| 1. |
- Austeng, Dordi, et al.
(författare)
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Incidence of and risk factors for neonatal morbidity after active perinatal care : extremely preterm infants study in Sweden (EXPRESS)
- 2010
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:7, s. 978-992
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
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| 2. |
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| 3. |
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| 4. |
- Bosshard, G, et al.
(författare)
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Forgoing treatment at the end of life in 6 European countries
- 2005
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Ingår i: Archives of Internal Medicine. - 0003-9926. ; 165:4, s. 401-407
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Tidskriftsartikel (refereegranskat)abstract
- Background: Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient's life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics. Methods: Between June 2001 and February 2002, samples were obtained from deaths reported to registries in Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. The reporting physician was then sent a questionnaire about the medical decision-making process that preceded the patient's death. Results: The incidence of nontreatment decisions, whether or not combined with other end-of-life decisions, varied widely from 6% of all deaths studied in Italy to 41% in Switzerland. Most frequently forgone in every country were hydration or nutrition and medication, together representing between 62% (Belgium) and 71% (Italy) of all treatments withheld or withdrawn. Forgoing treatment estimated to prolong life for more than I month was more common in the Netherlands (10%), Belgium (9%), and Switzerland (8%) than in Denmark (5%), Italy (3%), and Sweden (2%). Relevant determinants of treatment being withheld rather than withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the hospital (death in hospital: OR, 0.80; 95% CI, 0.68-0.93), and greater lifeshortening effect (OR, 1.75; 95% Cl, 1.27-2.39). Conclusions: In all of the participating countries, life prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low technology interventions, such as medication or hydration or nutrition, are most frequently forgone. in older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.
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| 5. |
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| 6. |
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| 7. |
- Bremberg, S, et al.
(författare)
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Justifications of physicians' choice of action - Attitudes among the general public, GPs, and oncologists in Sweden
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:2, s. 102-108
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare choice of actions and justifying reasons among the general public, GPs and oncologists. Design. A postal questionnaire using four vignettes: a healthy patient reluctant to quit smoking and one demanding an X-ray, a pulmonary cancer patient reluctant to quit smoking and one demanding immunotherapy. Subjects. A random sample of the general public (n=1000), GPs (n=200), and oncologists (n=200). Main outcome measures. The respondents' choice of how the physician should act (general public)/would act (physicians), and, with reference to their choice of action, their justifying reasons. Results. A majority answered that the physician should/would bring up the question about smoking cessation with the reluctant patient, justified by promotion of medical benefit and protection from harm. With reference to the reluctant cancer patient every second oncologist and every third GP would not mention smoking cessation, justified by respect for self-determination and enhancement of the relationship. Facing the patient demanding a new X-ray the general public was more in favour while the physicians rejected it. One-third of the general public answered that the seriously ill patient's demand for immunotherapy should be granted and referred to respect for self-determination and enhanced relationship. A majority of the physicians rejected such a demand, justified by promotion of a fair distribution of resources. Conclusion. The fear of infringing the patient's right to self-determination and harming the relationship is exaggerated by physicians. They are mostly expected to bring up smoking cessation with a reluctant patient. How to manage demanding patients is more controversial.
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| 8. |
- Cartwright, Colleen, et al.
(författare)
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Physician discussions with terminally ill patients: a cross-national comparison
- 2007
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Ingår i: Palliative Medicine. - : SAGE Publications. - 1477-030X .- 0269-2163. ; 21:4, s. 295-303
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Tidskriftsartikel (refereegranskat)abstract
- A major issue in the care of terminally ill patients is communication and information provision. This paper reports the extent to which physicians in Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland discuss topics relevant to end of life care with terminally ill patients and their relatives (without first informing the patient), and possible associations between physician-specific characteristics and such discussions. Response rates to the postal survey ranged from 39% to 68% (n = 10139). Physicians in most of the countries except Italy in principle, always' discuss issues related to terminal illness with their patients but not with patients' relatives without first informing the patient, unless the relatives ask. Cross-national differences remained strong after controlling for physician characteristics. The majority of physicians appeared to support the principle of patient-centred care to terminally ill patients, consistent with palliative care philosophy and with the law and/or professional guidelines in most of the countries studied.
