Ethical Issues In Practice Research Articles

Unmet Needs for Clinical Ethics Support Services in Nurse: Based on focus group interviews.

As nurses' ethical competence in their own fields is essential, clinical ethics support services help nurses improve ethical competence. The purpose of this study was to identify the unmet needs of ethical support for nurses in clinical settings and explore the differences by nursing units. Focus group interview design was applied. Participants and research context: Data were collected via four rounds of focus group interviews with 37 nurses at intensive care units, medical-surgical units, emergency departments and oncology units. Major questions were as follows: 'What is nurses' experience of ethical difficulties while working as a clinical nurse?' and 'What kinds of clinical ethics support services do nurses require in different clinical settings?' Inductive content analysis was performed to analyse the data. Ethical considerations: Ethical approval was obtained from the institutional review of board at the College of Nursing. Five categories (with 14 subcategories) were identified: difficulty providing evidence-based care, lack of support in maintaining patients' and family members' dignity, insufficient education regarding clinical ethics, loss of professional self-esteem and expectations concerning organizational support. Nurses' desire for ethical support varied according to department. Nurses face both practical and existential ethical issues that require rapid solution each day. There is a need for ethical counselling to prevent compassion fatigue and identify means via which nurses reflect on their daily lives in their own fields. In-house training should be provided for each unit, to improve ethical competence and facilitate the development of pragmatic, sensible solutions.

Ethics in Perinatal Medicine

Background: The current trend in perinatal medicine addresses the challenge posed to newborn survival by newborn prematurity and other morbidities requiring neonatal newborn intensive care. These ethical concerns span through the spectrum of education, clinical practice and research, domicile in obstetrics and neonatology. Effective application of ethics to perinatal medicine requires basic knowledge bioethics in health care and medical research.Objectives: The objective of the article is to highlight the basic aspects of ethics, review research ethics and practical ethical issues in perinatal medicine and provide an analytical application of the principles involved in bioethics.Methodology: A search for the relevant literature available on the internet, journal publications, textbooks and monographs was conductedResult: The basics of ethics span through the definition of medical ethics, ethical codes and bioethics. It also includes the various bioethical orientations (historical, duty-based, utilitarian, feminist, casuistry, communitarian and virtue orientation), together with the guiding principles of modern bioethics and their levels of application (micro-ethical, macro-ethical, meso-ethical and mega-ethical level). Research ethics developed tremendously during the 20th century and it was boosted by a number of regulations such as Nuremberg code, CIOMS, Helsinki declaration, Belmont Report and the Nigerian National Code of Health Research Ethics. Ethics in perinatal medicine focus on medical decision making and foeto-maternal conflict as well as the concept of a foetus as a patient and medical futility. It includes prenatal diagnosis and interventions for severe congenital malformations of the foetus, safe mother hood and cord blood collection and newborn care.Conclusion: Bioethics is an important component of perinatal medicine. The consideration and application of bioethics in all aspect of perinatal medicine will undoubtedly improve the quality of care for obstetric patients and their newborn infants.

Ethical Issues in Maternal and Child Health Nursing: Challenges Faced By Maternal and Child Health Nurses and Strategies for Decision Making

Background: Health care givers, particularly midwives, perinatal and neonatal nurses, face ethical issues possibly because of their interactions with patients and clients in the reproductive age groups. These issues are multiple and quite complex. Aim: To identify the ethical issues related to maternal and child care, the challenges faced by the nurses and to profer strategies for decision making. Methods: This is a literature review on ethical issues in maternal and child health nursing, challenges faced by maternal and child health nurses and strategies for decision making. Literatures related to the topic was gathered from pertinent literature, completed research works and published articles retrieved from searches of computerized databases and their findings were discussed. Findings: It was observed that maternal and child health nurses are usually faced with the problems of decision making in dealing with ethical issues in practice. It is either they make a wrong decision, delay decision making or fall in a state of dilemma when dealing with such issues. Conclusion: This review revealed that ethical issues remain a challenge. Maternal and child health nurses need to be aware of the steps in decision making, and be conversant with their professional ethics. Keywords: Ethical issues, decision making, maternity nursing, ethical principles, maternal and child health, child bearing age

Colorectal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.

