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Tore Nilstun

Publications and source records attributed to Tore Nilstun.

At least 37 records · Page 2Linked to original sources
PubMed2004

Ethics and vaccination.

BACKGROUND: Immunization programmes are ethically defensible and society has a significant role to play in providing vaccination against measles and safeguarding herd immunity to optimize its individuals' capabilities. Since preventive actions interfere with individuals who consider themselves as healthy, public health strategies - as distinct from advice in a clinical consultation - require something approaching certainty as to benefits and possible side effects of an intervention. The principle of individual autonomy, a fundamental value in bioethics, often makes discussions covering ethical issues in public health interventions difficult and non-productive as to practical solutions. In encounters intended to provide information on vaccination, discussions regarding risks tend to simplify the issue into an individual one: either the child gets measles or not, or is affected by side effects or not. METHOD AND CONCLUSIONS: A model is suggested for identification and analysis of the ethical conflicts in measles vaccination programmes, which contains two different dimensions: the affected persons and the relevant ethical principles. Justice as solidarity, not utility, should be paired with autonomy in ethical deliberations on preventive health interventions such as a vaccination programme for measles. If the goal is solidarity rather than conformity, the parents must be free to decide what they think is right, because that is what moral responsibility is all about. Solidarity, however, could never be accepted as an argument without parents trusting the messages from the health institutions and availability of reasonable societal support for those who claim an association between vaccinations and possible side effects.

Child Welfare↗
PubMed2003

End-of-life decision-making in six European countries: descriptive study.

BACKGROUND: Empirical data about end-of-life decision-making practices are scarce. We aimed to investigate frequency and characteristics of end-of-life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. METHODS: In all participating countries, deaths reported to death registries were stratified for cause (apart from in Switzerland), and samples were drawn from every stratum. Reporting doctors received a mailed questionnaire about the medical decision-making that had preceded the death of the patient. The data-collection procedure precluded identification of any of the doctors or patients. All deaths arose between June, 2001, and February, 2002. We weighted data to correct for stratification and to make results representative for all deaths: results were presented as weighted percentages. FINDINGS: The questionnaire response rate was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. Total number of deaths studied was 20480. Death happened suddenly and unexpectedly in about a third of cases in all countries. The proportion of deaths that were preceded by any end-of-life decision ranged between 23% (Italy) and 51% (Switzerland). Administration of drugs with the explicit intention of hastening death varied between countries: about 1% or less in Denmark, Italy, Sweden, and Switzerland, 1.82% in Belgium, and 3.40% in the Netherlands. Large variations were recorded in the extent to which decisions were discussed with patients, relatives, and other caregivers. INTERPRETATION: Medical end-of-life decisions frequently precede dying in all participating countries. Patients and relatives are generally involved in decision-making in countries in which the frequency of making these decisions is high.

Adolescent↗
PubMed2003

GPs facing reluctant and demanding patients: analysing ethical justifications.

BACKGROUND: Several studies have explored the physicians' preferred actions when facing a reluctant or a demanding patient, but only a few studies have explored the physicians' justifying reasons. OBJECTIVE: The aim of this study was to assess how GPs would act and how they would justify their choice. METHOD: A postal questionnaire with questions about preferred actions and justifying reasons was sent to a random sample of GPs in Slovenia (n = 160) and Sweden (n = 200) using four vignettes: (i). a healthy patient reluctant to quit smoking; (ii). a healthy patient demanding an X-ray; (iii). a pulmonary cancer patient reluctant to quit smoking; and (iv). a pulmonary cancer patient demanding immunotherapy. RESULTS: The majority of GPs would bring up the question about smoking with the patients reluctant to quit. They justified their choice by referring to promotion of medical benefit and to protection from harm. Swedish GPs were less inclined to bring up smoking than were their Slovenian colleagues. Those who would not bring up the question referred to respect for self-determination and an enhanced relationship as their justifying reasons. With reference to the demanding patients, a minority of GPs would grant the healthy patient's request for an X-ray that was not medically motivated. The answers were similar with respect to the seriously ill patient requesting non-medically motivated immunotherapy. Slovenian GPs were much more inclined to grant the request than were their Swedish colleagues. Enhancing the relationship and respect for self-determination were the most important reasons for granting the demands. When the demands were denied, the GPs mostly referred to promotion of fair distribution of resources. CONCLUSION: Many of the GPs considered their patients' right to self-determination less important than other values, e.g. the obligation to promote medical benefit, to protect from harm, to distribute public resources fairly and to enhance the patient-physician relationship.

Attitude of Health Personnel↗
PubMed2002

[Ethics in everyday care. The dialogue is physician's most important tool].

The principle of autonomy brings questions about the dialogue between physicians and their patients in focus. The controversial issue is not if, but when and how to inform patients about their diagnosis, prognosis and treatment options. In difficult situations the main problem is to find a reasonable balance between respect for self-determination and the obligation of beneficence, i.e. the professional responsibility based on assessments of the patient's best interest. One important tool for dealing with this balance in everyday practice is the art of communication with the patient.

Communication↗
PubMed2002

[General practitioners surveyed on ethical conflicts. How do you handle the "reluctant" patient? How do you handle the patient demanding unnecessary treatment?].