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| 9. |
- Cuttini, Marina, et al.
(författare)
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Patient refusal of emergency cesarean delivery - A study of obstetricians' attitudes in Europe
- 2006
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 108:5, s. 1121-1129
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the attitudes of a large sample of obstetricians from eight European countries toward a competent woman's refusal to consent to an emergency cesarean delivery for acute fetal distress. METHODS: Obstetricians' attitudes in response to a hypothetical clinical case were surveyed through an anonymous, self-administered questionnaire. The sample included 1,530 obstetricians (response rate 77%) from 105 maternity units (response rate 70%) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the United Kingdom. RESULTS: In every country, the majority of obstetricians would keep trying to persuade the woman, telling her that failure to perform cesarean delivery might result in the fetus surviving with disability, or even that her own life might be endangered. In Spain, France, Italy, and, to a lesser extent, Germany and Luxembourg, a consistent proportion of physicians would seek a court order to protect fetal welfare or avoid possible legal liability or both. In the United Kingdom, Sweden, and Netherlands, several respondents (59%, 41%, and 37%, respectively) would accept the woman's decision and assist vaginal delivery. Only a small minority (from 0 in the United Kingdom to 10% in France) would proceed with cesarean delivery without a court order. CONCLUSION: Case law arising from a few countries (United States, Canada, and the United Kingdom) and professional guidelines favoring women's autonomy have not solved the underlying ethical conflict, and in Europe acceptance of a woman's right to refuse cesarean delivery, at least in emergency situations, is not uniform. Differing attitudes between obstetricians from the eight countries may reflect diverse legal and ethical environments.
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| 10. |
- Danerek, Margaretha, et al.
(författare)
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Attitudes of Midwives in Sweden Toward a Woman's Refusal of an Emergency Cesarean Section or a Cesarean Section on Request.
- 2011
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Ingår i: Birth. - 0730-7659. ; 38:1, s. 71-79
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Tidskriftsartikel (refereegranskat)abstract
- Background: A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. Methods: The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). Results: In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. Conclusions: The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician. (BIRTH 38:1 March 2011).
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| 11. |
- Danerek, Margaretha, et al.
(författare)
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Attitudes of Swedish midwives towards management of extremely preterm labour and birth
- 2012
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 28:6, s. e857-e864
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Tidskriftsartikel (refereegranskat)abstract
- Objective the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. Design this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. Participants the answers from midwives (n=259) were collected in a prospective SWEMID study. Setting the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. Findings in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. Key conclusions midwives with experience of handling very preterm births at 21–28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. Implications for practice based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.
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| 12. |
- Eriksson, Tina, et al.
(författare)
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The ethics of risk communication in lifestyle interventions: Consequences of patient centredness
- 2007
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Ingår i: Health, Risk and Society. - : Informa UK Limited. - 1469-8331 .- 1369-8575. ; 9:1, s. 19-36
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Tidskriftsartikel (refereegranskat)abstract
- Background: Broader patient access to information, expanding clinical options and greater accommodation of patients' personal values makes clinical decision-processes increasingly complex. Given the challenges and implications of risk communication, it is important to explore what is happening when clinicians adopt different approaches to consultations. Aim: To perform an ethical analysis of personal risk communication based around a scenario of cardiovascular risk reduction by exploring how different consultation models raise different ethical implications. Method: We based our analysis on the triangle of autonomy, utility and justice. Because ethical questions arise during consultations, consultation approach is a basic context for interpretations. We chose four distinct approaches; paternalistic, shared decision-making, mandatory autonomist and narrative. Results: The ethical principles of autonomy, utility and justice proved ambiguous. Tradeoffs exist between principles to balance the rights of individual patients (autonomy and protection of personal rights and the patient's personal view on utility), with medical utility seen from the perspective of the health care system (with limited resources), equity and solidarity. Patient centredness is believed to enhance trust in the doctor -patient relationship, but the decisional authority given to patients in such approaches may hazard biomedical utility in the individual consultation and make prioritizing between tasks in the health care sector difficult. Conclusion: The consultation style of the GP has implications for the individual patient, for population health and for the cost of health care. This debate is unavoidable.
