Dignity Of Clients Research Articles

Educational needs of midwifery students in medical ethics: A qualitative study.

Background: Ethics education is a basic part of midwifery education program. However, there is no evidence to show that ethics education has been able to meet the educational needs of midwifery students. Purpose: This study aimed to explore the educational needs of students for ethics in midwifery program with a focus on the course of history, ethics, and rules of midwifery. Research design and participants: The present study is qualitative descriptive content analysis research, exploring midwifery students' needs of ethics education in bachelor's degrees. We conducted in-depth semi-structured interviews with 11 undergraduate midwifery students, seven midwives working in hospitals and health centers, and seven midwifery faculty members in Urmia University of Medical Sciences. The participants were selected using a purposeful sampling method and invited to join the study from December 2021 to June 2022. The sampling continued until data saturation. Findings: Content analysis identified four categories and associated subcategories: 1. "The client's rights": respecting the dignity of clients, confidentiality, the client's right to choose and make decisions; 2. "Legal and ethical requirements of fertility": abortion, alternative treatment for infertility, domestic violence; 3. "Communication skills": communication with the client, communication with clients' caregivers and communication with colleagues; and 4. "ethical principles in research": compliance with ethical principles in the research process and ethical principles in publishing research findings. Ethical considerations: The study was approved by the Ethics Committee of Urmia University of Medical Sciences. Before filling the questionnaires, written informed consent was obtained from the participants. The participants were assured of the confidentiality of personal information. Conclusion: The educational needs of midwifery students can be met by providing theoretical and practical training on respecting the pregnant mother, communication skills, legal and ethical aspects of the reproductive period, and incorporating ethical principles in related courses.

Gender diversity in autistic clients: an ethical perspective.

Autonomy and dignity are key ethical principles in psychiatric and psychological codes of ethics. Yet, when working with autistic individuals who are transgender/gender non-conforming (TGNC), non-autistic and cisgender clinicians can unintentionally take away client dignity and autonomy by disbelieving or stigmatizing clients' gender identities. Lack of awareness or discomfort around autism and gender dysphoria can lead clinicians to assumptions and interventions that damage both client rapport and client mental health; discouraging clients from being honest with clinicians about their mental health, and potentially leading to harm. Clinicians must take an intersectional view of their autistic clients' gender identities to reduce stigma and recognize the needs of the whole person. Facilitating access to gender-affirming care is an important part of caring for TGNC clients, including those who are autistic. The authors will discuss the ethical imperative to help autistic clients access gender-affirming care, while discussing common concerns clinicians have when helping autistic clients access this care, as well as the need to believe and support autistic clients when they share their gender identities with clinicians.

Ignorance and Cultural Diversity: the Ethical Obligations of the Behavior Analyst.

Applied behavior analysis (ABA) has featured an increasing concern for understanding and considering the cultural diversity of the populations behavior analysts serve in recent years. As an expression of that concern, the new BACB's Ethics Code for Behavior Analysts is more explicit and comprehensive in its inclusion of ethical obligations concerning cultural diversity. The purpose of this paper is to offer a discussion on the limitations of both our capacity and willingness to know and overcome our ignorance about our own and other cultures. We examine different ways in which our ignorance of other cultures plays out even in willful compliance with the BACB ethics code. We suggest part of the problem is that the BACB ethics code seems to operate under the assumption that practitioners are always aware or can be aware of what they do not know and of their biases. In contrast, we offer a reflection on a more complex picture of our understanding of ourselves and other cultures, where we cannot assume people are aware of what they ignore and of their biases. Ethically, we find that in some cases these blindspots are accounted for by the BACB ethics code and should be foreseen and addressed by the behavior analyst (BA). But in other cases, when a person is not aware of what they ignore, understanding the connection between cultural diversity ignorance and professional behavior requires a different approach. Our analysis suggests an attitude of being thoughtfully diligent and humble while learning about cultural diversity issues and examining the areas where we might be ignorant and not aware of our ignorance. We argue that BAs' obligations to respect the dignity of clients and their families and to provide effective treatment call for this attitude of diligence and humility that goes beyond mere compliance.

