Module Eight: Suffering, Quaternary Prevention, Ethics in Chronic Illness Situations
This module introduces quaternary prevention and addresses the role of nurses in situations where individuals and families may be suffering
.
Principles of ethics are revisited as related to suffering and the nursing role.
Module Objectives
1. Discuss types of suffering.
2. Address the role of nursing in situations of suffering.
3. Introduce quaternary prevention as it relates to nursing practice.
4
. Apply the Code of Ethics for Nurses with Interpretive Statements in situations of suffering.
5. Consider informed risk, autonomy, beneficence, and nonmaleficence in difficult situations.
Required resources and reading assignments:
Required videos linked into this module
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.).
(available free through the SMSU McFarland Library e
–
books:
https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk
&AN=2935865&scope=site
Focus on Standard 8
American Nurses Association (2015)
. Code of ethics for nurses: With interpretive statements. Silver
Spring, MD: ANA.
http://ssuproxy.mnpals.net/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&
AN=1021757&scope=site
Martins, C., Godycki-Cwirko, M., Heleno, B., & Brodersen, J. (2019). Quaternary prevention: an evidence based concept aiming to protect patients from medical harm. British Journal of General Practice, 69(689), 614–615.
https://doi
–
org.ssuproxy.mnpals.net/10.3399/bjgp19x706913
Martins, C., Godycki-Cwirko, M., Heleno, B., & Brodersen, J. (2018). Quaternary prevention: reviewing
the concept. European Journal of General Practice, 24(1), 106–111.
https://doi
org.ssuproxy.mnpals.net/10.1080/13814788.2
017
.1422177
Nagano, H., Chida, K., & Ozawa, T. (2022). Can We Be at Peace With Unsolvable Suffering? A Qualitative Study Exploring the Effectiveness of Supportive Communication and Resilience Building. Journal of Hospice & Palliative Nursing, 24(3), E76–E82.
https://doi
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org.ssuproxy.mnpals.net/10.1097/NJH.0000000000000852
Norman, A. H., & Tesser, C. D. (2019). Quaternary prevention: a balanced approach to demedicalisation. British Journal of General Practice, 69(678), 28–29.
https://doi
–
org.ssuproxy.mnpals.net/10.3399/bjgp19X700517
Palliative and Supportive Care at the End of Life: Reducing Suffering, Enhancing Meaning, and
Improving the Quality of Life. (2021). Journal of Oncology Navigation & Survivorship, 12(10), 360–361.
https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&
AN=153038018&scope=site
Potter, M.L., & Wynne, B.P. (2015). Loss, Suffering, Bereavement, and Grief. In M. Matzo & D.W.
Sherman (Eds.), Palliative care nursing:
Quality care to the end of life (4th ed., pp. 205 – 234).
Springer Publishing Company.
https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=e680s
ww&AN=801728&lang=en%2cen&scope=site
Tarzian, A.J., & Schwarz, J.K. (2015). Ethical Aspects of Palliative Care. In M. Matzo & D.W. Sherman (Eds.), Palliative care nursing:
Quality care to the end of life (4th ed., pp. 33-60).
https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=e680s
ww&AN=801728&lang=en%2cen&scope=site
Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical Principles &
Practice, 30(1), 17–28.
https://doi
-o
rg.ssuproxy.mnpals.net/10.1159/000509119
OPTIONAL readings
Alber, K., Kuehlein, T., Schedlbauer, A., & Schaffer, S. (2017). Medical overuse and quaternary prevention in primary care — A qualitative study with general practitioners. BMC Family Practice, 18, 1–13.
https://doi
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org.ssuproxy.mnpals.net/10.1186/s12875
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017
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0667
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4
Bolton, L. E., Seymour, J., & Gardiner, C. (2022). Existential suffering in the day to day lives of those living with palliative care needs arising from chronic obstructive pulmonary disease (COPD): A
systematic integrative literature review. Palliative Medicine, 36(4), 567–580.
https://doi
org.ssuproxy.mnpals.net/10.1177/02692163221074539
Derrington, S. (2021). Justice and the Ethical Response to Suffering. American Journal of Bioethics, 21(1), 73–75.
https://doi
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org.ssuproxy.mnpals.net/10.1080/15265161.2020.1850910
Duffee, C. (2020). What really is the nature of suffering? Three problems with Eric Cassell’s concept of distress. Bioethics, 34(7), 695–702.
https://doi
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org.ssuproxy.mnpals.net/10.1111/bioe.12748
.
Hofmann, B. (2021). How to Draw the Line Between Health and Disease? Start with Suffering. Health
Care Analysis,29(2),127–143.
https://doi
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org.ssuproxy.mnpals.net/10.1007/s10728
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021
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00434
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0
Lee, E., & Kim, Y. (2021). Caregivers’ psychological suffering and posttraumatic growth after patient
death. Perspectives in Psychiatric Care, 57(3), 1323–1330.
https://doi
org.ssuproxy.mnpals.net/10.1111/ppc.12693
(this addresses suffering of nurses)
Seng Beng, T., Ting Ting, T., Karupiah, M., Xin Ni, C., Li Li, H., Chong Guan, N., Ee Chin, L., Chee Loong, L., & Maw Pin, T. (2021). Patterns of Suffering in Palliative Care: A Descriptive Study. Omega:
Journal of Death & Dying, 84(2), 512–524.
https://doi
org.ssuproxy.mnpals.net/10.1177/0030222820903221
Takla, A., Savulescu, J., & Wilkinson, D. J. C. (2021). A conscious choice: Is it ethical to aim for
unconsciousness at the end of life? Bioethics, 35(3), 284–291.
https://doi
org.ssuproxy.mnpals.net/10.1111/bioe.12838
Graded Assignments: Focused reflection assignment
After viewing the videos by Dr. Gwande and a minimum of two Finding Hope videos (the videos are linked into the module and most videos are less than seven minutes long), and reviewing required resources (you may certainly find more evidence if you wish), respond to the following questions, adhering to the rubric found in Appendix C. Submit your responses to the assignment box.
1) Reflect on what nurses can do when individuals and families are living with suffering. Include a minimum of two citation/reference pairs in your response.
2) Review Standard 8 in the ANA: Nursing Scope and Standards of Practice. How does the role of advocacy fit with Quaternary Prevention?
3) Reflect on quaternary prevention. How does quaternary prevention ‘fit’ with Dr. Gwande’s views?
4) How does ‘informed risk’ fit with decision making?
5) Reflect on the ethical principles of autonomy, beneficence, and maleficence. How to they ‘fit’ in situations of chronic illness?
For the future
Dr. Atul Gwande is a prominent neurosurgeon whose perspective on death and dying changed when his own father was diagnosed with cancer. Dr. Gwande’s work has been very well received and recognized over the last few years. When you have a bit of free time (maybe between semesters), I strongly recommend reading his book titled
Being Mortal: Medicine and What Matters in the End – well worth your time!
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