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| 13. |
- Fellman, Vineta, et al.
(författare)
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One-year survival of extremely preterm infants after active perinatal care in Sweden.
- 2009
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Ingår i: JAMA : the journal of the American Medical Association. - : American Medical Association (AMA). - 1538-3598 .- 0098-7484. ; 301:21, s. 2225-33
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Tidskriftsartikel (refereegranskat)abstract
- Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling.
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| 14. |
- Fischer, S, et al.
(författare)
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Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland
- 2006
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Ingår i: Sozial- und Präventivmedizin. - : Springer Science and Business Media LLC. - 0303-8408 .- 1420-911X. ; 51:1, s. 24-33
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine the direction and magnitude of participation bias in end-of-life research. Methods: Within the framework of a European survey on medical end-of-life decisions, a non-response study was conducted among physicians in Denmark, the Netherlands, Sweden and Switzerland. People were asked about their attitudes and experiences in the area of medial end-of-life decision. The response rates ranged from 12.8% (Netherlands) to 39.4% (Switzerland). The responders (n = 5403) and the non-responders (n = 866) were compared regarding socio-demographic characteristics, experiences with terminal patients and agreement with attitudes towards "end-of-life decisions". The reasons for non-participation to the study were analyzed. Results: Non-response did not cause socio-demographic distortion, but non-responders had statistically significantly fewer terminal patients than responders. Agreement rates were statistically significantly higher among responders than among non-responders for euthanasia, non-treatment decision and life-preserving statements. Neutral answers were statistically significantly more frequent among non-responders than among responders for life-preserving and euthanasia statements. The most commonly mentioned reason for non-participation was "lack of time". Conclusion: Non-participation does cause an overestimation of proponents of life-shortening, as well as of life-preserving end-of-life decisions. Non-responders more often have ambiguous attitudes towards end-of-life decisions than responders.
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| 15. |
- Hagelin, J, et al.
(författare)
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Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing
- 2004
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Ingår i: Journal of Medical Ethics. - : BMJ. - 1473-4257 .- 0306-6800. ; 30:6, s. 521-523
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore whether the phrasing of the questions and the response alternatives would influence the answers to questions about legalisation of euthanasia. Methods: Results were compared from two different surveys in populations with similar characteristics. The alternatives "positive'', "negative'', and "don't know'' (first questionnaire) were replaced with an explanatory text, "no legal sanction'', four types of legal sanctions, and no possibility to answer "don't know'' (second questionnaire). Four undergraduate student groups (engineering, law, medicine, and nursing) answered. Results: In the first questionnaire (n = 684) 43% accepted euthanasia (range 28-50%), 14% (8-33%) did not, and 43% (39-59%) answered "don't know''. Two per cent of the respondents declined to answer. In comparison with previous surveys on attitudes to euthanasia the proportion of "don't know'' was large. The results of the second questionnaire (n = 639), showed that 38% favoured "no legal prosecution'' (26-50%). However, 62% (50-74%) opted for different kinds of legal sanctions, and two of four groups expressed significantly different views in the two surveys. A proportion of 10% declined to answer the second questionnaire. Conclusion: An introduction of an explanatory text and a wider range of response alternatives produced differences between the results of the two surveys conducted.
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| 16. |
- Hallström, Inger, et al.
