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- Determinants and outcomes of psychological empowerment in healthcare professionals: How to promote empowermentPublication . Hernández-Marrero, Pablo; Pereira, Sandra Martins; Teixeira, Carla Margarida; Carvalho, Ana Sofia
- Compared to palliative care, working in intensive care more than doubles the chances of burnout: results from a nationwide comparative studyPublication . Pereira, Sandra Martins; Teixeira, Carla Margarida; Carvalho, Ana Sofia; Hernández-Marrero, PabloIntroduction: Professionals working in intensive and palliative care units, hence caring for patients at the end-of-life, are at risk of developing burnout. Workplace conditions are determinant factors to develop this syndrome among professionals providing end-of-life care. Objectives: To identify and compare burnout levels between professionals working in intensive and palliative care units; and to assess which workplace experiences are associated with burnout. Methods: A nationwide, multicentre quantitative comparative survey study was conducted in Portugal using the following instruments: Maslach Burnout Inventory–Human Services Survey, Questionnaire of workplace experiences and ethical decisions, and Questionnaire of socio-demographic and professional characteristics. A total of 355 professionals from 10 intensive care and 9 palliative care units participated in the survey. A series of univariate and multivariate logistic regression analyses were performed; odds ratio sidelong with 95% confidence intervals were calculated. Results: 27% of the professionals exhibited burnout. This was more frequent in intensive care units (OR = 2.525, 95% CI: 1.025–6.221, p = .006). Univariate regression analyses showed that higher burnout levels were significantly associated with conflicts, decisions to withhold/withdraw treatment, and implementing palliative sedation. When controlling for socio-demographic and educational characteristics, and setting (intensive care units versus palliative care units), higher burnout levels were significantly and positively associated with experiencing conflicts in the workplace. Having post-graduate education in intensive/palliative care was significantly but inversely associated to higher burnout levels. Conclusions: Compared to palliative care, working in intensive care units more than doubled the likelihood of exhibiting burnout. Experiencing conflicts (e.g., with patients and/or families, intra and/or inter-teams) was the most significant determinant of burnout and having post-graduate education in intensive/palliative care protected professionals from developing this syndrome. This highlights the need for promoting empowering workplace conditions, such as team empowerment and conflict management. Moreover, findings suggest the need for implementing quality improvement strategies and organizational redesign strategies aimed at integrating the philosophy, principles and practices of palliative care in intensive care units.
- Portuguese medical students’ perceptions and willingness to perform uuthanasia and physician-assisted suicide: results from a mixed-methods studyPublication . Pereira, Sandra Martins; Hernández-Marrero, Pablo
- Palliative care nursing education across the EU: results from an international survey studyPublication . Pereira, S. Martins; Hernández-Marrero, P.; Capelas, M. L.; Pasman, H. R.; Larkin, P.; Franck, A.
- Integrating palliative care and Intensive care: a spectrum of ethical issuesPublication . Pereira, Sandra Martins; Teixeira, Carla; Carvalho, Ana Sofia; Hernández-Marrero, PabloBackground: The integration of palliative care (PC) in intensive care (IC) can be framed ethically. By integrating the core principles of PC in IC, the ethical principles of autonomy, beneficence, non-maleficence and justice are fostered together with the ethical principles of dignity, integrity and vulnerability. Several organizational initiatives have been described worldwide on integration. Little is known on the ethical principles supporting this integration. Aims: To ethically frame and understand healthcare professionals’ perspectives about integrating PC and IC. Methods: A qualitative study, using in-depth interviews to collect data from healthcare professionals working in Portuguese PC and IC units. Data is being analysed using a thematic analysis approach. A snowball sampling procedure is being applied until reaching theoretical saturation. Up-to-date, 22 professionals (8 physicians and 14 nurses) across settings and cities were interviewed. Results: Participants understand the integration of PC in IC as a way of improving end of life care and end of life decision-making processes. In their speech, an early integration of PC is needed, particularly in other settings (e.g., medical and surgical) in order to prevent invasive interventions and admissions in IC units. This is linked to the application of the ethical principles of beneficence, non-maleficence and justice into practice. Professionals also consider that the integration of PC in IC may foster patient autonomy, by allowing patients to be cared for and die in their place of preference, and integrity, through a holistic approach. Patients in IC are particularly vulnerable; integrating the principles of PC can protect them of any further harm. While professionals working in PC consider that integration should be promoted by implementing a mixed-organizational model, professionals from IC units defend an educational model, which should be promoted during medical specialty training as intensivists, PC being part of this education programme. Conclusions: This is the first study addressing the integration of PC in IC in Portugal, following an ethical frame. Professionals working in PC and IC seem to have different perspectives on how the integration model should be. Findings show the potential for a successful integration; more research is needed to develop an effective, sustainable and ethically sound integration model. Acknowledgments: Fundação Grünenthal and Fundação Merck, Sharp and Dohme.
