues, namely ‘including patients’ experiences in palliative nursing care’ and ‘relational distribution of power and knowledge’, inspired primarily by Hannah Arendt’s concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients’ palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned ‘thoughtlessness’ of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients’ invitations to involve them in their own case.Conclusion:The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that ‘thoughtlessness’ appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses’ ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
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| 7. |
- Hallström, Inger, et al.
(author)
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An observational study of the level at which parents participate in decisions during their child's hospitalization.
- 2002
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 9:2, s. 202-214
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Journal article (peer-reviewed)abstract
- When a child is hospitalized, the parents find themselves in an unfamiliar environment and their parental role changes. They are in a stressful and often anxiety-filled situation and it may be difficult for them to participate in decisions. The purpose of this study was to examine the extent to which parents participate in decisions during the course of events when their child is hospitalized. Thirty-five parents of 24 children (aged 5 months to 18 years) were followed by mobile observation during their child's hospitalization in a paediatric department in Sweden. Three researchers analysed field notes in three steps, using manifest and latent coding. In step 1, 119 situations that included a decision process were identified. In step 2, the situations were assessed according to a five-level scale concerning how the parents' wishes, desires or values had been respected. In step 3, each situation was scrutinized with respect to factors influencing the extent of the parents' participation. The results showed that parents have varying ability to be involved in decision making. Professionals need to communicate more openly with them in order to identify and satisfy their needs because some parents are unwilling or incapable of expressing them.
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| 8. |
- Hallström, Inger, et al.
(author)
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Decision making in paediatric care: an overview with reference to nursing care.
- 2005
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 12:3, s. 223-238
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Journal article (peer-reviewed)abstract
- The purpose of this overview of published articles on decision making in paediatric care was to identify important aspects of its possible use in clinical practice and to obtain a base for future research. A literature review was undertaken utilizing snowball sampling to identify articles because of the diversity present within the area of decision making in paediatric care. The databases PubMed and CINAHL were used. The search was limited to articles published in English during the period 1994-2004. The analysis entailed a series of comparisons across articles, focusing on major areas of enquiry and patterns of results. Various levels of decision making are described because these seem to form a basis for how decisions are made. Concepts found to be of importance for decision making are described under the following headings: competence, the child’s best interests, knowledge, values and attitudes, roles and partnership, power, and economy. Further research is suggested.
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| 9. |
- Hallström, Inger, et al.
(author)
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Needs during hospitalization: definitions and descriptions made by patients
- 2001
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In: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 8:5, s. 409-418
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Journal article (peer-reviewed)abstract
- Patients are supposed to be given care according to their needs. This concept is, however, difficult to define and patients and caregivers may have different opinions about a patient's needs. Twenty patients were interviewed and asked to give a definition of need, describe their needs while hospitalized and depict what they do to make sure their needs are fulfilled. Ten groups of needs were identified: communication, basic care, contact with other people, behaviour of staff, empathy, competent caregivers, continuity, integrity, participation in decision making, and pain relief. The descriptions patients gave of how they ensured their needs were met could be divided into two groups: openly seeking attention; or not wanting to disturb the staff. Interviews with patients emphasized the importance of recognizing that they have individual needs and varying abilities to see that their needs are fulfilled.
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| 10. |
- Khalaf, Atika, et al.
(author)
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Caring for undernourished patients in an orthopaedic setting
- 2009
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In: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 16:1, s. 5-18
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Journal article (peer-reviewed)abstract
- This study elucidates the nursing of undernourished patients as experienced by eight registered clinical nurses and five nursing assistants by using content analysis. The participants' narratives describe the inner perspective of caring for undernourished patients, known in Sweden as `the thin ones'. Categories identified were: frustration in nursing, joy in nursing and that undernourishment is taboo. The taboo was narrated as feelings of guilt and shame. Frustration in nursing could be seen as feeling stressed, exposed, lonely, powerless, helpless, and being torn between demands and needs. Joy in nursing was experienced when creating a trusting relationship, promoting pleasure in the meal situation and working with respect for each individual's life-style and context of life. Understanding staff members' views is important when implementing guidelines as well as in the teaching situation in order to identify where staff stand with regard to knowledge and attitudes.
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