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Ethical dilemmas in providing acute medical care at home for children: a survey of health professionals.

ABSTRACT: Objective:Acute care at home is increasing. We aimed to determine the views of healthcare professionals on the ethics of providing home care and compare the impact of situational changes on their opinions. Design:An analysis of opinions of home healthcare professionals. Setting:The Australasian Hospital-in-the-Home Annual Conference, November 2017. Participants:Eighty physicians, nurses and allied health staff who provide acute care for children and adults at home. Methods:Clinical scenarios were presented about a 14 years old receiving intravenous antibiotics at home via an established home care pathway, and participants were asked to vote manually on whether providing home care was ethical. Main outcomes:The proportions of healthcare professionals who believed that provision of home care was ethical in different situations. Results:For each question the response rate ranged from 71% to 100%. While the provision of acute home care was deemed ethical by the majority (77/80, 96%), this decreased when other factors were involved such as domestic violence (37/63 (59%) OR 0.06, 95%?CI 0.02 to 0.20, p<0.001) and parental reluctance (28/67 (42%) OR 0.02, 95%?CI 0.008 to 0.09, p<0.001). The age of consent affected the proportion who considered home care ethical against parental wishes: 16 years (48/58, 83%) versus 14 years (33/53, 52%) OR 4.4, 95%?CI 1.9 to 10.1, p<0.001. The lowest proportion to consider home care ethical (16%) was when home care was deemed less than hospital care. Conclusions:Home healthcare providers are supportive of the ethics of providing acute care at home for children, although differ among themselves with situational complexities. Applying the tenets of medical ethics (autonomy, non-maleficence, beneficence and justice) can provide insights into the factors that may influence opinions.

SUBMITTER: Bryant PA

PROVIDER: S-EPMC7015051 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Ethical dilemmas in providing acute medical care at home for children: a survey of health professionals.

Bryant Penelope A PA

BMJ paediatrics open 20200206 1

<h4>Objective</h4>Acute care at home is increasing. We aimed to determine the views of healthcare professionals on the ethics of providing home care and compare the impact of situational changes on their opinions.<h4>Design</h4>An analysis of opinions of home healthcare professionals.<h4>Setting</h4>The Australasian Hospital-in-the-Home Annual Conference, November 2017.<h4>Participants</h4>Eighty physicians, nurses and allied health staff who provide acute care for children and adults at home.<h ...[more]

PMID: 32099907

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Project description:BackgroundRecent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person's needs and preferences. There is limited research exploring health professionals' views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals' experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care.MethodsSemi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis.ResultsTwo main themes and six sub-themes emerged from the material. Theme 1: 'Meeting patients with complex nutritional problems' with the sub-themes: 'It is much more complex than just not eating' and 'seeing nutrition as a part of the whole'. Theme 2: 'The structure of the nutritional care', with the sub-themes: 'Nutritional routines: Much ado, but for what?', 'lack of time to individualize nutritional care', 'lack of interdisciplinary collaboration in nutritional care' and 'meeting challenging situations with limited resources in home care'.ConclusionsThe healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients' nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients' preferences for care and nutritional care practice.

Project description:ObjectivesInternationally, public health strategies encourage health care professionals to deliver opportunistic behaviour change interventions. The present study: (1) examines the barriers and enablers to delivering interventions during routine consultations, and (2) provides recommendations for the design of interventions to increase delivery of opportunistic behaviour change interventions.DesignQualitative interview study.MethodsTwenty-eight semi-structured interviews were conducted with patient-facing health care professionals. The Behaviour Change Wheel informed a framework analysis in which findings were mapped onto the Theoretical Domains Framework (TDF). Intervention functions and behaviour change techniques (BCTs) targeting each TDF domain were identified.ResultsHealth care professionals understood the importance of opportunistic behaviour change interventions (beliefs about consequences), but were sceptical about their capabilities to facilitate behaviour change with patients (beliefs about capabilities). Some clinicians were unwilling to discuss behaviours perceived as unrelated to the patient's visit (social/professional role and identity). Discipline-specific tasks were prioritized, and delivering interventions was perceived as psychologically burdensome. One-to-one contact was favoured over busy hospital settings (environmental context and resources). Seven intervention functions (training, restriction, environmental restructuring, enablement, education, persuasion, and modelling) and eight BCT groupings (antecedents, associations, comparison of outcomes, covert learning, feedback and monitoring, natural consequences, reward and threat, and self-belief) were identified.ConclusionsAcross disciplines, health care professionals see the value of opportunistic behaviour change interventions. Barriers related to workload, the clinical environment, competence, and perceptions of the health care professional role must be addressed, using appropriate intervention functions and BCTs, in order to support health care professionals to increase the delivery of interventions in routine practice. Statement of contribution What is already known on this subject? Brief, opportunistic interventions can be a cost effective way of addressing population health problems. Public health policies compel health care professionals to deliver behaviour change interventions opportunistically. Health care professionals do not always deliver interventions opportunistically during routine medical consultations; however the barriers and enablers are currently unclear. What does this study add? This is the first study to examine cross-disciplinary barriers and enablers to delivering opportunistic behaviour change interventions. Across diverse professional groups, working in different medical professions, participants saw the value of delivering opportunistic behaviour change interventions. Targeting key theoretical domains that are shared across professional groups may be useful for increasing the delivery of opportunistic behaviour change interventions.

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Ethical dilemmas in providing acute medical care at home for children: a survey of health professionals.

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Ethical dilemmas in providing acute medical care at home for children: a survey of health professionals.

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