Ethical Decision Making Capacity Of Healthcare Professionals During Disaster Triage : Example Of Izmir Province

Yıl 2018, Cilt: 9 Sayı: 1, 57 - 66, 17.04.2018

Gülhan Şen

https://doi.org/10.22312/sdusbed.299650

Cited By: 2

Öz

Objective:
This
study aimed to examine whether the qualities healthcare professionals in Izmir
related to disaster triage were adequate and whether these qualities influence
their capacity to make ethical decisions.

Material-Methods:
The
researcher used a questionnaire form prepared with binding vignette method for
data collection. The survey was completed by 215 healthcare professional
working in Emergency-Medical Stations, National Medical Rescue Teams and
Search-Rescue-Health Teams in Izmir. Through this method, their ability to
carry disaster triage and make ethical desicions in conflictual situations is
measured in relation to different variables.

Results:
According
to results, it was determined that 51.2% of the participants had inadequate
knowledge level of ethical principles of disaster triage. their knowledge level
of ethical principles of disaster triage and allocation of scarce resources increased, their tendency to
make ethical decisions also increased (p=0,00). Also, They stayed in ethical
dilemmas that perform cardio-pulmonary resuscitation, manage limited resources
and make decisions to die.

Conclusion:
So
results of this study suggest that more training on disaster triage should be
provided on the areas of the pre-impact phase of disaster. In addition, ethical
dimension of disaster triage should be included in the syllabi of the ethics
classes in the vocational training for healthcare professionals. Drill,
simulations, and board exercises can be used to improve ethical decision making
abilities of healthcare professionals. Disaster scenarios where ethical
dilemmas are faced should be prepared for such applied training programs. 

Anahtar Kelimeler

Disaster Triage, Medical Ethics, Ethical Principles of Disaster Triage, Ethical Decision-Making

Sağlık Profesyonellerinin Afet Triajında Etik Karar Verebilme Durumları: İzmir İli Örneği

Öz

Amaç:
Bu
araştırmanın amacı
İzmir’deki sağlık profesyonellerinin afet triajına ilişkin etik bilgi
düzeylerinin yeterli olup olmadığı ve bunun etik karar verme eğilimlerine etkisini
belirlemektir.

Materyal-Metod:
Veri
toplama aracı olarak bağlayıcı vignette yöntemi ile hazırlanmış olan anket
formu kullanılmıştır. Hazırlanan
anket formları çalışmanın yapıldığı ildeki 112 Acil Sağlık İstasyonları
çalışanları, UMKE ekibi ve AKS-110 ekibinden toplam 215 sağlık profesyoneline
uygulanmıştır. Böylelikle sağlık profesyonellerinin afet triajı yapabilme
yeterlilikleri ve ikilem halinde etik karar verebilme düzeylerini
değerlendirilmiş ve değişkenler ile arasındaki ilişkiler belirlenmiştir.

Bulgular: Araştırma sonucunda katılımcıların
%51,2’sinin afet triajı etik bilgi düzeylerinin yetersiz olduğu tespit
edilmiştir. Katılımcıların afet triajı etik bilgi
düzeyi arttıkça etik karar verme eğilimlerinin de arttığı gözlemlenmiştir
(p=0,00). Katılımcılar, afet triajında ölüm kararı verme, CPR uygulama ve kıt
kaynakların paylaştırılması konusunda etik ikilemde kalmışlardır.

Sonuç:
Öncelikli
olarak afet öncesi hazırlık döneminde afet triajına yönelik eğitimlerin
arttırılması ve sağlık profesyonellerinin mesleki eğitimlerinde almış oldukları
etik derslerine afet triajının etik boyutunun da dahil edilmesi önerilmektedir.
Sağlık profesyonellerinin etik düşünebilme ve etik karar verebilme yetenekleri
yapılan tatbikatlar, simülasyonlar ve masa üstü egzersizlerle
geliştirilmelidir. Hazırlanacak bu uygulamalı eğitimlerde etik ikilemin
yaşanabileceği afet senaryoları yer almalıdır.