Improving the quality and effectiveness of care is a key priority of any health policy. The outcomes of health care can be considered as indicators of effectiveness or quality. The scientific literature that evaluates the association between the volume of activity and the outcome of health interventions has greatly developed over the past decade, but, for practical reasons, ethical and social issues, a few randomized controlled studies were made to evaluate this association, although there are numerous observational studies of outcome and systematic reviews of the studies themselves. The colorectal surgery is the most studied area and it represents the ideal testing ground to determine the effectiveness of the quality indicators because of the high incidence of the disease and the wide spread in the territory of the structures that aim to tackle these issues. Numerous studies have documented an association between the large number of colo-rectal surgical procedures and the quality of results. In particular, the volume of activity is one of the characteristics of measurable process that can have a significant impact on the outcome of health care. In conclusion, the ability to use volume thresholds as a proxy for quality is very tempting but it is only part of reality. Infact, the volume-outcome relationship strictly depends on the type of cancer (colon vs rectum) and it appears somehow stronger for the individual surgeon than for the hospital; especially for the 5-year overall survival, operative mortality and number of permanent stoma.

Keeping confidence: HIV and the criminal law from HIV service providers’ perspectives

We present qualitative research findings about how perceptions of criminal prosecutions for the transmission of HIV interact with the provision of high-quality HIV health and social care in England and Wales. Seven focus groups were undertaken with a total of 75 diverse professionals working in clinical and community-based services for people with HIV. Participants’ understanding of the law in this area was varied, with many knowing the basic requirements for a prosecution, yet lacking confidence in the best way to communicate key details with those using their service. Prosecutions for HIV transmission have influenced, and in some instances, disrupted the provision of HIV services, creating ambivalence and concern among many providers about their new role as providers of legal information. The way that participants approached the topic with service users was influenced by their personal views on individual and shared responsibility for health, their concerns about professional liability and their degree of trust in non-coercive health promotion approaches to managing public health. These findings reveal an underlying ambivalence among many providers about how they regard the interface between criminal law, coercion and public health. It is also apparent that in most HIV service environments, meaningful exploration of practical ethical issues is relatively rare. The data presented here will additionally be of use to managers and providers of HIV services in order that they can provide consistent and confident support and advice to people with HIV.

Critical Realism and Empirical Bioethics: A Methodological Exposition.

This paper shows how critical realism can be used to integrate empirical data and philosophical analysis within 'empirical bioethics'. The term empirical bioethics, whilst appearing oxymoronic, simply refers to an interdisciplinary approach to the resolution of practical ethical issues within the biological and life sciences, integrating social scientific, empirical data with philosophical analysis. It seeks to achieve a balanced form of ethical deliberation that is both logically rigorous and sensitive to context, to generate normative conclusions that are practically applicable to the problem, challenge, or dilemma. Since it incorporates both philosophical and social scientific components, empirical bioethics is a field that is consistent with the use of critical realism as a research methodology. The integration of philosophical and social scientific approaches to ethics has been beset with difficulties, not least because of the irreducibly normative, rather than descriptive, nature of ethical analysis and the contested relation between fact and value. However, given that facts about states of affairs inform potential courses of action and their consequences, there is a need to overcome these difficulties and successfully integrate data with theory. Previous approaches have been formulated to overcome obstacles in combining philosophical and social scientific perspectives in bioethical analysis; however each has shortcomings. As a mature interdisciplinary approach critical realism is well suited to empirical bioethics, although it has hitherto not been widely used. Here I show how it can be applied to this kind of research and explain how it represents an improvement on previous approaches.

Audiology practice management in South Africa: What audiologists know and what they should know.

BackgroundIn future, the South African Department of Health aims to purchase services from accredited private service providers. Successful private audiology practices can assist to address issues of access, equity and quality of health services. It is not sufficient to be an excellent clinician, since audiology practices are businesses that must also be managed effectively.ObjectiveThe objective was to determine the existing and required levels of practice management knowledge as perceived by South African audiologists.MethodAn electronic descriptive survey was used to investigate audiology practice management amongst South African audiologists. A total of 147 respondents completed the survey. Results were analysed by calculating descriptive statistics. The Z-proportional test was used to identify significant differences between existing and required levels of practice management knowledge.ResultsSignificant differences were found between existing and required levels of knowledge regarding all eight practice management tasks, particularly legal and ethical issues and marketing and accounting. There were small differences in the knowledge required for practice management tasks amongst respondents working in public and private settings.ConclusionIrrespective of their work context, respondents showed that they need significant expansion of practice management knowledge in order to be successful, to compete effectively and to make sense of a complex marketplace.