(författare)
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The parent between the child and the professional--some ethical implications
- 1997
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Ingår i: Child: Care Health and Development. - : Wiley. - 1365-2214 .- 0305-1862. ; 23:6, s. 447-455
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Tidskriftsartikel (refereegranskat)abstract
- In this paper ethical implications of parental participation in paediatric care are discussed. The paper is based on interviews with 20 parents, whose children were admitted and operated on at a paediatric surgery department in Sweden. In one part of the interview the parent was invited to speak about situations experienced as problematic during the hospitalization. Three different types of situations were described by the parents as especially problematic. In the first situation the parents' ability to influence their own situation was limited. Parents got upset when staff did not treat them as autonomous persons. In the second type of situation things 'had to be done' to the child, for example the surgery, the anaesthesia, removing an indwelling catheter and giving an enema. The parents understood and accepted this, but the child was sometimes unable to agree usually because of anxiety and fear. In the third type of situation parents felt that professionals did not take them or their child seriously. In order to avoid or alleviate such situations, the professionals ought to mediate a permissive attitude to the expressions of concern. Thus, when the parents worry, the professionals ought to listen more attentively and, whenever possible and adequate, respect their concerns.
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| 17. |
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| 18. |
- Johansson, Barbro, et al.
(författare)
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När hjärnan är drabbad
- 2005
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Ingår i: Att få hjälp att dö - synsätt, erfarenheter, kritiska frågor. - 9144035624 ; , s. 55-55
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 19. |
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| 20. |
- Krantz, Ingela, et al.
(författare)
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Ethics and vaccination.
- 2004
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Ingår i: Scand J Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 32:3, s. 172-8
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Tidskriftsartikel (refereegranskat)
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| 21. |
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| 22. |
- Krantz, Ingela, et al.
(författare)
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Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS) : An ethical analysis
- 2008
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Ingår i: Scandinavian Journal of Public Health. - London : SAGE Publications. - 1403-4948 .- 1651-1905. ; 36:2, s. 211-216
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous. Methods: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used. Results: In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word. Conclusions: Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one.
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| 23. |
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| 24. |
- Loefmark, Rurik, et al.
(författare)
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Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia
- 2008
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Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: In this study we investigated (a) to what extent physicians have experience with performing a range of end-of-life decisions (ELDs), (b) if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c) which background characteristics are associated with having experience with/or being willing to make such ELDs. Methods: An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Results: The response rate differed between countries (39-68%). The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%. Conclusion: There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude.
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| 25. |
- Lofmark, R, et al.
(författare)
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From cure to palliation: Staff communication, documentation, and transfer of patient
- 2005
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 8:6, s. 1105-1109
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Tidskriftsartikel (refereegranskat)abstract
- In the transition from curative treatment to palliative care of a general end-of-life patient population, the internal communication of the acute care staff seems to be less than optimal. The communication had reference to the dialogue within the staff both before and after the decision to concentrate on palliative care, and possible transfer of the patient. This survey of Swedish nurses and physicians showed that most of 780 respondents wanted more internal communication, and a more individualized procedure of decision-making. All staff should be informed about the decision made but full agreement was not seen as realistic. The largest difference of opinion between nurses and physicians concerned the involvement of nurses in the decision-making about the transition. A uniform documentation of the decision to transfer care focus was the ideal. Approximately every fourth patient in acute care is transferred to receive palliative care. Only approximately half of the respondents had any training in palliative care and the majority wanted more training. There seems to be a need for more palliative care training, perhaps somewhat different for each speciality. Furthermore, a common language to enable nurses and physicians to communicate more easily may improve the transition process.
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| 26. |
- Lofmark, R, et al.
(författare)
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Palliative care training: a survey of physicians in Australia and Europe
- 2006
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Ingår i: Journal of palliative care. - : SAGE Publications. - 0825-8597 .- 2369-5293. ; 22:2, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to present data about the level and background characteristics of physicians’ training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), the Netherlands (NL), Sweden (SE) and Switzerland (CH) (n=16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3–10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training.
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| 27. |
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| 28. |
- Lundqvist, Anita, et al.
(författare)
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Both empowered and powerless: mothers' experiences of professional care when their newborn dies.