Anahtar Kelimeler

Afet Triajı, Medikal Etik, Afet Triajı Etik İlkeleri, Etik Karar Verme

Kaynakça

• 1. Bostick NA, Subbarao I, Burkle FM, Hsu, EB, Armstrong JH, James JJ. Disaster Triage Systems For Large-Scale Catastrophic Events. Disaster Medicine and Public Health Preparedness, 2008; 2(S1): 35-39.
• 2. Lanoix R, Wiener DE, Zayas VD. Concepts in Disaster Triage in The Wake Of The World Trade Center Terrorist Attack. Advanced Emergency Nursing Journal, 2002; 24 (2):60-71.
• 3. Rådestad M, Lennquist MK, Rüter A, Castrén M, Svensson L, Gryth D, Fossum B. Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study. Prehospital And Disaster Medicine, 2016; 31 (4): 1-10.
• 4. Geale SK. The Ethics of Disaster Management. Disaster Prevention And Management: An International Journal, 2012; 21(4): 445 – 462.
• 5. Ranse J, Zeitz K. Disaster Triage. International Disaster Nursing. Cambridge University Press. 2010: 57-79
• 6. T O'Laughlin D, Hick JL. Ethical Issues in Resource Triage. Respiratory Care. 2008; 53(2): 190-200.
• 7. Tännsjö T. Ethical Aspects of Triage in Mass Casualty. Current Opinion in Anesthesiology. 2007, 20 (2): 143-146.
• 8. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York: Oxford University Press, 2001:12-20.
• 9. Good L. Ethical Decision Making in Disaster Triage. Journal of Emergency Nursing. 2008; 34(2): 112-115.
• 10. Carter R. Special Considerations in Disaster Zones. Emergency Medical Services: Clinical Practice And Systems Oversight, Second Edition,USA: Wiley. (2015; 283-287
• 11. Özdemir A. Yöntem Biliminde İleri Araştırma Yöntemleri ve Uygulamalar. İstanbul: Beta Yayıncılık, 2010:122
• 12. Kaya Z, Kaya ON. Öğretmen Eğitiminde Vignette Tekniği ve Uygulamaları. Eğitim ve Bilim Dergisi. 2013; 38(168): 129-142.
• 13. Daniel M. Bedside Resource Stewardship in Disasters: A Provider’s Dilemma Practicing in An Ethical Gap. The Journal Of Clinical Ethics. 2012; 23(4): 331-335.
• 14. Goodman A, Black L. The Challenge Of Allocating Scarce Medical Resourc-Es During A Disaster İn A Low İncome Country: A Case Study From The 2010 Haitian Earthquake. Palliat Med Hosp Care Open J. 2015; 1(1): 24-29.
• 15. Rios CL, Redlener M, Cioe E, Roblin PM, Kohlhoff S, Rinnert S, ... & Arquilla B. Addressing The Need, Ethical Decision Making in Disasters, Who Comes First?. Journal Of US-China Medical Science. 2015, (12): 20-26.
• 16. Ekşi A. Kitlesel Olaylarda Hastane Öncesi Acil Sağlık Hizmetleri Yönetimi. İzmir: KitapAna, 2015.
• 17. Howard PK, Foley AL. Disaster Triage-Are You Ready?. Journal of Emergency Nursing. 2014, 40(5): 515-517.
• 18. Koziel JR, Meckler G, Brown L, Acker D, Torino M, Walsh B, Cicero MX. Barriers To Pediatric Disaster Triage: A Qualitative Investigation. Prehospital Emergency Care. 2015, 19 (2): 279-286.
• 19. Cicero MX, Overly F, Brown L, Yarzebski J, Walsh B, Shabanova V, ...Cone DC. Comparing The Accuracy Of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation. Disaster Medicine And Public Health Preparedness. 2016; 10 (02): 253-260.
• 20. Wagner JM, Dahnke MD. Nursing Ethics and Disaster Triage: Applying Utilitarian Ethical Theory. Journal Of Emergency Nursing. 2015; 41(4): 300-306.
• 21. Schultz CH, Koenig KL. Disaster Preparedness. Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences, 2013; pp: 2457- 2468. http://www.slremeducation.org/wp-content/uploads/2015/02/Chapter-193.-Disaster-Preparedness.pdf, 17.06.2016.
• 22. Mace SE, Mayer TA. Triage. Pediatric Emergency Medicine. Saunders Elsevier. 2008; 1087-1096. https://books.google.com.tr/books?id=4XcatTO8dVUC, 05.01.2016.
• 23. Lanoix R, Wiener DE, Zayas VD. Concepts in Disaster Triage in The Wake Of The World Trade Center Terrorist Attack. Advanced Emergency Nursing Journal. 2002; 24 (2):60-71.
• 24. Pesik N, Keim, ME, Iserson KV. Terrorism and the Ethics of Emergency Medical Care. Annals of Emergency Medicine. 2001: 37(6): 642-646.
• 25. Pou AM. Ethical and Legal Challenges in Disaster Medicine: Are You Ready?. Southern Medical Journal. 2013; 106 (1): 27-30.