'My Bewildering Brain Toils in Vain': Traumatic Brain Injury, the Criminal Trial Process, and the Case of Lisa Montgomery

Individuals with traumatic brain injuries (TBI) have a greater risk of becoming justice-involved due to the role that many TBIs play in impulse control and judgment. Attorneys assigned to represent this cohort may not have encountered individuals with TBI before, and may not be familiar with behavioral manifestations that could be relevant as a defense or as mitigation in individual cases. In this regard, TBI is grossly misunderstood. A grave example of this point, and a foundation for this article, is the case of Lisa Montgomery, who despite evidence of serious mental illness and significant brain damage, was convicted, sentenced to death, and ultimately executed for the murder of a pregnant woman and the kidnapping of the woman’s unborn child. Her case reflects all that is wrong with the way we treat criminal defendants with traumatic brain injuries. In this paper, we discuss common ways that individuals with traumatic brain injuries become involved in the criminal justice system, and how attorneys can better prepare an effective defense or mitigation. We consider, in some depth, several of the substantive areas of criminal law and procedure in which an understanding of TBI is especially significant (including, but not limited to, competency status, the insanity defense and the death penalty), and assess the quality of counsel –and experts -- in such cases, again, in some instances, using the Montgomery case as a prism. We believe that one (at least partial) remedy for the current situation is a turn to therapeutic jurisprudence (TJ) The TJ doctrine emphasizes giving an individual client dignity, voice, validation and voluntariness of action and decision. This is particularly important for an individual with TBI, who will likely have the capacity to make the majority of decisions about his case, but who may still need behavioral treatment or interventions for symptoms of the TBI. We will discuss the ways that TJ plays into these issues, and how TJ must be the grounding of any representation of this population. We conclude with some modest suggestions as to how we can begin to make needed changes in the criminal justice system to take all of these issues into account.

Improving Performance Covertly and Remotely with Tactile Stimulation.

Tactile stimulation can be used to privately prompt or provide feedback for a variety of behaviors. However, technological limitations have primarily resulted in narrow investigations of tactile stimulation delivered on a time-based schedule by a device like a MotivAider or WatchMinder. Recent advances in smartphone and watch technologies have created new ways for practitioners to deliver tactile stimulation privately and remotely to improve behavior. The purpose of this Brief Report is to provide a case study and a description of the advantages and applications of utilizing this technology, including preserving the privacy and dignity of clients by covertly improving performance; prompting behavior based on environmental events independent of scheduled times; delivering feedback quickly, quietly, and remotely without interrupting interactions; and fading dependencies on tactile prompting and feedback.

Promoting Dignity and Preventing Shame and Humiliation by Improving the Quality and Education of Attorneys in Sexually Violent Predator (SVP) Civil Commitment Cases

In Strickland vs. Washington, the Supreme Court acknowledged that the role of counsel is critical to the ability of the adversarial system to best insure that just results are produced. Yet, the Court did not elaborately define the Sixth Amendment constitutional right to counsel and lower courts, have set the bar shockingly low.In this article we examine the quality of attorneys who litigate Sexually Violent Predator Act (SVPA) cases, and conclude that a failure to apply a higher standard of adequate counsel – beyond what was set out in Strickland – results in humiliation, shame and lack of dignity for clients. Effective and competent counsel must be cognizant of how shame and humiliation corrupts our legislation, court proceedings and subsequent management of the sex offender population.We explore the concepts of shame and humiliation and how the effects of these concepts damage not only the client, but the integrity of the court proceeding and subsequent goals of treatment rehabilitation. We focus on the volatile “arranged marriage” of law and psychology in sex offender civil commitment cases that require attorneys to have a particular set of skills and knowledge in order to conduct a fair, judicious and ethical trial, and to secure an accurate verdict. This is necessary to not only preserve the dignity of the legal system but additionally preserve the dignity of clients facing – what is most likely considered – one of the most undignified adjudicative determinations: that of “sexual violent predator. We propose that without specialized training and expert collaboration, attorneys cannot provide even remotely adequate or effective representation.We consider these issues through the prism of therapeutic jurisprudence, which we believe is vital to any authentic understanding of the underlying issues and offer suggestions to prevent and minimize client shame, humiliation and lack of dignity (including sample dialogues that counsel might have with her client).

