Bridging Impasses Between Nurses and Providers.

Hospital pharmacists' ethical exposure and decision-making.

Ethical decision-making in school administration has received considerable attention in educational leadership literature. However, most research has focused on principals working in secondary school settings while studies that explore ethical reasoning processes of academic deans have been significantly few. This qualitative study aims to describe the ethical decision-making processes employed by a select group of Filipino college deans in solving ethical dilemmas using the ethical paradigms proposed in the works of Starratt (Educ Adm Q 27:185–202, 1991) and Shapiro and Stefkovich (Ethical leadership and decision-making in education: applying theoretical perspectives to complex dilemmas, 2005) as frameworks for the analysis. Data was gathered using semi-structured interviews and field text was analyzed using deductive thematic analysis. Findings of this study show that majority of the deans chose to share ethical dilemmas involving students and teachers. The findings also show the ethical frameworks of care, justice, and profession as the dominant paradigms utilized by Filipino deans and their preference for adopting multiple ethical frameworks when making their decisions. Most of the ethical dilemmas which the deans narrated relate to their tasks of academic administration such as monitoring student performance, faculty evaluation and maintaining school discipline. Interestingly, only a few dilemmas involving university administrators were expressed, and dilemmas that refer to broader societal issues usually associated with school administrators’ utilization of the ethic of critique were also significantly left out in the narratives of this study. This paper intends to contribute to current literature by expanding research to administrators working in the context of higher education in the Philippine setting. The findings of this study could serve as knowledge base in designing ethics courses to enhance educational leaders’ ethical decision-making skills. The study also provides useful insights of ethical decisions and reasoning processes employed by academic administrators in resolving real life ethical dilemmas that could be useful at the practical level for aspiring and practicing deans.

Ethical decision-making is the process which make choices based on ethical principles and values. Several decision-making frameworks have been developed utilizing ethical principles and guidelines for nurses to assist in ethical decision-making. Each framework directs ethical considerations from a distinct point of view. In this light, this study aimed to identify the ethical problems and describe the application of decision-making models in nursing practice. A literature search, ranging from 2000 to 2022, was conducted using the keywords “ethical decision-making models”, “clinical practice”, and “nursing” on electronic databases, Google Scholar, PubMed, Science Direct and CINAHL. Twenty-four (24) articles were selected for analysis. Three categories of ethical issues were identified, namely healthcare team member-related issues, patient-related issues, and caring behavior-related issues such as ethical conflicts. Four main factors (external factors, individual factors, environmental factors and facilitating strategies) which affect ethical decision-making were identified. The literature chosen for the study highlights four decision-making models: the clinical nursing accountability cycle model, the integrated ethical decision-making model, the integrated ethically driven environmental model, and the MORAL model. Nurses encounter numerous ethical challenges with patients and colleagues, underscoring the importance of sound ethical decision-making. Individual, environmental, and external factors, as well as facilitating strategies, influence their ethical decisions. Nurses frequently utilize ethical decision-making models to support their practice, emphasizing the need for updated models to improve their capabilities and address ethical dilemmas effectively.

Special Report: Ethical Decision-Making in Contemporary Psychiatric Practice—An Evolving Challenge

The author, head of a teaching hospital surgical unit, argues that the medical curriculum must ensure that all students are exposed to a minimum of ethical discussion and decision-making. In describing his own approach he emphasises the need to show students that it is 'an intensely practical subject'. Moreover, he reminds them that moral dilemmas in medicine--perhaps a better term than medical ethics--are unavoidable in clinical practice. Professor Johnson emphasises the need for small group teaching and discussion of real cases, preferably chosen and 'worked up' by individual students. He suggests that ethical issues could profitably be introduced into written, oral and clinical examinations.

When Chinese social workers face ethical dilemmas, responsibilities, and obligations conflict, how to make ethical decisions. The aims of this study include demonstrating the ethical dilemma that social workers and resource master confront when they collaborate in Chinese culture. It uses Reamer's ethical decision-making model to explore the ethical decision-making process of Chinese social workers and discuss social workers' ethical choices about whistle-blowing and human relationships. This paper applies the case of social work services for the disabled in Taiwan to analyze and research. The conclusions of this paper are the ethical value judgment and decision-making of social workers; the process of whistle-blowing, and the moral courage and practice of social workers. It is hoped that the discussion in this paper will provide a reference for the ethical decision-making of social workers in the Chinese mainland.

