The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

Kuek, Joshua Tze Yin; Ngiam, Lisa Xin Ling; Kamal, Nur Haidah Ahmad; Chia, Jeng Long; Chan, Noreen; Abdurrahman, Ahmad Bin Hanifah Marican; Ho, Chong Yao; Tan, Lorraine Hui En; Goh, Jun Leng; Khoo, Michelle Shi Qing; Ong, Yun Ting; Chiam, Min; Chin, Annelissa; Mason, Stephen; Krishna, Lalit Kumar Radha

doi:10.1186/s13010-020-00096-1

Cited by 35 publications

(57 citation statements)

References 66 publications

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“…Conceiving the effects of caring for dying patients in ICU from evidence-based data (Kuek et al 2020 ) through the lens of the RToP emphasises that the impact of working in the ICU has wide ranging effects upon physicians. Psychological, emotional, academic, research, administrative, personal and professional matters may come together to impact the Innate, Individual, Relational and Societal Rings of their RToP, eventually shifting their needs, values, thinking, motivations and actions with ripple effects.…”

Section: Discussionmentioning

confidence: 99%

“…They remain outside of Physician A’s locus of control. Such external factors can be very real, including a poor working environment, poor intercollegial support and the lack of timely, personalised, accessible support at the institutional level, and the lack of rotations or roles outside of their ICU clinical duties to recuperate, reflect, process their ICU experiences and receive support if required(Kuek et al 2020 ).…”

Section: Internal Constituents and External Factorsmentioning

confidence: 99%

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Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

Chan

Chia

et al. 2021

ABR

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It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support.

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Section: Discussionmentioning

confidence: 99%

Section: Internal Constituents and External Factorsmentioning

confidence: 99%

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

Chan

Chia

et al. 2021

ABR

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Section: Krishna's Ring Theory Of Personhoodmentioning

confidence: 99%

“…The employ of the RToP to capture the impact of bereavement is not new [24][25][26][27][28][29][30][31][32]. The RToP has been used within other Palliative Medicine settings to study changes in thinking, values, beliefs, roles and relationships amongst terminally ill patients [24][25][26][27][28][29][30][31][32]. Here extrapolating its use to bereaved parents finds support from Kuek, Ngiam [32]'s study of the impact of caring for dying patients upon physicians in the intensive care.…”

Section: Krishna's Ring Theory Of Personhoodmentioning

confidence: 99%

“…It is to this sense of disruption of a parent's concept of personhood or "what makes 'you' you" [27][28][29][30][31][32][33][34][35] that we turn our attention to in order to better understand the impact of such loss, and to better direct timely, personalised, appropriate, holistic and longitudinal support to bereaved parents. Thus, a review of current data on the effects of a child's death on a parent through the lens of the Ring Theory of Personhood (henceforth RToP) [27,35] was carried out.…”

mentioning

confidence: 99%

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Parental bereavement – impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review

et al. 2021

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Background Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child’s death, aged 0–12 years, through the lens of the Ring Theory of Personhood (RToP). Methods To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna’s Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA). Results Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents. Conclusion In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent’s personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.

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Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians

Bokek-Cohen,

Marey-Sarwan,

Tarabeih

2023

Bioethical Inquiry

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The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

Cited by 35 publications

References 66 publications

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

Parental bereavement – impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review

Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians

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