A Practical Guide and Perspectives on the Use of Experimental Pain Modalities with Children and Adolescents

Use of experimental pain is vital for addressing research questions that would otherwise be impossible to examine in the real world. Experimental induction of pain in children is highly scrutinized given the potential for harm and lack of direct benefit to a vulnerable population. However, its use has critically advanced our understanding of the mechanisms, assessment and treatment of pain in both healthy and chronically ill children. This article introduces various experimental pain modalities, including the cold pressor task, the water load symptom provocation test, thermal pain, pressure pain and conditioned pain modulation, and discusses their application for use with children and adolescents. It addresses practical implementation and ethical issues, as well as the advantages and disadvantages offered by each task. The incredible potential for future research is discussed given the array of experimental pain modalities now available to pediatric researchers.

Clinical issues in genetic testing for multifactorial diseases

Technological advances in genomics are shifting the genetic testing paradigm, from testing targeted mutations in selected genes to testing whole genes and even whole genomes. These exciting developments raise numerous practical pitfalls and ethical issues. Two articles in this issue of the SAMJ address genetic testing for multifactorial diseases.

Ethical issues in practice: A survey of home-visiting nurses in Japan

The purposes of this study were to identify specific components and frequencies of ethical issues that home-visiting nurses encountered in their practice, relationships between ethical issues and demographic data, and experience of ethics education and workplace environment. A self-administered questionnaire was distributed to home-visiting nurses in Japan. Usable data (1961) were analyzed. Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (i) concern about respecting client or relationships with relevant professionals; (ii) differences in treatment or care-taking views among home-visiting nurse and client and family, or relevant professionals; and (iii) discrepancy of intention between family and client or home-visiting nurse. All factors were significantly positively related to the current position, duration of working experience as a home-visiting nurse, and type of nursing education; age was significantly negatively related. Home-visiting nurses noted that programmed continuing education systems and staff-training programs were not sufficiently available. The findings of this study indicated the characteristics of ethical issues that home-visiting nurses encountered in their practice and insufficient continuing education system including ethics education. Ethics education programs tailored to home-visiting nurses ethical concerns and traits and continuing education systems are needed.

Ethical Issues in Brain–Computer Interface Research, Development, and Dissemination

The steadily growing field of brain-computer interfacing (BCI) may develop useful technologies, with a potential impact not only on individuals, but also on society as a whole. At the same time, the development of BCI presents significant ethical and legal challenges. In a workshop during the 4th International BCI meeting (Asilomar, California, 2010), six panel members from various BCI laboratories and companies set out to identify and disentangle ethical issues related to BCI use in four case scenarios, which were inspired by current experiences in BCI laboratories. Results of the discussion are reported in this article, touching on topics such as the representation of persons with communication impairments, dealing with technological complexity and moral responsibility in multidisciplinary teams, and managing expectations, ranging from an individual user to the general public. Furthermore, we illustrate that where treatment and research interests conflict, ethical concerns arise. On the basis of the four case scenarios, we discuss salient, practical ethical issues that may confront any member of a typical multidisciplinary BCI team. We encourage the BCI and rehabilitation communities to engage in a dialogue, and to further identify and address pressing ethical issues as they occur in the practice of BCI research and its commercial applications.

