[Effectiveness of a training course in bioethics and of the introduction of a checklist to detect ethical problems in a home care support team].
ABSTRACT To study the concordance in the number of ethical problems identified in the care of the terminally ill between the members of a home care support team (HCST) and a group of experts before and after a course in bioethics and the introduction of a checklist.
Before-and-after intervention study.
Area 7 of Primary Care, Madrid.
Terminally ill patients attended by the HCST between November 2001 and June 2002.
Bioethics course and introduction of a checklist.
Age, sex, basic illness, number of ethical problems identified by the HCST and by the group of experts before and after the intervention. The intraclass correlation coefficient (ICC) for the number of problems identified was calculated in both groups before and after the intervention.
31 cases before and 29 after the intervention were studied. Before the intervention the HCST identified an average of 2.7 +/- 2.3 ethical problems per case; and the group of experts found 11.8 +/- 6.1. The ICC for the number of problems identified was 0.53 (moderate correlation). After the intervention, the HCST identified 5.9 +/- 6.5 ethical problems per case; and the group of experts, 10.7 +/- 7.9. The ICC for the number of problems identified was 0.87 (close correlation).
The course and the introduction of a checklist helped professionals who were not experts in bioethics to detect ethical problems in treating terminally ill patients.
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ABSTRACT: Main Objective: to identify ethical problems in primary care according to nurses' and doctors' perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Synthesis to integrate and reinterpret primary results of qualitative studies. Primary healthcare centers, Sao Paulo, SP, Brazil. PARTICIPANTS AND/OR CONTEXT: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation.Atención Primaria 08/2010; 42(8):406-12. · 0.96 Impact Factor
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ABSTRACT: To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. Nine primary care nursing clinics and 2 university classes in Granada, Spain. Patients who were of age and were first- or second-year university students, without any cognitive deterioration. The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives.Atención Primaria 08/2008; 40(7):345-9. · 0.96 Impact Factor