Ethics at the End of Life

so I did my presentation on ethics during a pandemic.

The ethical dilemma is health care providers feeling responsible to

care for covid 19 patients with the risks that are

involved. Some of those risks include not having appropriate PPE

or resources.

Um, the increased risk for contracting the infection, the increased

risk for bringing the virus home to your family.

Emotional trauma acquired through seeing these this virus firsthand discrimination

in the workplace related to symptoms or calling out because

of symptoms.

Um, CDC statistics show that nursing represents almost 40% of

all health care providers that contract the virus.

A study was conducted to determine occupational status of covid

positive cases, and of 50,000 cases, almost 10,000 were identified

as healthcare per fighters.

That's one in five.

So some strains on the institution.

When Covid first hit, we didn't have a lot of

data and the institution was implementing frequent policy changes.

Uh, this created an unstable work environment and made several

feel very unsafe.

With the frequent practice changes recording, um regarding appropriate PPE.

Several of the changes made by the institution were to

ration PPE for fear of shortage, and this left healthcare

providers without proper safety equipment.

Um, due to the decrease in staffing as well.

There was extreme burnout and emotional trauma with the increased

demands at work.

So why this matters?

This is Jill Jill's.

A 43 year old marathon runner, she worked in an

ICU taking care of Covid 19 patients in Utah.

She's a mother of three, and she has no comorbidities.

She contracted covid back in November.

She was in, and I see you in Utah for

a month before she was transferred to Shantz.

And she was on VV ECMO for over a month.

That shots before she received a double lung transplant.

This is the facility where I work, and she was

very depressed in considering withdrawal of care while she was

sick, She survived.

This is Jill.

While she was calculated for ECMO and with a tracheostomy,

she was very, very sick.

This is gel before and after her lung transplant, and

this is her leaving Shan's facility to return to Utah

to complete her rehabilitation.

So the impact on nursing a systematic review of nurses

concluded that nurses are very likely to experience psychological issues

that lead to burnout and a decrease in the overall

workforce, stopping nurses make up the largest section of healthcare

workers as frontline workers.

Being in close proximity with these patients increases the risk

for infection drastically.

The review found that out of all health care providers,

female nurses were the most likely to leave their job

since the perceived risk was too high.

Um, this has a significant impact on health care systems.

So this systematic review also found three synthesize findings.

So I found supportive nursing teams.

This actually found that nurses, even through everything in the

risk, found a professional obligation to provide care to these

patients. It also showed improved staff camaraderie.

However, it did create a sense of social isolation from

friends and family while working, acknowledging the physical and emotional

impact was the second.

So the systematic review found that these impacts have short

and long term consequences, and the largest issue was potential

fear of infecting others, Um, and the sense of powerless

powerlessness that came with being under this extreme pressure with

a reduced standard of care and not having control over

the situation.

Um, the third one is responsiveness, and this actually looks

at the resilience of the nursing staff to create, to

come together and create resources such as PPE by their

own means, to ensure that they were safe, even when

the institution could not provide those means.

Overall, the largest complaint during the study was the lack

of preparedness at a management level.

So K, H N and the Guardians have been doing

these interviews and tracking healthcare providers who have passed away

due to Covid.

Over the last nine months, they've interviewed more than 300

family members of people who have passed away, and the

biggest concern is one and third of those said that

their family members had been complaining of not having appropriate

PPE at work before they contracted the virus and passed

away. The data shows to that at least 680 of

those were were in New York and New Jersey.

So the global impact this is a pandemic.

So the statistics statistics show that 1.6 million healthcare workers

have been infected with covid.

Um, there's been over 2000 nurses that have passed away,

and of those, about 60% were reported in America.

Um, 45% of Iranian nurse workforce contracted the virus.

That's around 60,000 nurses, and I assume that's probably due

to a lack of PPE as well.

Um, so these associations reported the emotional well being of

these these, uh, these people.

So Japan reported an increase in discrimination, and 50 15%

of the nurses actually resigned.

American reported being overwhelmed, stressed and, um, nurse to patient

ratios had increased threefold.

Africa had the only comparable statistics, with 2% reporting depression

before the pandemic and 20% of healthcare workers reporting depression.

While in the pandemic, Spain had an 80% report for

anxiety, and everywhere seemed to have a lot of burnout.

So the International Council of Nurses projects a global shortfall

of more than 10 million nurses.

By 2030 the statistic was actually before covid.

So with covid, these nurses are leaving the profession and

the due to the burn out, and they're estimating the

nursing gap to be closer to 14 million, if not

higher in 2030.

Yeah, so some evidence based research, um covid 19 patients

come with their risks and a few evidence based practices

can reduce the risk of infection and also help with

resource allocation, minimizing the risk.

A study that looked at 16 clinical studies found that

wearing a mask, strict social isolation and taking appropriate distancing

measures can reduce the spread of covid by 99.3%.

Another evidence based practice center reviewed old evidence from previous

pandemics and epidemics to look at the best way to

minimize scarce resources.

And, of course, they promote vaccines and social isolation to

not contract the virus firsthand as well as augmenting resources

by reusing things that can be reused as well as

using pop up facilities to try and minimize people coming

in the hospital.

Um, overall good ways to limit resources.

So in summary, obviously, it's apparent that the pandemics having

a tremendous impact on health care workers.

Um, several report PTSD emotional trauma.

They've had friends, they've lost family members.

They've lost, um, they've been sick themselves.

Um, and the research shows, though, that health care providers

actually found it to be their professional obligation to take

this risk for their patients.

Through evidence based practice, there is an ability to decrease

the risk of contracting the virus drastically and allocating resources

and maximizing PPE.

Um, overall, this pandemic has taken a lot from healthcare

workers, but it has created a stronger group of nurses

in the future.

I hope that the government and health institutions and the

community can come together to better support the health care

um, providers.

This is just a list of references, not that.

Ethics at the End of Life

Chapters

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