Showing 10 results for Emergency
Zhamak Khorgami, Amir Hosein Gougol, Ahmadreza Soroush,
Volume 5, Issue 3 (6-2012)
Abstract
In recent years, a new manner has been common practice in emergency departments (EDs) of governmental hospitals in Iran, in which, of course illegally, patients are encouraged to self-discharge or refer to other EDs. This is done by giving incomplete or even false information and deceiving patients. The purpose of this study is to identify the underlying causes from the point of view of EDs' personnel to clarify the root of this burden for authorities and pave the way for more studies.
This is a cross-sectional descriptive-analytic study, gathering opinions via questionnaire and/or direct interview with open-ended questions. During November and December 2009, hospital managers, hospital heads, faculty members, residents in specialties involved with the ED, interns, ED nurses, and nurse supervisors were interviewed regarding the frequency of such instances in their hospital, the main violators, and its possible causes and determinants.In this study 114 persons from different groups took part. From participants' point of view, the main violators in EDs are junior residents and interns 48 (42.1%) participants pointed to junior residents and 29 (25.4%) participants found interns responsible. The estimated number of patients which were refused during a week was stated as 18.1 ± 15.6 (range between 0 to 90). Among participants remarks, the most important factors which lead staff to non-admission were high work load, overcrowding of EDs, lack of facilities, lack of any motivation or incentive for doing tough tasks, inappropriate patient transfer by city emergency system, bad policies and rules, lack of sufficient supervision from deputies, and improper work sharing between different levels.Patient non-admission and diversion through deception is a common practice among EDs of educational hospitals in Tehran. High work load and overcrowding of these centers should be considered a high priority target for interventions. Further studies are highly suggested to find appropriate solutions. In future studies, junior residents and interns should be considered as main target groups.
Ali Labaf, Amirhossein Jahanshir, Amir Amir Shahvaraninasab,
Volume 7, Issue 1 (5-2014)
Abstract
Breaking bad news is one of the most difficult tasks an emergency physician has to perform and unfortunately it is not well studied. Almost all of the original studies for compilation of the guidelines of breaking bad news have been conducted in a non-emergent situation and were physician-oriented. In this study and by reviewing related articles in medical databases, the authors try to show the necessity of adapting these guidelines into the situation of the emergency departments and indigenizing them for non-Western countries. This can be the first step to design a guideline for the emergency department.The different nature of bad news and the chaotic situation in the emergency departments are the two most important points that may prevent using these guidelines in the emergency departments.
On the other hand, breaking bad news guidelines are designed based on Western cultures and their application in a non-Western country may decrease their effectiveness.To the best of our knowledge, there is no national guideline for breaking bad news in Iran. There is a long way to go before we can suggest a national guideline for emergency departments, so we recommend using one of the Western guidelines and indigenizing it according to the Iranian culture and emergency situations.
Maryam Gholami, Marziye Khojastefar, Hossein Moravej, Zahra Kavosi,
Volume 9, Issue 1 (5-2016)
Abstract
Observation of patients’ rights as a major component in defining the standards of clinical services can increase patient satisfaction and is an important indicator of health care quality. Since most hospital patients are admitted through the emergency department, this study was conducted to investigate the observance of patients’ rights in the emergency department of Nemazee Hospital during 2015.
This cross-sectional study was performed on 100 patients over a period of one month. Data were collected by a questionnaire and analyzed using SPSS version 21 and statistical tests including descriptive statistics and inferential analysis.
The mean of the patients’ age in this study was 54.4 ± 19.35. Based on our findings, the overall level of observing patients’ rights was 51%, while patients’ expectations were 93%. Moreover, there was a meaningful difference between observance of the patients’ rights and their expectations in all aspects based on the paired sample t-test (P<0.05). It was also established that age was one of the factors affecting observance of patients’rights (P<0.05).
In this study, observation of patients’ rights in the emergency department was at the intermediate level, while patients’ expectations were higher in comparison.
In order to promote patient satisfaction, it seems necessary to educate the personnel and medical students on patients’ rights by holding workshops, reducing the waiting time for receiving services, and establishing an order in the system based on the patient’s condition.
Seyed Saied Seyed Mortaz, Parvin Delavar, Nafiseh Zafarghandi, Mohammad Reza Yektaei, Qolamreza Moarefi, Ali Davati, Shiva Rafati, Siamak Afshin Majd, Ahia Garshasbi,
Volume 11, Issue 0 (3-2018)
Abstract
A 62-year-old man referred to the emergency department 48 hours ago with chief complaint of repeated bloody vomiting. The patient is admitted and the necessary measures are taken. Within 24 hours, he received 6 units of blood. The patient has undergone endoscopy, but endoscopic endorsement has failed to stop the bleeding. The surgeon consulted and visited the patient. He considered urgent emergency laparotomy. The patient is alert and refuses surgery. The hemodynamic status of the patient is not stable and gastrointestinal bleeding continues. These questions are posed to medical staff and hospital managers: "What is our duty”? "Should we respect the choice of the patient and witness the progress of the disease and deterioration of the patient's condition"? "Can he be discharged from the hospital on the basis of the patient's refusal to take medical treatment"? "Can we take appropriate diagnostic and therapeutic measures with the use of legal capacity and support despite patient’s opposition? "How can one regard autonomy, beneficence, and nonmaleficence at the same time, in this situation "? In this study, which is one of the problems of medical ethics, the ethical, legal, and health aspects of the presented patient are discussed.