Ethical Issues in Practice: A Survey of Public Health Nurses in Japan

The purposes of this study were to identify specific components and frequencies of ethical issues that public health nurses (PHNs) encountered in their practice, relationships between ethical issues and demographic data, and ethics education and workplace environment. Cross-sectional survey for PHNs at local governmental agencies in Japan. Usable data were 3,409. Public health nurses completed the frequency of ethical issues, experience of ethics education, workplace environment, and demographics. Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (1) discrepancy of intention between client and his/her family on treatment or care; (2) differences in views between PHNs and their organization's administrators regarding providing services; and (3) discrepancy of caretaking views between PHNs and various professionals. All factors were related to work experience and one factor was specifically related to the type of local government employing PHNs. Only 11.1% of PHNs received ethics education via continuing education programs. PHNs reported that programmed continuing education systems were not sufficiently available. Systematic continuing ethics education programs for PHNs need developing, tailored to the specific characteristics associated with PHNs' ethical concerns, such as nurses' working experience and the type of employing local government.

Critical incidents in the marriage of psychology and technology: A discussion of potential ethical issues in practice, education, and policy.

We identified critical incidents in psychologists’ use of technology in their service provision with clients. Study coordinators sent messages out to various listservs requesting that practicing psychologists respond to an online survey for their reports of how the integration of certain technology advances (e.g., e-mail, electronic health records, social-networking websites, etc.) may have compromised client privacy or confidentiality. Twenty-eight participants responded to the survey and noted a variety of concerns, including themes of (a) unauthorized access to electronic client records, (b) inappropriate dissemination of client information via technology, and (c) unique client concerns associated with social-networking websites (e.g., Twitter, Facebook, etc.). We discuss ramifications and strategies related to these ethical concerns in education, practice, and ethical standards and principles.

To pray or not to pray: a question of ethics

There is a widespread belief that nurses have a duty to provide spiritual care. However, many feel there is still a need for debate surrounding the ethical use of prayer in both nursing research and practice. By using critical reflections and evidence-based literature, this paper develops a discourse on the ethics of prayer as a spiritual intervention in nursing and health care practice. Several key ethical issues are highlighted. In regards to research, lack of informed consent is a major concern in both research and nursing practice. Key ethical issues in practice include questions around intention and authority, e.g. despite the religious beliefs of the nurse, intentions to proselytize must be avoided to protect patient autonomy and avoid abuse of the nurse's authority. Furthermore, prayer has unknown side effects and implications. This paper concludes that, in practice, nurses must reconcile their personal, spiritual beliefs with their professional duties, and while this may be a delicate balance, it is not yet appropriate to encourage or dissuade a patient from their beliefs until appropriate research evidence is produced.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Focus groups and observation studies

AbstractThis paper reviews research undertaken in pharmacy practice and related settings employing focus groups and observation methods. The aim of the review is to identify the main methodological considerations of these approaches to enable pharmacy practice researchers to benefit from the experiences of their colleagues when conducting their own research. The paper is in two parts. Focus groups have become increasingly prominent in pharmacy practice and health services research. They are an attractive and effective alternative to individual qualitative interviews for particular problems in pharmacy research. In this paper, the use of focus groups by researchers in pharmacy practice and related settings is reviewed. Observation studies have been applied widely to address many research questions. They are a valuable method of obtaining data, documenting actual events and activities rather than relying on self-reports of behaviours and events. Observation methods have been used both as a sole method for a research study and in combination with other methods. In the pharmacy practice literature there are examples of participant and non-participant observation studies and both quantitative and qualitative approaches. Through the experiences of pharmacy practice researchers, the methodological and ethical issues that these studies present are identified and ways in which they have been addressed are explored.

Pharmacy practice research, ethical issues and local research ethics committees

Abstract Pharmacy practice research projects carried out in a community setting will often require approval from a local research ethics committee. This article discusses the processes, and problems, involved in seeking ethical approval, and sets out a framework for incorporating ethics committee approval into the design of a project.

Patients in a permanent vegetative state or minimally conscious state in the Maine-et-Loire county of France: A cross-sectional, descriptive study

PurposesTo determine how many patients in a permanent vegetative state or a minimally conscious state are living in healthcare institutions in the Maine-et-Loire county of western France. To evaluate patient management, physical complications, problems encountered by nursing staff and the patient care teams’ wishes. Patients and methodsWe performed a cross-sectional, descriptive study in physical medicine and rehabilitation departments, nursing homes, geriatric units and local hospitals. All patients and their medical records were examined by the same investigator. A questionnaire for carers was used to evaluate nursing tasks and a second questionnaire for head nurses served to assess staff needs and the patient care teams’ wishes. ResultsThirteen patients were identified. Four were in a permanent vegetative state and nine were in a minimally conscious state. Ten patients were cared for in geriatric units, one in a physical medicine and rehabilitation department and two in local hospitals. All patients displayed limited joint angle ranges. All the patient care teams reported practical difficulties and ethical issues. DiscussionOur survey highlighted the variety of care scenarios for patients in a permanent vegetative state or a minimally conscious state. It revealed practical difficulties and, above all, ethical questions. The present work could serve as a basis for implementation of a recently issued French government circular on defining specific wards for these patients.

