• Nursing ethics · Feb 2021

    Managing ethical aspects of advance directives in emergency care services.

    • Silvia Poveda-Moral, Dolors Rodríguez-Martín, Núria Codern-Bové, Pilar José-María, Pere Sánchez-Valero, Núria Pomares-Quintana, Mireia Vicente-García, and Anna Falcó-Pegueroles.
    • University of Barcelona, Spain; 212203Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (Universitat Autònoma de Barcelona), Spain; Barcelona College of Nursing, Spain.
    • Nurs Ethics. 2021 Feb 1; 28 (1): 91-105.

    BackgroundIn Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient's advance directives and implement them.ObjectivesTo analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services.Research Design, Participants, And ContextThis is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis.Ethical ConsiderationsThis study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients' anonymity and willingness to participate in the study were guaranteed.FindingsThere were four types of barriers that hindered the proper management of patients' advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals' decision-making.DiscussionThese results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals' beliefs and the opinions of colleagues and family members, can also influence the professionals' final decisions.ConclusionThe different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated.

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