- Integrating palliative cre in intensive care: a systematic review of outcomesPublication . Niemeyer-Guimarães, Márcio; Pereira, Sandra Martins; Antunes, Bárbara; Hernández-Marrero, Pablo
- Toward a bioethical framework for antibiotic use, antimicrobial resistance and for empirically designing ethically robust strategies to protect human health: a research protocolPublication . Hernández-Marrero, Pablo; Pereira, Sandra Martins; Brandão, Patrícia Joana de Sá; Araújo, Joana; Carvalho, Ana SofiaIntroduction: Antimicrobial resistance (AMR) is a challenging global and public health issue, raising bioethical challenges, considerations and strategies. Objectives: This research protocol presents a conceptual model leading to formulating an empirically based bioethics framework for antibiotic use, AMR and designing ethically robust strategies to protect human health. Methods: Mixed methods research will be used and operationalized into five substudies. The bioethical framework will encompass and integrate two theoretical models: global bioethics and ethical decision-making. Results: Being a study protocol, this article reports on planned and ongoing research. Conclusions: Based on data collection, future findings and using a comprehensive, integrative, evidence-based approach, a step-by-step bioethical framework will be developed for (i) responsible use of antibiotics in healthcare and (ii) design of strategies to decrease AMR. This will entail the analysis and interpretation of approaches from several bioethical theories, including deontological and consequentialist approaches, and the implications of uncertainty to these approaches.
- How to optimize Informed consent in patients with dementia?Publication . Hernández-Marrero, P.; Pereira, S. Martins
- Ethical decision making in pain management: a conceptual frameworkPublication . Carvalho, A. S.; Martins Pereira, S.; Jácomo, A.; Magalhães, S.; Araújo, Joana; Hernández-Marrero, P.; Gomes, Carlos Costa; Schatman, M. E.Introduction: The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician–patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with druginduced risk of tolerance and fear of addiction; 5) concerns regarding “last-ditch” treatments of severe pain; and 6) failure to be accountable and equitable. Objective: The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. Methods: This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. Discussion: We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Conclusion: Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound.
- Burnout em médicos e enfermeiros: estudo quantitativo e multicêntrico em unidades de cuidados paliativos em PortugalPublication . Pereira, Sandra Martins; Teixeira, Carla Margarida; Ribeiro, Orquídea; Hernández-Marrero, Pablo; Fonseca, António M.; Carvalho, Ana SofiaTheoretical Framework: Systematic contact with death is considered a risk factor for burnout in health, particularly for doctors and nurses who develop their professional activity in palliative care. Objectives: To study the syndrome of burnout in these professionals in Portugal. Methodology: A multicenter quantitative survey study. Results: Out of 142 professionals, 88 returned the completed questionnaire; of these, only 3% were in burnout and 13% at high risk of developing this syndrome. Professing a religion (p=.005) and having post-graduate education/training in palliative care (p=.011) were significantly and inversely associated with burnout. Conflicts with other professionals (p=.012) were significantly associated with developing this syndrome. Conclusion: Although the percentage of professionals with high levels of burnout in palliative care is low, there are risk factors that can be optimized to promote a higher well-being state among professionals.
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