Conflicts between the patient's right to make his own decisions and the physician's obligation to promote health may cause ethical problems in general practice. A questionnaire was sent to 120 Swedish general practitioners; 82 responded, 47 of whom were later interviewed. Faced with a patient reluctant to consent to a medically well founded intervention a majority of the GPs said that they would try to persuade the patient, while they would not agree to medically unjustifiable treatment to patients demanding this. Nor only ethical guidelines, but also a situational ideal of covenant in the patient-physician relationship is desirable in the GP's everyday practice.

Decision Making↗
PubMed2002

Both empowered and powerless: mothers' experiences of professional care when their newborn dies.

BACKGROUND: The death of a newborn is a complex and tragic situation, the uncertain and stressful nature of which places emotional burdens on the parents. The aim of this study was to examine and illuminate mothers' experiences and perceptions of the care given to them at neonatal clinics while facing the threat and the reality of losing their baby. METHOD: Interviews were performed, in the form of conversations, with 16 mothers approximately 2 years after the death of their newborns. The interviews were analyzed using a hermeneutic phenomenological method. RESULTS: The primary themes identified were feeling empowered and feeling powerless. Three related themes to feeling empowered were a sense of nearness--supporting confidence; a sense of encouragement--supporting self-esteem; and a sense of empathy--supporting comfort. Three related themes to feeling powerless were a sense of distance--leading to strength or adjustment; a sense of violation--leading to helplessness and despondency; and a sense of disconnection--leading to insecurity and discouragement. All mothers felt both empowered and powerless. When experiencing empowering care, they had a feeling of encountering benevolence, with respect to their individual desires. Experiencing competent care without humane treatment madethemfeel powerless, and they were neither respected as a mother nor a person. CONCLUSIONS: Feelings of empowerment emerged when the health care professionals not only saw the mother as an individual but also "saw through the mothers' eyes" and "felt with the mother's feelings". Feelings of powerlessness emerged when the similarity in the lifeworld (i.e., the world of lived experiences) differed, and the perspectives of the mothers and the health care professionals did not correspond.

Adult↗
PubMedDate not supplied

Neonatal end-of-life care in Sweden.

A survey was carried out of Swedish neonatal end-of-life regarding practice before birth, at birth, during dying and after death using a descriptive questionnaire with close-ended questions and individual comments. The practice in 32 of 38 neonatal units, as described by the head nurse or the registered nurses, was largely similar. Respectful treatment of both the neonate and the parents during neonatal end-of-life care was indicated. Differences were found in pre-natal care concerning the information about the risks of pre-term birth, the opportunity for parents to view a pre-term neonate and meet its family, as well as a social worker. Practice directly after birth was also different. A little less than half of the units answered that they gave a description of the seriously ill neonate to the parents before the first visit to the ward. Practice during dying indicated that only a few units permitted the neonate to die at home.

Attitude to Death↗
PubMedDate not supplied

Neonatal end-of-life care in Sweden: the views of Muslim women.

OBJECTIVE: To explore Muslim women's views of neonatal end-of-life-care in Sweden. METHODS: Interviews using a standardized questionnaire with open-ended questions about care before birth, directly after birth, and during and after the death of the infant. Content analysis was performed on the data. PARTICIPANTS: Eleven immigrant women of Muslim background living in Sweden. RESULTS: The categories identified were information both useful and threatening, priority of medical facts, maternal feelings, roles of significant others, predetermined lifetime, protection of the dying infant, staff's role, memories aggravate the grief, special tradition, life after death and belief in the future. CONCLUSIONS: The women provided suggestions for improvement of care including being given sufficient information of and the need for culturally sensitive care. In providing care for Muslim women it is imperative that care take into account the woman's religion and ethnicity as well as individual preferences.

Adult↗
PubMedDate not supplied

When the unreal becomes real: family members' experiences of cardiac arrest.

The aim of this study was to provide insight into family members' experiences related to cardiac arrest. Data were collected through semi-structured interviews with 17 family members approximately 5-34 months after the cardiac arrest of a relative. As the focus was on the family members' experiences seen from a holistic perspective, content analysis was chosen for the study. When the event occurred to the patient, family members realized the need for assistance and managed to initiate first actions. When the emergency medical service arrived, family members responded to stress and forgot their own needs. When the staff took over at the hospital, family members not only received sympathy but also encountered professional distancing. Because their experiences vary widely, the encounter has to be developed through a comforting, sympathetic and respectful dialogue in consideration for individuals' preferences.

Adaptation, Psychological↗
PubMedDate not supplied

Experiencing neonatal death: an ambivalent transition into motherhood.

OBJECTIVE: To illuminate the lived experience of women facing the threat of lossing their newborn child and then experiencing the reality of their infant's death. STUDY DESIGN: Sixteen women were interviewed approximately 2 years after the death of their infant using a hermeneutic phenomenological approach. FINDINGS: The main theme was ambivalent transition into motherhood. The women went through the whole life-span of their infant during a very short time. The women's narratives were interpreted as broken expectations, total confusion, reality awareness, consciously leave-taking, and elusive grief. CONCLUSIONS: Women need the opportunity to evolve their own patterns and rhythms in the ambivalent transition from expected motherhood to experiencing neonatal dying and death. Knowledge about the individuality of this process may assist nurses in improving the quality of care.

Adaptation, Psychological↗