During pandemics, there are considerable ethical dilemmas. It is imperative that nurses are involved in ethical decision-making bringing nursing theory, practice and perspectives to better advocate for patients. In order to prepare nurses to be partners in ethical dilemma decision-making during pandemics, it is vital to understand the extent that nurses are involved in such decision-making during the COVID-19 pandemic. The purpose of this concept analysis is to identify nurse involvement in ethical decision-making during pandemics. Concept analysis methodology based on literature searches used bibliographic databases: PubMed - 20 papers; Google Scholar - 8120 papers; EMBASE - 25 papers; Science Direct - 246 papers and hand searches. Nurse involvement in ethical decision-making during pandemics focused on nurses' physical and emotional stress, communication challenges, saturation and collapse of limited resources and allocation of scarce resources. Additional dilemmas included, changing nature of nurses' relationships with patients and families, questionable ethical equipoise preforming COVID-19 research, triage patient decisions receiving scarce resources, partner participation during labour and delivery and end-of-life decisions. In order to protect and sustain nurses' well-being and competency, nurses should establish a framework for nurses' involvement in ethical policy development in emergencies, pandemics, education and preparedness and decision-making to be able to deal with public health emergencies.

This study explores the transformative learning experiences of nursing students during community health practicums, focusing on how these experiences shape their understanding and professional development in healthcare settings. Grounded in Mezirow’s transformative learning framework, this qualitative study employs Interpretative Phenomenological Analysis (IPA) to examine participants’ lived experiences, particularly their emotional and ethical challenges in real-world healthcare environments. Eighteen final-year nursing students, selected for their involvement in community health practicums, participated in semi-structured interviews. The participants, aged 19–21 years (with an average age of 20.68 years), comprised predominantly female students (88.88%). These students were chosen based on their exposure to complex healthcare challenges within the community healthcare context. The study identified four key themes. The first theme, Emotional Dilemmas Requiring Empathy and Professionalism, explores how students faced emotionally intense situations and developed essential emotional regulation skills. This theme highlights their ability to balance empathy with professionalism and navigate family disagreements in care decisions. The second theme, Ethical Dilemmas in Patient Care, addresses the ethical challenges students encountered, including decisions related to patients with limited recovery potential and respecting patients’ autonomy when they declined treatment. Through these experiences, students refined their ethical reasoning and decision-making capabilities. The third theme, Navigating Roles and Responsibilities within Community Healthcare Teams, examines how students clarified their roles within multidisciplinary teams, improving their communication and collaboration skills. This theme emphasizes the growth in confidence and adaptability as students engaged in team-based care. The fourth theme, Resource Allocation Ethics in Community Healthcare, discusses the challenges posed by resource limitations. Students developed critical thinking and adaptability as they navigated ethical dilemmas related to resource constraints, particularly in home visits and access to care. Through these experiences, students critically reassessed their beliefs, refined their ethical decision-making, and developed emotional intelligence and problem-solving strategies. Reflective practices, including journaling, played a key role in bridging theoretical knowledge with experiential insights, further enhancing adaptability and relational understanding. The findings underscore the significance of integrating transformative learning principles into nursing education. Structured experiential and reflective practices foster critical thinking, emotional regulation, and interprofessional collaboration, thereby preparing nursing students to address the challenges of contemporary healthcare with professionalism and ethical integrity.

Influence of empathy and professional values on ethical decision-making of emergency nurses: A cross sectional study

The relationship between moral sensitivity and professional values and ethical decision-making in nursing students

With the advancement of Chinese teacher ethics, the significance of professional ethics among kindergarten teachers has gained prominence. Early childhood professional practice encompasses intricate ethical dilemmas that teachers must promptly identify and address. Consequently, the ability to make ethical decisions has become a crucial skill in teachers’ professional ethical practice. This study investigates the ethical dilemmas and decision-making of Chinese kindergarten teachers (N = 19) through semi-structured interviews and non-participant observation in a specific kindergarten setting. The findings reveal that Chinese kindergarten teachers face ethical dilemmas that revolve around four main themes: matters related to teacher’s work, matters related to parental expectations and requirements, matters related staff’s behaviour, conflicts between common rules. Chinese kindergarten teachers’ ethical decision-making can be categorised into four main types: inadvertently ignoring or giving less consideration, avoiding, delegating, and dialogue. Given China’s current focus on strengthening teacher ethics at the policy level, the results of this research hold significant reference value for enhancing the quality of teacher-child interaction and teachers’ ethical standards.

