scholarly journals Clinical ethics of end-of-life care in an emergency medical center

2012 ◽  
Vol 23 (2) ◽  
pp. 39-50
Author(s):  
Asako Matsushima ◽  
Naoko Ogawa ◽  
Hiroshi Ogura ◽  
Takeshi Shimazu ◽  
Motomu Shimoda ◽  
...  
Keyword(s):  
End Of Life ◽  
Clinical Ethics ◽  
End Of Life Care ◽  
Medical Center ◽  
Life Care ◽  
Emergency Medical

Application of METAP methodology for clinical ethics consultation in end-of-life care in Bulgaria

2020 ◽  
Vol 15 (4) ◽  
pp. 204-212
Author(s):  
Silviya Stoyanova Aleksandrova-Yankulovska
Keyword(s):  
End Of Life ◽  
Clinical Ethics ◽  
End Of Life Care ◽  
Ethics Consultation ◽  
Biomedical Ethics ◽  
Clinical Ethics Consultation ◽  
Life Care ◽  
Social Good ◽  
Unequal Treatment ◽  
The Usa

Although clinical ethics consultation has existed for more than 40 years in the USA and Europe, it was not available in Bulgaria until recently. In introducing clinical ethics consultation into our country, the Modular, Ethical, Treatment, Allocation of resources, Process (METAP) methodology has been preferred because of its potential to be used in resource-poor settings and its strong educational function. This paper presents the results of a METAP evaluation in a hospital palliative care ward in the town of Vratsa. The evaluation was based on Beauchamp and Childress’ four principles of biomedical ethics and involves implementation of specific instruments for clinical ethics decision-making. Research tasks emphasised analyses of ethics meetings in the ward. Data were processed by SPSS v.24 using descriptive statistical analysis. Altogether, 32 ethics meetings of an average duration 20.63 min were conducted on cases involving critically ill patients. Most of the participants (86.0%) expressed satisfaction with the ethics process. The principlist approach supported resolution of conflicts between autonomous patients and their relatives, clarified definitions of “medical benefit” and “social good,” and enabled assessments of the risk of unequal treatment. Even as the specific research tasks were achieved, further participant follow-up is necessary to identify any improvement in healthcare personnel’s ethical competence. METAP worked well in end-of-life care settings. Participants experienced several benefits, including improved team communication, better understanding of patient preferences, and confidence in the correctness of decisions. Despite the significant educational potential of METAP, the need for additional and ongoing ethics training of health professionals should not be underestimated.

Preparation for Frontline End-of-Life Care: Exploring the Perspectives of Paramedics and Emergency Medical Technicians

2014 ◽  
Vol 17 (3) ◽  
pp. 338-341 ◽  
Author(s):  
Deborah P. Waldrop ◽  
Brian Clemency ◽  
Eugene Maguin ◽  
Heather Lindstrom
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Emergency Medical Technicians ◽  
Life Care ◽  
Emergency Medical

End-of-life care provided in emergency medical system in Japan.

2020 ◽  
Author(s):  
Takahiro Onuki ◽  
Shinji Nakahara ◽  
Takashi Fujita ◽  
Yasufumi Miyake ◽  
Tetsuya Sakamoto
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Medical System ◽  
Emergency Medical System ◽  
Life Care ◽  
Emergency Medical

scholarly journals Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting

2018 ◽  
pp. 1-10 ◽  
Author(s):  
B. Emily Esmaili ◽  
Kearsley A. Stewart ◽  
Nestory A. Masalu ◽  
Kristin M. Schroeder
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Pediatric Patients ◽  
Developing World ◽  
Participant Observation ◽  
Medical Center ◽  
Life Care ◽  
Patients With Cancer ◽  
Bugando Medical

Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective—and more appropriate—palliative care policies for young patients with cancer in the developing world.

