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- Title
Obstacles to Timely Decision-Making for Unrepresented Critical Care Patients Without Capacity and Associated Staff Moral Distress: A Single-Center Quality Improvement Study.
- Authors
Finkel, Francisca; Dey, Amit; Sotomayor, Claudia R.; Spevak, Christopher
- Abstract
Background: Incapacitated patients without surrogates are a highly vulnerable population that pose a unique challenge in the critical care setting. Laws regarding consent in this population vary, with many states requiring a lengthy guardian appointment process. Lack of familiarity with local laws and ambiguity with hospital policy can contribute to staff moral distress and exacerbate delays in patient care. Methods: A single-center interdisciplinary focus group was conducted to characterize staff opinions and workflow in the guardianship petition process. Subsequently, a survey was disseminated to various members of the ICU care team. The survey captured demographic information, familiarity with certain aspects of the guardianship process, opinions of appropriateness of care of these patients, and overall feelings of moral distress. Results: Focus group themes included administrative processes, desire for more education, and ethical concerns. Survey results show that clinical staff were largely unfamiliar with both hospital policies (50%) and local legislation surrounding legal guardianship (68%). There was a strong desire for an institutional procedural flowchart (85%). Perception on care varied but had no correlation to demographic factors. Every respondent reported moral distress, ranging from mild to severe (100%). Moral distress was correlated with perception of care (p=0.015), but not demographic factors. Conclusion: An institutional flowchart and other educational materials were developed with the primary intention of alleviating staff moral distress. Secondarily, these educational materials are also intended to improve delays in initiation of the guardianship process as even marginally improving the timeliness of care for vulnerable patients is worthwhile. Continued careful attention to institutional processes can be a manner of upholding the ethical pillar of justice for highly vulnerable individuals.
- Subjects
PSYCHOLOGICAL distress; FOCUS groups; HEALTH facility administration; TEACHING aids; DECISION making; BIOETHICS; ETHICS; SURVEYS; THEMATIC analysis; WORKFLOW; INFORMED consent (Medical law); ATTITUDES of medical personnel; QUALITY assurance; INTERDISCIPLINARY research; GUARDIAN &; ward; DATA analysis software; TIME; CRITICAL care medicine; CRITICALLY ill patient psychology; PSYCHOLOGICAL vulnerability
- Publication
Journal of Hospital Ethics, 2024, Vol 10, Issue 1, p38
- ISSN
1938-4955
- Publication type
Article