- 2002
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Ingår i: Birth. - 0730-7659. ; 29:3, s. 192-199
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Tidskriftsartikel (refereegranskat)abstract
- The death of a newborn is a complex and tragic situation, the uncertain and stressful nature of which places emotional burdens on the parents. The aim of this study was to examine and illuminate mothers' experiences and perceptions of the care given to them at neonatal clinics while facing the threat and the reality of losing their baby. METHOD: Interviews were performed, in the form of conversations, with 16 mothers approximately 2 years after the death of their newborns. The interviews were analyzed using a hermeneutic phenomenological method. RESULTS: The primary themes identified were feeling empowered and feeling powerless. Three related themes to feeling empowered were a sense of nearness-supporting confidence; a sense of encouragement-supporting self-esteem; and a sense of empathy-supporting comfort. Three related themes to feeling powerless were a sense of distance-leading to strength or adjustment; a sense of violation-leading to helplessness and despondency; and a sense of disconnection-leading to insecurity and discouragement. All mothers felt both empowered and powerless. When experiencing empowering care, they had a feeling of encountering benevolence, with respect to their individual desires. Experiencing competent care without humane treatment madethemfeel powerless, and they were neither respected as a mother nor a person. CONCLUSIONS: Feelings of empowerment emerged when the health care professionals not only saw the mother as an individual but also "saw through the mothers' eyes" and "felt with the mother's feelings".Feelings of powerlessness emerged when the similarity in the lifeworld (i.e., the world of lived experiences) differed, and the perspectives of the mothers and the health care professionals did not correspond. (BIRTH 29:3 September 2002)
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| 29. |
- Lundqvist, Anita, et al.
(författare)
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Experiencing neonatal death: an ambivalent transition into motherhood
- 2002
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Ingår i: Pediatric nursing. - 0097-9805. ; 28:6, s. 621-625
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To illuminate the lived experience of women facing the threat of lossing their newborn child and then experiencing the reality of their infant's death. STUDY DESIGN: Sixteen women were interviewed approximately 2 years after the death of their infant using a hermeneutic phenomenological approach. FINDINGS: The main theme was ambivalent transition into motherhood. The women went through the whole life-span of their infant during a very short time. The women's narratives were interpreted as broken expectations, total confusion, reality awareness, consciously leave-taking, and elusive grief. CONCLUSIONS: Women need the opportunity to evolve their own patterns and rhythms in the ambivalent transition from expected motherhood to experiencing neonatal dying and death. Knowledge about the individuality of this process may assist nurses in improving the quality of care.
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| 30. |
- Lundqvist, Anita, et al.
(författare)
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Human dignity in paediatrics: the effects of health care.
- 2007
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Ingår i: Nursing Ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 14:2, s. 215-228
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Tidskriftsartikel (refereegranskat)abstract
- Human dignity is grounded in basic human attributes such as life and self-respect. When people cannot stand up for themselves they may lose their dignity towards themselves and others. The aim of this study was to elucidate if dignity remains intact for family members during care procedures in a children's hospital. A qualitative approach was adopted, using open non-participation observation. The findings indicate that dignity remains intact in family-centred care where all concerned parties encourage each other in a collaborative relationship. Dignity is shattered when practitioners care from their own perspective without seeing the individual in front of them. When there is a break in care, family members can restore their dignity because the interruption helps them to master their emotions. Family members' dignity is shattered and remains damaged when they are emotionally overwhelmed; they surrender themselves to practitioners' care, losing their self-esteem and self-respect.
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| 31. |
- Lundqvist, Anita, et al.
(författare)
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Neonatal death and parents' grief. Experience, behaviour and attitudes of Swedish nurses
- 1998
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Ingår i: Scandinavian Journal of Caring Sciences. - 1471-6712. ; 12:4, s. 246-250
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to survey the experience, behaviour and attitudes of nurses in Swedish neonatal wards towards parents who refuse or are reluctant to see, touch or hold their dying or dead baby. A questionnaire was distributed to 173 nurses, of whom 144 responded. The questionnaire contained questions about the nurses' own experience of such situations, their behaviour, and their attitude towards influencing the parents. Seventy-four percent answered that they had experience of such situations, 59% that they often tried to persuade or in other ways influence the parents to change their mind, and 60% were of the opinion that the parents mourning-process is always facilitated when they touch or hold their dead baby. Most nurses (83%) were of the opinion that the conflict between beneficence and autonomy was difficult but not impossible to solve. A majority of the nurses were inclined to give priority to the principle of beneficence. But is this inclination ethically justified? A well-founded answer to this question requires more knowledge about the experiences of parents who have lived through such traumatic situations.
