Compassionate care during withdrawal of treatment:A secondary analysis of ICU nurses' experiences

Background: Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units. Objectives: The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal. Design: The study employed a qualitative approach conducting secondary analysis of an original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care. Ethical considerations: The primary study was approved by the local Research Ethics Committee and the hospital’s Research and Development services. Findings: Compassionate care was mostly directed to the patient’s family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient’s dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus. Conclusion: This study’s findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians’ roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this.</p

The experiences of fathers who have offspring with autism spectrum disorder

Research exploring parents’ experiences of having offspring with autism spectrum disorder (ASD) currently underrepresents fathers. This study aimed to develop an understanding of the experience of fathers, with a view to facilitating improved support. Eight fathers participated in semi-structured interviews exploring their experiences of fathering children with ASD. Fathers described their experiences as a path towards acceptance, with independence and integration for their offspring being key goals. Fathers saw themselves as advocates fighting obstructive services to access appropriate care. The value placed on formal and informal support varied, although the need for personalised support was emphasised. Enabling fathers to see their experiences as a journey, whilst engaging them on the important topics of independence and integration, may improve their experience

Fallacious, misleading and unhelpful:The case for removing ‘systematic review’ from bioethics nomenclature

Attempts to conduct systematic reviews of ethical arguments in bioethics are fundamentally misguided. All areas of enquiry need thorough and informative literature reviews, and efforts to bring transparency and systematic methods to bioethics are to be welcomed. Nevertheless, the raw materials of bioethical articles are not suited to methods of systematic review. The eclecticism of philosophy may lead to suspicion of philosophical methods in bioethics. Because bioethics aims to influence medical and scientific practice it is tempting to adopt scientific language and methods. One manifestation is the increasing innovation in, and use of, systematic reviews of ethical arguments in bioethics. Yet bioethics, as a broadly philosophical area of enquiry, is unsuited to systematic review. Bioethical arguments are evaluative, so notions of quality and bias are inapplicable. Bioethical argument is conceptual rather than numerical, and the classification of concepts is itself a process of argument that cannot aspire to neutrality. Any ‘systematic review’ of ethical arguments in bioethics thus falls short of that name. Furthermore, labels matter. Although the bioethics research community may find that adopting the language and the outward methods of clinical science offers apparent prospects of credibility, policy influence and funding, we argue that such misdirection carries risks and is unlikely to pay dividends in the long term. Bioethical sources are amenable to the review methods of the social sciences, and it is on these methods that specific methods of bioethics literature review should be built

Teaching Medical Humanities in Medical Schools with Open Education Resources

In this chapter we will explore various ways in which open education resources might be utilised in the teaching of medical humanities in medical schools. Open education resources are generic open access materials in a particular field, which can be used by educators and students alike to support teaching and learning. They might be particularly useful when an institution lacks staff with specific expertise to teach essential but ‘minority’ subjects. The open and generic nature of these resources almost always means that they can be used flexibly to suit the teaching and learning contexts in which they are used. However, that same generic character means that they will be rarely directed towards specific learning outcomes, and therefore educators might struggle to fit them into teaching programmes, or have to alter their own learning outcomes and curricula in order to fit the resources available.Here, we outline and reflect upon different ways we have used open access medical humanities materials developed by the ALCMAEON project to support teaching in UK medical programmes the medical schools at the University of Bristol and University of St Andrews respectively. We begin by discussing the difficulties often encountered in teaching medical humanities in the crowded medical curriculum, before outlining what open education resources are and how they can help, with particular reference to the ALCMAEON project. We then outline and reflect on three different ways in which the ALCMAEON resources have been used to support teaching and learning with medical humanities, and consider the wider lessons we can draw from that experience about the use and development of open education resources to support learning and teaching of ‘minority’ subjects in medical curricula.<br/