Responding to Domestic Minors Sex Trafficking (DMST): Developing Principle-Based Practices

ABSTRACTOver the last decade, modern slavery has emerged as a major social-justice issue. Many new organizations in the United States have begun serving survivors of domestic minor sex trafficking (DMST), while others have expanded their services to include this vulnerable population in their mission. This qualitative study describes the principle-based practices that emerged from structured interviews with staff employed at five well-established organizations in the United States whose missions include providing direct services to DMST survivors. Thematic analysis identified five guiding principle-based practices for working with DMST survivors: nurture the humanity and dignity of clients; contextualize the needs of survivors within a broader social-justice framework; prioritize the immediate and practical needs of clients; support of the dynamic nature of survivors’ healing; help identify and engage community and professional partners who are essential to the work of serving DMST survivors and ending sex trafficking. This research enhances the field’s understanding of principle-based practice with DMST survivors and encourages those working with DMST survivors to critically consider the principles behind their practice. The findings are particularly important given complex vulnerabilities and needs, and the significant rise in the number of untrained organizations providing services to survivors.

Case Management Ethics: High Professional Standards for Health Care's Interconnected Worlds.

The purpose of this discussion is to draw attention to the considerable pressure on professional case managers today to coordinate with multiple stakeholders, with responsibilities that put them at the forefront of contact with payers and providers. This discussion raises awareness of how case managers, and board-certified case managers in particular, must demonstrate that they adhere to the highest ethical standards, as codified by the Commission for Case Manager Certification's Code of Professional Conduct for Case Managers. This discussion applies to case management practices and work settings across the full continuum of health care. As advocates for clients (individuals receiving case management services) and their families/support systems, case managers must adhere to the highest of ethical and professional standards. The Code of Professional Conduct for Case Managers is an indispensable resource for case managers to ensure that they place the public interest above their own, respect the rights and inherent dignity of clients, maintain objectivity in their relationships with clients, and act with integrity and fidelity with clients and others, as stipulated by the code.

Respect for dignity and forensic psychiatry

Respect for persons is one of forensic psychiatry's ethical principles. It is a principle that is usually laid down without conditions, raising the question of what aspect of someone's “personhood” might deserve our unconditional respect. This paper nominates dignity. One argument against respect for dignity as a principle is that anything it stands for can be subsumed into respecting people's autonomy. This seems not to be correct. Another argument has been that the term dignity has too often been used loosely and vaguely. This does not mean that the term itself is necesarily without value. Dignity seems to refer to something close to the moral meaning of “worth”. Respecting dignity has a role in protecting the vulnerable. Respecting a client's dignity is an important aspect of the ethical practice of forensic psychiatry.

Evaluating the Effects of Intimate Touch Instruction: Facilitating Professional and Respectful Touch by Male Nursing Students

Nurses are expected to touch areas of patients' bodies that are considered private and emotionally sensitive (intimate), yet little is known about how nursing students learn, rehearse, and incorporate appropriate touch strategies. Although touch education is important to all nurses, male students face additional challenges due to gender roles and negative stereotypes. The purpose of this quasi-experimental pilot study was to evaluate whether a 3-hour intimate touch instructional laboratory with subsequent clinical experience (intervention group) facilitated male students' development of intimate touch knowledge, skills, and attitudes, compared with having only clinical experience and no laboratory (control group). Findings revealed that intervention group participants were significantly more comfortable with cleansing genitalia, less apprehensive about touch being misperceived as sexual, reported less gender requirement rigidity, and scored significantly higher on measures associated with client dignity, comfort, and respect than control group participants in a simulated perineal hygiene demonstration.

Pathways and Barriers to Care for LGBT Veterans in the U.S. Department of Veterans Affairs (VA)

To assess the perceived needs of lesbian, gay, bisexual, and transgender (LGBT) Veterans when they engage in counseling services through the Veterans’ Health Administration (VHA), psychologists working in VHA were reached through an online survey as well as an open-ended question that asked psychologists to offer their thoughts about the needs of LGBT Veterans in VHA and current VHA resources. Their answers were content analyzed to determine what lessons can be learned from their experiences with LGBT Veterans in the VHA system. Four major themes emerged: Concern about the current culture of the medical facilities as a whole (Veterans, staff, environment), concern for the safeguarding of privacy and dignity of clients through the electronic medical record when writing counseling progress notes, need for training of counselors, and need for resources for counselors and Veterans.