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| 32. |
- Lundqvist, Anita, et al.
(författare)
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Neonatal end-of-life care in Sweden.
- 2003
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Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 8:5, s. 197-202
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Tidskriftsartikel (refereegranskat)abstract
- A survey was carried out of Swedish neonatal end-of-life regarding practice before birth, at birth, during dying and after death using a descriptive questionnaire with close-ended questions and individual comments The practice in 32 of 38 neonatal units, as described by the head nurse or the registered nurses, was largely similar. Respectful treatment of both the neonate and the parents during neonatal end-of-life care was indicated Differences were found in pre-natal care concerning the information about the risks of pre-term birth, the opportunity for parents to view a pre-term neonate and meet its family, as well as a social worker Practice directly after birth was also different. A little less than half of the units answered that they gave a description of the seriously ill neonate to the parents before the first visit to the ward Practice during dying indicated that only a few units permitted the neonate to die at home
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| 33. |
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| 34. |
- Lundqvist, Anita, et al.
(författare)
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Noddings's caring ethics theory applied in a paediatric setting.
- 2009
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Ingår i: Nursing Philosophy. - 1466-7681. ; 10:2, s. 113-123
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Tidskriftsartikel (refereegranskat)abstract
- Since the 1990s, numerous studies on the relationship between parents and their children have been reported on in the literature and implemented as a philosophy of care in most paediatric units. The purpose of this article is to understand the process of nurses' care for children in a paediatric setting by using Noddings's caring ethics theory. Noddings's theory is in part described from a theoretical perspective outlining the basic idea of the theory followed by a critique of her work. Important conceptions in her theory are natural caring (reception, relation, engrossment, motivational displacement, reciprocity) and ethical caring (physical self, ethical self, and ethical ideal). As a nurse one holds a duty of care to patients and, in exercising this duty, the nurse must be able to develop a relationship with the patient including giving the patient total authenticity in a 'feeling with' the patient. Noddings's theory is analysed and described in three examples from the paediatrics. In the first example, the nurse cared for the patient in natural caring while in the second situation, the nurse strived for the ethical caring of the patient. In the third example, the nurse rejected the impulse to care and deliberately turned her back to ethics and abandoned her ethical caring. According to the Noddings's theory, caring for the patient enables the nurse to obtain ethical insights from the specific type of nursing care which forms an important contribution to an overall increase of an ethical consciousness in the nurse.
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| 35. |
- Löfmark, R, et al.
(författare)
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Conditions and consequences of medical futility - from a literature review to a clinical model
- 2002
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Ingår i: Journal of Medical Ethics. - : BMJ. - 1473-4257 .- 0306-6800. ; 28:2, s. 115-119
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To present an analysis of futility that is useful in the clinical setting. Design: Literature review. Material and methods: According to Medline more than 750 articles have been published about medical futility. Three criteria (language, time period, and the authors expressed their own opinions) singled out 43 of them. The authors opinions about futility were analysed using the scheme: If certain conditions are satisfied, then a particular measure is futile and If a particular measure is futile, then certain moral consequences are implied. Results: Regarding conditions, most authors stated that judgments about futility should be made by physicians. The measure was usually some kind of medical treatment, and the goals related to quality of life, physiological improvement, or prolongation of life. The probability of success in reaching the goal was in most cases described in semiquantitative terms. Regarding consequences, the authors stated that health care professionals may (sometimes ought or should) withhold or withdraw a futile measure, most often after a dialogue with the patient (29 articles), but sometimes without informing the patient (nine articles), or with one-way information (four articles). Over time more and more articles recommend that the patient should be involved in joint decision making. Based on this literature review a clinical model was developed. Conclusions: The model, requiring that conditions and consequences should be made explicit, may, in futility situations, facilitate both the collection of the necessary information and make the moral implications visible. It also makes communication about measures considered to be futile possible without using such ambiguous terms as futile.
