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Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care

BACKGROUND: DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethi...

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Autores principales: Pettersson, Mona, Hedström, Mariann, Höglund, Anna T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007064/
https://www.ncbi.nlm.nih.gov/pubmed/29914440
http://dx.doi.org/10.1186/s12910-018-0300-7
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author Pettersson, Mona
Hedström, Mariann
Höglund, Anna T.
author_facet Pettersson, Mona
Hedström, Mariann
Höglund, Anna T.
author_sort Pettersson, Mona
collection PubMed
description BACKGROUND: DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions. METHODS: Individual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis. RESULTS: Physicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing. CONCLUSIONS: In order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient.
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spelling pubmed-60070642018-06-26 Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care Pettersson, Mona Hedström, Mariann Höglund, Anna T. BMC Med Ethics Research Article BACKGROUND: DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions. METHODS: Individual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis. RESULTS: Physicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing. CONCLUSIONS: In order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient. BioMed Central 2018-06-19 /pmc/articles/PMC6007064/ /pubmed/29914440 http://dx.doi.org/10.1186/s12910-018-0300-7 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Pettersson, Mona
Hedström, Mariann
Höglund, Anna T.
Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care
title Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care
title_full Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care
title_fullStr Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care
title_full_unstemmed Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care
title_short Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care
title_sort ethical competence in dnr decisions –a qualitative study of swedish physicians and nurses working in hematology and oncology care
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007064/
https://www.ncbi.nlm.nih.gov/pubmed/29914440
http://dx.doi.org/10.1186/s12910-018-0300-7
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