Some Ethical Issues in Prehospital Emergency Medicine

Erbay, Hasan

doi:10.5505/1304.7361.2014.32656

Cited by 35 publications

(57 citation statements)

References 28 publications

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“…10 Research from the personnel's perspective shows different value priorities between justice, utility and rights, which could influence the relationship. 11,12 Ethically problematic care situations involve areas such as termination of resuscitation and care in the end of life phase, [13][14][15] triage, 16 child abuse, 17 refusal of treatment, 18,19 delay or denial of transport for non-emergent conditions, 17 the patient's decision-making capacity, 16 and the patient's self-determination. 3 Research has pointed to the patient relationship as the epicentre of ethical conflicts in the ambulance service, for example, regarding patient self-determination and acting in the patient's best interest.…”

Section: Introductionmentioning

confidence: 99%

Ethical conflicts in patient relationships: Experiences of ambulance nursing students

Bremer

Holmberg

2020

Nurs Ethics

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Background Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.

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Section: Introductionmentioning

confidence: 99%

Ethical conflicts in patient relationships: Experiences of ambulance nursing students

Bremer

Holmberg

2020

Nurs Ethics

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“…Unlike EMTs, nurses do not receive specialized training during their nursing program and this has resulted in nurses facing numerous challenges in the pre‐hospital setting (Fallahi Khoshknab, Khankeh, Hosseini, Hosseinzadeh, & Haghi Monie, ; Haghani & Sadeghi, ). Studies have shown that pre‐hospital nurses experience intense workplace violence (Rahmani et al, ), stress (Dadashzadeh, Rahmani, Hasankhani, & Elmi, ) and occupational conflicts (Erbay, ).…”

Section: Introductionmentioning

confidence: 99%

Iranian pre‐hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study

et al. 2019

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Aim:To explore the experiences of Iranian nurses working in pre-hospital emergency care services and the strategies used to manage of workplace violence.Background: Pre-hospital emergency nurses are subject to workplace violence; however, little research addresses their experiences, particularly related to their strategies in dealing with workplace violence. Methods:A descriptive qualitative study that involved nineteen male nurses who were working in pre-hospital services collected data using semi-structured interviews and analysed it using qualitative content analysis.Results: Data analysis yielded four descriptive categories including no reaction to violence (tolerance and acceptance as common workplace conflicts), situational management (patient and scene management), confrontation (direct and indirect) and escaping the scene. Patient management was the dominant strategy used and had the best outcomes related to both patient and personnel safety. Conclusion:This study showed that pre-hospital nurses use different strategies to manage violence and patient management was a common and useful strategy for managing workplace violence. However, the pre-hospital nurses have little training, insufficient support and are poorly prepared to manage workplace violence. Implications for Nursing Management:The development of context-based guidelines, continuing education, better-equipped ambulances that include medical and defence equipment, as well as better coordination of the police force in ambulance operations, can help to reduce workplace violence. K E Y W O R D S emergency medical technician, nurse strategies, pre-hospital emergency care, workplace violence | 1191 DADASHZADEH Et Al. How to cite this article: Dadashzadeh A, Rahmani A, Hassankhani H, Boyle M, Mohammadi E, Campbell S. Iranian pre-hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study. J Nurs

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“…The complexity of the care work of SANs means that ethical dilemmas can arise in different care situations. Previous research describes specific ethical dilemmas that arise within prehospital emergency care (Eraby 2014). These might include resuscitation of terminally ill patients (Henman 2017) and support to survivors of suicide victims (Nilsson et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Ethical dilemmas in prehospital emergency care – from the perspective of specialist ambulance nurse students

Abelsson

Lindwall

2018

International Journal of Ethics Education

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The aim of this study was to describe specialist ambulance nurse students' experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse (SAN) students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient's body and identity; Not agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient's dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient's body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene.

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Some Ethical Issues in Prehospital Emergency Medicine

Cited by 35 publications

References 28 publications

Ethical conflicts in patient relationships: Experiences of ambulance nursing students

Ethical conflicts in patient relationships: Experiences of ambulance nursing students

Iranian pre‐hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study

Ethical dilemmas in prehospital emergency care – from the perspective of specialist ambulance nurse students

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