The nurses perspective of the effectiveness and value of the respiratory distress observation scale.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 139-139
Author(s):  
Kerstin Scheper
Keyword(s):  
Focus Group ◽  
Respiratory Distress ◽  
End Of Life ◽  
End Of Life Care ◽  
Medical Center ◽  
Self Report ◽  
Pharmacological Intervention ◽  
Life Care ◽  
Observation Scale ◽  
Oncology Unit

139 Background: The nurses on the oncology unit at Overlook Medical Center have been using the Respiratory Distress Observation Scale (RDOS) since September 2013 to assess and manage respiratory distress and dyspnea at end of life for our cognitively impaired patients. The gold standard for managing dyspnea has been the ability of the patient to self-report. Cognitive impairment may interfere with the assessment of respiratory distress and dyspnea leading to under recognition and under or over medication of symptoms. Methods: A nurse focus group was formed and elicited discussion, information, and opinion of the implementation and effectiveness of the RDOS on the medical oncology unit. The nurses were tasked with identifying if the RDOS improved their ability to assess and manage respiratory symptoms for this patient population. The group consisted of eight nurses from the oncology unit who shared a passion for end of life care, but varied in levels of expertise and years of experience. The participants answered nine open-ended questions relating to the implementation and effectiveness of the RDOS, its use in communicating with patient’s family, and their experiences with end of life care both on their unit and throughout the hospital. Approximately fifty six patients were evaluated with the RDOS by these nurses prior to the focus group meeting. Results: All participants stated the RDOS was easy, took two minutes to perform and has improved their ability to assess and manage dyspnea while enhancing their ability to effectively communicate with physicians. All were passionate in their belief that the RDOS is a tool that validates their decision to medicate and facilitates educating families that may be resistant to pharmacological intervention. Conclusions: Our focus group results were similar to research findings identifying the RDOS as effective in managing dyspnea. The group advocated its use and support implementation of the RDOS house wide. The group produced useful information and elicited candid discussion on its ability to favorably impact care.

scholarly journals Responding to SUPPORT: An Academic Medical Center Examines Its End-of-Life Care Practices

2001 ◽  
Vol 21 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Nancy Dendaas ◽  
Teresa A Pellino ◽  
Kate Ford Roberts ◽  
James Cleary
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Life Care ◽  
Academic Medical ◽  
Care Practices

scholarly journals Transport Home and Terminal Extubation by Emergency Medical Services: An Example of Innovation in End-of-Life Care

2019 ◽  
Vol 58 (2) ◽  
pp. 355-359
Author(s):  
Brian M. Clemency ◽  
Kathleen T. Grimm ◽  
Sandra L. Lauer ◽  
Jenna C. Lynch ◽  
Benjamin L. Pastwik ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
End Of Life ◽  
End Of Life Care ◽  
Medical Services ◽  
Life Care ◽  
Emergency Medical

scholarly journals MANAGING DEATH IN THE FIELD: HOW EMERGENCY MEDICAL SERVICES TEAMS PROVIDE END-OF-LIFE CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S499-S499
Author(s):  
Deborah P Waldrop ◽  
Jacqueline M McGinley ◽  
Brian M Clemency
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Emergency Medical Services ◽  
End Of Life ◽  
End Of Life Care ◽  
Medical Services ◽  
Life Care ◽  
Serious Illness ◽  
Emergency Medical ◽  
Seriously Ill

Abstract Emergency medical services (EMS) providers respond more frequently to calls for older adults with serious illness than for people in other age groups. Recent legislation that makes it possible to document healthcare decisions has facilitated an era of choice in end-of-life care. EMS teams make time-sensitive decisions about care, resuscitation and hospital transport that influence how and where a seriously ill older adult will die and how his/her family will experience the death. Yet, EMS providers’ perspectives on urgent decision-making and how they work with families are unknown. The purpose of this study was to explore the decision-making process that occurs how EMS teams respond when someone is dying from a serious illness (vs. an injury). In-depth in-person interviews were conducted with 50 EMS providers (24 emergency medical technicians [EMTs] and 26 Paramedics) from four ambulance services. Participants’ ages ranged from 21-57 (M=37.9) and 70% were male. Qualitative data was coded using Atlas.ti software. Three themes illuminated participants’ experiences with end-of-life calls: (1) How legally binding documents (e.g. Do Not Resuscitate [DNR] orders, Medical Orders for Life Sustaining Treatment [MOLST]) inform care; (2) Decision-making about foregoing or halting resuscitation (e.g. no hospitalization, death at home); and (3) Family care, support and education. The results suggest that EMS providers have critically important roles in upholding the wishes of seriously ill older adults and helping caregiving families through the end-of-life transition. Implications: Discussions about the meaning of legally binding documents (e.g. DNR, MOLST) and EMS calls are important in advance care planning.

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