Ali Labaf, Fariba Asghari, Talayeh Mirkarimi,
Volume 11, Issue 0 (3-2018)
Abstract
Trust is one of the most important issues in patient-physician relationship and affects the treatment acceptance and followup from the patient and optimal outcome. Patient trust to emergency physician is different from other physicians in many ways because of patient’s urgent situation and lack of choice in physicians. This paper explores the reasoning for (dis)trust in emergency physicians in Imam khomeini hospital. A qualitative study in Imam khomeyni hospital was done including 5 recorded focused groups (with 3-6 patients in each group) and 8 in-depth interviews with patients. Patient trust’s issues were divided into 2 major groups: 1- issues that depend on emergency physicians (including professionalism; practical skills and physician’s personal factors) 2-issues independent to emergency physicians (including patient’s previous beliefs; environmental and hospital’s factors and patient’s personal factors). Many factors about emergency physicians like personal factors that are extracted from this study were similar to other physicians. In other hand, it seems that patient trust in emergency physicians is affected by environmental factors especially hospital related factors and it is better to consider it as an integrated foundation and not only trust between persons.
Morad Momivand, Arash Ghodousi, Neda Yavari,
Volume 11, Issue 0 (3-2018)
Abstract
Professional nurse should be familiar with the principles of biomedical ethics and how to deal with situations of moral conflict. Nurses encounter a variety of ethical conflicts in their work environments, which, if not properly educated for that, may be destructive. One of the first steps to recognize and help resolve moral conflicts seems to be a better understanding of the underlying causes of these conflicts. For this purpose, this study compared the exposure of pre-hospital emergency staff and nurses of the ophthalmologic departments in Isfahan with ethical conflicts in their careers. This descriptive-analytic study was performed on 44 pre-hospital emergency personnel and 42 nurses in ophthalmic and postgraduate degrees. Data were collected using Falco's moral conflict questionnaire. The results were analyzed using descriptive statistics such as frequency distribution tables, dispersion indexes, and mean and analytical statistics such as T test and ANOVA. Data were analyzed using SPSS software version 8. The results of this study showed that the prevalence of ethical conflicts among pre-hospital emergency personnel with a mean of 61.65 was higher than nurses in ophthalmic departments with an average of 40.23. Therefore, according to the results of this study, the degree of exposure to ethical conflict situations for pre-hospital emergency personnel more common in comparison with the staff of the elective hospital units in more stressful situations. The degree of exposure to ethical conflict situations is also more significant for pre-hospital emergency personnel than nurses in the ophthalmic departments.
Mostafa Ghasempour, Abbas Dadashzadeh, Majid Purabdollah, Fezeh Hoseini Lilab,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity is a crucial attribute for pre-hospital emergency personnel, significantly impacting their ethical decision-making and patient care in urgent and often complex situations. Defined as the capacity to recognize ethical dilemmas and comprehend their implications, moral sensitivity empowers personnel to navigate challenges such as resource limitations, critical patient conditions, and the imperative for rapid, independent decision-making. This study aimed to evaluate the level of moral sensitivity among Emergency Medical Technicians (EMTs) and identify key influencing factors. A cross-sectional study was conducted in 2023, encompassing 245 EMTs selected through cluster random sampling. Data were collected using the Moral Sensitivity Questionnaire (MSQ) and analyzed employing correlation tests and regression analysis. The findings revealed a mean moral sensitivity score of (39.45 ± 7.13) among participants, indicating a moderate-to-high level of ethical awareness. A significant correlation was observed between moral sensitivity and specific demographic and professional characteristics. Notably, work experience emerged as a key determinant (P < 0.001). Regression analysis further emphasized work experience (β = 0.08, P < 0.001) as a strong predictor, demonstrating that increased exposure to clinical and ethical challenges over time enhances moral sensitivity. Enhancing ethical sensitivity among pre-hospital emergency personnel is paramount to improving their ability to identify and address complex ethical challenges and deliver high-quality patient care. Given the unique demands of emergency situations, including time constraints, resource limitations, and the need for immediate action, it is crucial to equip personnel with the tools necessary to recognize and navigate ethical dilemmas. Implementing comprehensive training programs that emphasize ethical awareness and reasoning can empower EMTs to make more informed and empathetic decisions. Furthermore, cultivating a supportive organizational culture that prioritizes ethical performance and provides ongoing training can further enhance their confidence and competence in managing ethically sensitive situations.