Addressing the Spiritual Needs of People Infected With and Affected by HIV and AIDS in Swaziland

Researchers seem to be in agreement that spirituality is an important component of the holistic care approach commonly found in palliative care. Shiselweni Home-Based Care (SHBC) is a faith-based organization in Swaziland working among people with HIV and AIDS in the poorest and most affected areas of the country. They endeavor to restore and build up each client's dignity through the way in which they are approached, not only when giving physical assistance, but also when they address their spiritual needs. This article emphasizes the need for spiritual care as part of the caregiving program and then also illustrates the positive feelings of both the SHBC caregivers as well as their clients as they share some of the experiences encountered during spiritual care.

A sense of people’s worth

It is vital that nursing students understand and promote the concept of patient dignity, writes Milika Matiti Read More: http://rcnpublishing.com/doi/abs/10.7748/ns2012.08.26.52.64.p9221 The International Council of Nurses urges all healthcare professionals, including students, to promote patient or client dignity. In the UK this position is endorsed in the Nursing and Midwifery Council’s code of conduct, performance and ethics.

A sense of people’s worth

It is vital that nursing students understand and promote the concept of patient dignity, writes Milika Matiti Read More: http://rcnpublishing.com/doi/abs/10.7748/ns2012.08.26.52.64.p9221 The International Council of Nurses urges all healthcare professionals, including students, to promote patient or client dignity. In the UK this position is endorsed in the Nursing and Midwifery Council’s code of conduct, performance and ethics.

Couples with Schizophrenia “Becoming like Others” in South Korea: Marriage as Part of a Recovery Process

Very little is known about the married life of couples with schizophrenia. In this paper, authors report perceptions and experiences of 5 married couples with schizophrenia on their strategies in forming and maintaining healthy marriage. Our data reveal that participants had realistic expectations of marriage, and recognized benefits as well as obstacles in their marriages with respect to their recovery. This paper examines the importance of extended family members, mental health professionals, and the larger society's attitudes toward marriage as a factor in the recovery process for persons with schizophrenia. The authors identify implications for mental health professionals regarding the respect of client dignity and the applicability of a strengths perspective when working with couples with schizophrenia. The authors argue that mental health professionals' decisions regarding the balance between respecting a client's self-determination and protecting a client from risks associated with cohabitation and marriage should no longer be a dilemma for those working with people with mental illness.

When Clients Sense the Presence of Loved Ones Who Have Died

The continued bonds between bereaved individuals and the deceased are central to the process of mourning. One challenging form of continuing bond is that in which the mourner senses the actual presence of the deceased--i.e., seeing one's deceased husband at the kitchen counter. Some see this experience as a sign of pathology while others see it as a normal, healthy aspect of grief and mourning. Twenty-one social workers shared their experiences in addressing this issue with clients. Despite conceptualizing this experience in a variety of ways, they all grounded their interactions with clients around this issue on the fundamental social work value of respecting the client's dignity and experience. Their experiences and insights may be useful to other practitioners.

Confidentiality

Confidentiality was the ethical dilemma most frequently encountered by Israeli social workers in a 1998 national survey (Linzer, Conboy and Ain, 2002). A reanalysis of survey responses found the social workers cared about preventing violations of client privacy, promoting client self-determination, and respecting client dignity, especially when challenged by: (1) public institutions' right to know, (2) limitations of protection of client communications and information, including duty to warn, (3) child and family dilemmas, (4) informed consent ambiguities, and (5) computers and technology utilization. Social workers looked to their own counsel, colleagues, and supervisor's advice and their professional code of ethics for guidance.

A Foreword of Thoughts

With the help of colleagues, I became interested in welcoming a group of authors to write on the topic of “process ethics.” This view of ethics transcends traditional ideas about ethics and the politics of modernistic empiricism of our field today. Process ethics explores instead the social construction of ethics that is local to the therapeutic process and relationship between the client and therapist. This relationship focuses on what is “good and proper” or ethical, based on the voice of the client as consumer, and the therapist as partner and participator. Ethics, considered from this position, centers on therapeutic endeavors that directly represent clients’ voices and desires for change. Within process ethics, clients are viewed foremost as the experts in what they view as problem and change. The client, as consumer, defines with the therapist what characterizes ethical standards and clinical proficiency. Process ethics serves to supplement traditional content ethics. Content ethics represents standardizations to protect the integrity and dignity of clients. Process ethics looks to communally agreed upon values and actions that the therapist and client mutually create. The opportunity to pull together a special section on process ethics continues my informal and formal inquiry into what generates ethical actions to occur in therapy, and what mental health providers can do to facilitate and sustain them. The following presentations, three brief commentaries and two extensive articles, reflect these ideas. When first reading the manuscripts that address the subject of process ethics, I was struck by the metaphor of a pebble skipping upon calm water. It was