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| 36. |
- Löfmark, Rurik, et al.
(författare)
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From cure to palliation : concept, decision and acceptance
- 2007
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Ingår i: Journal of Medical Ethics. - : BMJ. - 0306-6800 .- 1473-4257. ; 33:12, s. 685-688
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this paper is to present and discuss nurses' and physicians' comments in a questionnaire relating to patients' transition from curative treatment to palliative care. The four-page questionnaire relating to experiences of and attitudes towards communication, decision-making, documentation and responsibility of nurses and physicians and towards the competence of patients was developed and sent to a random sample of 1672 nurses and physicians of 10 specialties. The response rate was 52% (n = 844), and over one-third made comments. The respondents differed in their comments about three areas: the concept of palliative care, experiences of unclear decision-making and difficulties in acceptance of the patient's situation. The responses are analysed in terms of four ethical theories: virtue ethics, deontology, consequentialism and casuistry. Many virtues considered to be appropriate for healthcare personnel to possess were invoked. Compassion, honesty, justice and prudence are especially important. However, principles of medical ethics, such as the deontological principle of respect for self-determination and the consequence of avoidance of harm, are also implied. Casuistry may be particularly helpful in analysing certain areas of difficulty namely, what is meant by '' palliative care '', decision-making and accepting the patient's situation. Keeping a patient in a state of uncertainty often causes more suffering than necessary. Communication among the staff and with patients must be explicit. Many of the staff have not had adequate training in communicating with patients who are at the end of their life. Time for joint reflection has to be regained, and training in decision-making is essential. In our opinion, palliative care in Sweden is in need of improvement.
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| 37. |
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| 38. |
- Miccinesi, G, et al.
(författare)
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Physicians' attitudes towards end-of-life decisions: a comparison between seven countries
- 2005
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 60:9, s. 1961-1974
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Tidskriftsartikel (refereegranskat)abstract
- In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support-between and within countries-for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores.
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| 39. |
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| 46. |
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| 47. |
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| 48. |
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| 49. |
- Nilstun, Tore, et al.
(författare)
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Scientific dishonesty--questionnaire to doctoral students in Sweden.
- 2010
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Ingår i: Journal of Medical Ethics. - : BMJ. - 1473-4257 .- 0306-6800. ; 36:5, s. 315-318
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Tidskriftsartikel (refereegranskat)abstract
- 'Scientific dishonesty' implies the fabrication, falsification or plagiarism in proposing, performing or reviewing research or in reporting research results. A questionnaire was given to postgraduate students at the medical faculties in Sweden who attended a course in research ethics during the academic year 2008/2009 and 58% answered (range 29%-100%). Less than one-third of the respondents wrote that they had heard about scientific dishonesty in the previous 12 months. Pressure, concerning in what order the author should be mentioned, was reported by about 1 in 10 students. We suggest that all departments conducting research should have a written policy about acceptable research behaviour and that all doctoral students should be informed of the content of this policy. Participants in the research groups concerned should also be required to analyse published articles about scientific dishonesty and critically discuss what could be done about unethical conduct.
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| 50. |
- Nilstun, Tore, et al.
(författare)
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Sjukvårdens metoder bör analyseras ur ett etiskt perspektiv.
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:52, s. 3510-3512
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Tidskriftsartikel (refereegranskat)abstract
- Many methods exist for ethical analysis guiding decision-making. This essay presents only one method. Both facts and values are employed with this method and, as an example we use a Swedish preventative measure for individuals who abuse narcotics. The ethical analysis presupposes good knowledge of the case at hand and the approach recommended is a combination of stakeholder analysis and decision matrix analysis. In applying the model, stakeholders are identified and the ethical principles are formulated to identify the ethical costs and benefits. To balance the costs and benefits good medical judgement is needed. But now and again this approach is not enough. The method may be in need of some form of supplementary analysis, which, for instance, could be the use of similar cases, situation ethics and virtue ethics.
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