Soolmaz Moosavi ,
Volume 17, Issue 0 (12-2024)
Abstract
The elderly population is rapidly increasing, and as a result, the demand for emergency services for this age group is also growing. Due to their specific physical and mental conditions, the elderly are exposed to numerous ethical issues and challenges when receiving emergency services. These issues are significant because their physical and mental conditions can prevent them from making decisions independently and achieving informed consent. The aim of this article is to examine the ethical challenges associated with the care of the elderly in the emergency department and to provide suggestions for improving this care. This educational narrative review article examines and analyzes ethical challenges in elderly care in the emergency department using reliable sources and articles between 2005 and 2024. Keywords included "medical ethics," "elderly care," and "emergency," and sources were extracted from reliable scientific databases such as PubMed, Scopus, and Google Scholar. Ethical challenges in elderly care in the emergency department include maintaining the independence of the elderly, obtaining informed consent, ensuring privacy and confidentiality, decision-making at the end of life, observing justice and fairness, maintaining honesty, providing psychological and emotional support, offering compassion and empathy, upholding professional principles of education and awareness, communicating effectively with the family, managing pain, and ensuring patient comfort. Although developed countries have long faced the issue of aging, in recent years, the growth rate of aging in developing countries has accelerated. These countries face major challenges in elderly care due to inadequate infrastructure and rapid demographic changes. Ethical challenges in caring for elderly patients in emergency rooms are among the most important issues that healthcare teams face. These challenges are exacerbated by the physical and mental sensitivity of the elderly, the complexities of treatment, and the need for rapid decision-making. Adherence to ethical principles, along with ongoing education of caregivers, can improve the quality of care for the elderly in emergency situations and prevent physical and mental harm. Therefore, in addition to knowledge and skills, caring for the elderly requires adherence to ethical principles and humane behavior. By following these principles, a sense of trust and peace can be fostered in the elderly. Some suggested solutions include educating and raising awareness among healthcare teams, strengthening communication with family and legal representatives, using ethical standards, encouraging the elderly to prepare a medical will, and utilizing psychological and physical assessments.
Milad Kazemi Najm, Tahereh Toulabi, Abbas Abbaszadeh, Rasoul Mohammadi, Nasrin Imanifar,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as the largest group of healthcare workers globally, are responsible for providing holistic care to patients. Holistic care encompasses physical, mental, social, and spiritual dimensions. This study aimed to determine the effect of professional ethics training on the spiritual care competence of emergency nurses. This two-group field trial study with a pre-test and post-test design was conducted with 84 nurses working in the emergency departments of Lorestan University of Medical Sciences. Participants were selected through stratified random sampling. The intervention group participated in four workshops. The study tool was the Spiritual Care Competency Questionnaire. Data analysis was performed using SPSS, employing descriptive statistics (mean, median, and percentage) and inferential statistical tests, including repeated measures ANOVA, independent t-tests, and Fisher’s exact test.
The study included two groups: intervention (n = 42) and control (n = 42). Most participants in both groups were women. A significant difference was observed in the average total spiritual care competence scores and its dimensions (excluding the self-knowledge subscale) over different time points in the intervention group (P < 0.001). However, for the self-knowledge subscale, no significant difference was found in the average scores between the control and intervention groups at different time points. The results of this study demonstrated that professional ethics training improves nurses' spiritual care competence. By conducting workshops, training programs, and in-service courses on professional ethics and spiritual care, the quality of nursing care can be enhanced, ultimately improving patient safety. It is recommended that healthcare policymakers and nursing managers prioritize professional ethics as the foundation of all nursing practices. Employing innovative and engaging methods, such as the scenario-based approach used in this study, can further support the development of professional ethics in nursing.
Leila Masoudiyekta, Ehsan Hassanpour Pazevar , Alireza Parsapour, Ehsan Shamsi Gooshki, Mohammd Jalili, Amirahmad Shojaei,
Volume 18, Issue 1 (3-2025)
Abstract
Moral distress constitutes a significant challenge for healthcare professionals, arising when individuals find themselves unable to act in accordance with their personal and professional values due to both internal and external pressures. Healthcare professionals may face scenarios that prompt them to question the ethical acceptability of their decisions and treatment practices, often feeling powerless in the face of perceived unethical changes. This study sought to explore the experiences of moral distress encountered by emergency medicine physicians and nurses in the emergency department. This study was conducted using qualitative content analysis. Data were collected through semi-structured interviews with 25 healthcare providers selected via purposive sampling. Data analysis was conducted using MAXQDA 2018 software. The results indicated that the experiences of moral distress among emergency medicine physicians and nurses in the emergency department can be classified into four primary categories including those related to: 1. patient rights, 2. medical staff and colleagues, 3. management, and 4. professionals. Notably, factors such as overcrowding, inadequate staffing, discrepancies between salaries and workloads, and poor management of human and physical resources emerge as significant contributors to moral distress in the emergency department of Imam Khomeini Hospital. To improve patient care quality, it is essential to implement strategies that enhance triage processes, prioritize human resources, align resources with patient needs, monitor patient attendance, and develop a comprehensive protocol for staff.
