Screening and Early Intervention for Ethical Conflicts at the End of Life

2.50
Hdl Handle:
http://hdl.handle.net/10755/294045
Category:
Abstract
Type:
Research Study
Level of Evidence:
Qualitative Study, Other
Research Approach:
Qualitative Research
Title:
Screening and Early Intervention for Ethical Conflicts at the End of Life
Author(s):
Pavlish, Carol Pillsbury; Henriksen Hellyer, Joan; Brown-Saltzman, Katherine; Miers, Anne; Squire, Karina
Lead Author STTI Affiliation:
Zeta
Author Details:
Carol Pavlish, PhD, RN, FAAN, cpavlish@sonnet.ucla.edu; Joan Henriksen Hellyer, PhD, RN, henriksenhellyer@mayo.edu; Katherine Brown-Saltzman, MA, RN, brownsaltzman@mednet.ucla.edu; Anne Miers, MSN, RN, ACNS, CNRN, miers.anne@gmail.com; Karina Squire, MPH, BSN, RN, CCRN, squire.karina@mayo.edu
Abstract:

The success of a screening tool is determined by clinicians’ assessment of usefulness in clinical practice. The Ethics Screening and Early Intervention Tool is an evidence-based tool that was developed from a critical incident study on risk factors and early indicators of ethical dilemmas. The aim of the tool is to identify clinical situations with a high probability for ethical conflict and prompt nurses to initiate early dialogue, referrals, and interventions that avoid conflict and mitigate moral distress. The objective of this study was to assess feasibility of using the Ethics Screening and Early Intervention Tool in clinical practice at two large medical centers. Nurses reported ease of use and how the tool deepened their understanding of moral concerns in difficult circumstances. However, many also described risk to themselves when initiating follow-up actions. Nurses rated the highest risk actions in both settings as: discussing ethical concerns with the medical team, calling for an ethics consultation, and initiating conversation with patients and families. Narrative explanations of barriers to initiating ethics-specific actions included:

  • “Letting it slide”
  • “Questioning myself”
  • “Being the troublemaker”
  • “Finding the gatekeepers”
  • To improve teamwork, all members of the healthcare team need to feel safe in raising ethics-related questions. Environments need to support normalizing ethics conversations with innovative tools such as the Ethics Screening and Early Intervention Tool, so more nurses feel confident when expressing their moral concerns.

Keywords:
Moral distress; Ethical conflicts
MeSH:
Terminal Care; Ethics
Repository Posting Date:
14-Jun-2013
Date of Publication:
14-Jun-2013
Sponsors:
Sigma Theta Tau International
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.; The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryAbstracten
dc.typeResearch Studyen
dc.evidence.levelQualitative Study, Otheren
dc.research.approachQualitative Researchen
dc.titleScreening and Early Intervention for Ethical Conflicts at the End of Lifeen_US
dc.contributor.authorPavlish, Carol Pillsburyen
dc.contributor.authorHenriksen Hellyer, Joanen
dc.contributor.authorBrown-Saltzman, Katherineen
dc.contributor.authorMiers, Anneen
dc.contributor.authorSquire, Karinaen
dc.contributor.departmentZetaen
dc.author.detailsCarol Pavlish, PhD, RN, FAAN, cpavlish@sonnet.ucla.edu; Joan Henriksen Hellyer, PhD, RN, henriksenhellyer@mayo.edu; Katherine Brown-Saltzman, MA, RN, brownsaltzman@mednet.ucla.edu; Anne Miers, MSN, RN, ACNS, CNRN, miers.anne@gmail.com; Karina Squire, MPH, BSN, RN, CCRN, squire.karina@mayo.eduen
dc.identifier.urihttp://hdl.handle.net/10755/294045en
dc.description.abstract<p>The success of a screening tool is determined by clinicians’ assessment of usefulness in clinical practice. The Ethics Screening and Early Intervention Tool is an evidence-based tool that was developed from a critical incident study on risk factors and early indicators of ethical dilemmas. The aim of the tool is to identify clinical situations with a high probability for ethical conflict and prompt nurses to initiate early dialogue, referrals, and interventions that avoid conflict and mitigate moral distress. The objective of this study was to assess feasibility of using the Ethics Screening and Early Intervention Tool in clinical practice at two large medical centers. Nurses reported ease of use and how the tool deepened their understanding of moral concerns in difficult circumstances. However, many also described risk to themselves when initiating follow-up actions. Nurses rated the highest risk actions in both settings as: discussing ethical concerns with the medical team, calling for an ethics consultation, and initiating conversation with patients and families. Narrative explanations of barriers to initiating ethics-specific actions included:</p> <ul> <li>“Letting it slide”</li> <li>“Questioning myself”</li> <li>“Being the troublemaker”</li> <li>“Finding the gatekeepers”</li> <p>To improve teamwork, all members of the healthcare team need to feel safe in raising ethics-related questions. Environments need to support normalizing ethics conversations with innovative tools such as the Ethics Screening and Early Intervention Tool, so more nurses feel confident when expressing their moral concerns.</p>en_GB
dc.subjectMoral distressen_GB
dc.subjectEthical conflictsen_GB
dc.subject.meshTerminal Careen_US
dc.subject.meshEthicsen_US
dc.date.available2013-06-14T18:24:42Zen
dc.date.issued2013-06-14en
dc.date.accessioned2013-06-14T18:24:42Zen
dc.description.sponsorshipSigma Theta Tau Internationalen
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.en
dc.description.noteThe Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.en
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