Due to the insufficient education of medical ethics and tending to medical moral education, the residents lack the ability to make ethical decisions. Therefore, we applied Four Topics method in the clinical ethics training of residents. The clinical ethics training was divided into three stages, and each stage had different training content and objectives. Dongyang People's Hospital adopted the form of lectures and panel discussions. During the group discussion, the group leader was in charge of case preparation, which came from clinical practice, and then all members applied the Four Topics method to analyze and discuss the ethical conflicts, and make the ethical decision. Through this process, residents' ability to solve ethical problems in clinical practice was enhanced. Key words: Four topics method; Clinical ethics; Ethical decision; Standardized resident training

Decisions in the Gray Zone: Evidence-Based or Culture-Based?

BackgroundThe integration of Artificial Intelligence (AI) in nephrology has raised concerns regarding bias, fairness, and ethical decision-making, particularly in the context of Diversity, Equity, and Inclusion (DEI). AI-driven models, including Large Language Models (LLMs) like ChatGPT, may unintentionally reinforce existing disparities in patient care and workforce recruitment. This study investigates how AI models (ChatGPT 3.5 and 4.0) handle DEI-related ethical considerations in nephrology, highlighting the need for improved regulatory oversight to ensure equitable AI deployment.MethodsThe study was conducted in March 2024 using ChatGPT 3.5 and 4.0. Eighty simulated cases were developed to assess ChatGPT’s decision-making across diverse nephrology topics. ChatGPT was instructed to respond to questions considering factors such as age, sex, gender identity, race, ethnicity, religion, cultural beliefs, socioeconomic status, education level, family structure, employment, insurance, geographic location, disability, mental health, language proficiency, and technology access.ResultsChatGPT 3.5 provided a response to all scenario questions and did not refuse to make decisions under any circumstances. This contradicts the essential DEI principle of avoiding decisions based on potentially discriminatory criteria. In contrast, ChatGPT 4.0 declined to make decisions based on potentially discriminatory criteria in 13 (16.3%) scenarios during the first round and in 5 (6.3%) during the second round.ConclusionWhile ChatGPT 4.0 shows improvement in ethical AI decision-making, its limited recognition of bias and DEI considerations underscores the need for robust AI regulatory frameworks in nephrology. AI governance must incorporate structured DEI guidelines, ongoing bias detection mechanisms, and ethical oversight to prevent AI-driven disparities in clinical practice and workforce recruitment. This study emphasizes the importance of transparency, fairness, and inclusivity in AI development, calling for collaborative efforts between AI developers, nephrologists, policymakers, and patient communities to ensure AI serves as an equitable tool in nephrology.

Background: Ethical analysis frameworks can help to identify the ethical dimensions to clinical care and provide a method for justifying clinical decisions. Published frameworks, however, have some limitations to easy, practical use.Aims: The aim was to identify a comprehensive yet easy-to-use framework that clarifies ethical decision-making, suitable for use by medical learners and clinical educators.Method: A literature search identified published frameworks that define the components of ethical clinical decision-making. On this basis, a new framework, the ‘CoRE-Values Compass and Grid’ was constructed. This was formally evaluated during a medical school interprofessional teaching session.Results: For 88% of 228 medical and nursing students, the new framework was easy to understand; 85% reported it as easy to use. The framework improved awareness of the ethical dimensions to a clinical scenario for 97% of students and the ability to systematically identify ethical aspects for 83%. Students and instructors reported that the framework helped to link ethics theory with clinical practice. The framework was described as a useful educational tool by 85% of students and 95% of instructors.Conclusions: The ‘CoRE-Values Compass and Grid’ is a new framework, shown to aid the systematic identification and consideration of ethical aspects to clinical cases.