(Er)Race-ing an Ethic of Justice

For several years, I have pursued a project devoted to the study of race, lawyers, and ethics in the American criminal justice system. Building on the evolving jurisprudence of Critical Race Theory, the project spans a series of case studies investigating the rhetoric of race, or race-talk, in the prosecution and defense of racially motivated violence. The first work of the series examines the rhetoric of race in cases of black-on-white racially motivated violence, highlighting the self-subordinating, racialized defense of Damian Williams and Henry Watson on charges of beating Reginald Denny and others during the 1992 South Central Los Angeles riots. The next work inspects racial rhetoric in cases of white-on-black racially incited violence, extrapolating other-subordinating, racialized defense strategies from the criminal and civil trials of the United Klans of America and several Ku Klux Klan members in the 1981 lynching of Michael Donald in Mobile, Alabama. A third work analyzes the discursive and symbolic meaning of race in double trials involving successive state criminal and federal civil rights prosecutions, citing the trials of Lemrick Nelson and Charles Price arising out of four days of interracial violence in the Crown Heights section of Brooklyn, New York in 199L. A forthcoming work explores the federal criminal prosecution of five white New York City police officers on charges of physically and sexually assaulting Abner Louima, a young Haitian immigrant, at a Brooklyn station house in 1997. The purpose of this ongoing project is to understand the meaning of racial identity, racialized narrative, and race-neutral representation in law, lawyering, and ethics. To that end, the case studies serve as a means to develop working hypotheses regarding the sociolegal experience of subordination: specifically, the subordinating discourse and imagery of race trials, the nature of client and community harm caused by such subordination, the colorcoded partisanship of purportedly race-neutral ethics regimes that countenance such subordination, and the legitimacy of alternative race-conscious ethical regulation. The process of reworking these hypotheses, one hopes, will not only reveal the sociolegal structures of racial violence in American history, but also reconstruct dominant visions of racial dignity and community in American law. The reconstructive nature of this project derives in part from the teachings of Critical Race Theory and the emerging voices of color in Asian-Pacific and LatCrit scholarship. Unlike traditional canons of colorblind or color-coded representation, the vision of practice underlying this growing jurisprudential movement implies an ethic of good lawyering based on a color-conscious, contextual approach to civil and criminal advocacy. Still formative, the approach strives to accommodate the identity interests of client dignity and community integrity and, at the same time, to heed the injunction of effective representation. The centrality of context to this approach lends added significance to the celebrated publication of William Simon's The Practice of Justice: A Theory of Lawyers' Ethics. Together with the new wave quartet of Robert Gordon, David Luban, Deborah Rhode, and David Wilkins, Simon stands among the preeminent scholars in legal ethics, singular in his deft integration of critical theory into the study of the legal profession. Simon's trenchant critique of the profession and its jurisprudential underpinnings gives direction to second wave projects like the one at hand. Indeed, The Practice of Justice provides a normative framework for designing race-conscious, community regarding duties of legal representation. Instead of simply rehearsing Simon's critique and casting objections against it, this essay endeavors to put Simon's book to work in the service of fashioning an ethic of representation in race cases. The essay is divided into four parts. Part I outlines Simon's jurisprudential critique and revision of liberal ethics regimes. Part II describes a postliberal vision of ethics tied to race-consciousness and racial community. Part III contemplates the practicalities of institutionalizing a race-conscious, community ethic of representation. Part IV parses and responds to theoretical objections to a race-conscious regulatory regime.

Health Care Decision-Making for Incapacitated Elders:An Innovative Social Service Agency Model

Jewish Family Service of Worcester, Inc. has been assuming legal guardianship of adjudicated incompetent elders since 1982. In past ten years, it has developed a model of social service agency guardianship that incorporates the social work goals of client advocacy, respect for client dignity, and the right of self-determination. Within the guardianship program, a process for medical decision-making for incapacitated elders has been developed. The program promotes a team approach to the "substituted judgment" and "best interests" models of decision-making and includes ethical considerations and client/family preferences.