Caring for HIV-Infected Patients in the ICU in The Highly Active Antiretroviral Therapy Era

The use of intensive care units (ICU) resources for HIV-Infected patients has been controversial since the first reported cases, raising practical ethical and economic issues about aggressive treatment. The aim of this review of the literature is to provide current information on the epidemiology of human immunodeficiency virus (HIV)-infected patients admitted to ICU during the era of highly active antiretroviral therapy (HAART) and to highlight issues related to HAART that are relevant to the intensivist. Overall mortality of critically ill HIV-infected patients in ICU has decreased in the HAART era and patients are more commonly admitted with non-HIV-related illnesses. Use of HAART in ICU is problematic, however it may be associated with improved outcomes. More HIV-infected patients surviving ICU admission are more likely to need critical care for problems unrelated to HIV infection or for conditions related to HAART toxicity. Intensivists need to be familiar with HAART (i) to recognize life-threatening toxicities unique to these drugs; (ii) to avoid drug interactions, which are extremely common and potentially life-threatening; (iii) to avoid enhancing HIV drug resistance, an occurrence that could have devastating consequences for the patient following ICU discharge.

Forgotten Practices and Sins of Omission

The idea is not at all new, but I would like to focus here on the thought that sins of omission are as unethical as sins of commission. Failure to use good practice is perhaps the least-obvious ethical sin. In some cases, what we know to do and do not do can be worse than what we do. To date, the primary focus of Ethical Human Psychology and Psychiatry (EHPP) has been related primarily to clinical subjects, and there certainly is nothing wrong that. The clinical issues that have graced our pages have served as incredibly valuable material to force the issues of ethical practice in serving the needs of humanity, and that emphasis should not be reduced. Society needs institutions, organizations, and individuals who represent the conscience of the whole. Our parent organization, the International Center for the Study of Psychiatry and Psychology, serves such a function. Having participated peripherally in the discussions that led to the establishment of this journal, I am cognizant of the need to keep that function front and center. Hence the title of the journal: Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry. I believe, however, that that traditional emphasis still can be honored by expanding the focus. My particular professional lens is a combination of school psychology and special education. The latter subject has often been addressed in the pages of EHPP, but usually from the perspective of a diagnosis or a treatment. I'd like to consider instead the basic programming provided for students-what we call instruction-which, if it is effective, more often than not can make the need for diagnosis and treatment (in the clinical sense) unnecessary. It is fascinating that, in the sociopolitical, professional world of education, we hear a great deal these days about research-based programs, strategies, and initiatives, as though this emphasis is something that we have been ignoring. In the 1970s, we had promising practices. In the 1980s, we had proven practices. In the 1990s, we had preferred practices and evidence-based practices. Now we have research-based practices. And, as if that might not even be enough, the research is supposed to be scientifically based. What is it that we keep looking for by invoking different adjectives? Any day now, I expect to see the announcement that we are promoting progressive practices, because the No Child Left Behind legislation requires a measure of adequate yearly progress to establish that current practice is acceptable. The question is not what new, promising, proven, research-based practice might be out there that will solve our current problems. The problem is that we aren't using what we already know. We continue to search for the Holy Grail when we already have the sacred talisman. But we seem to refuse, either consciously or unconsciously, to use it. The sword is no longer in the stone-hasn't been for years. Instead it lies unused on the ground. Today's new idea is exceeded only by tomorrow's innovation, and neither will be around long enough to be anything but promising practice, let alone preferred. There simply are too many fads bombarding us. How do we evaluate the innovations that fill our professional inbox? What are our criteria for evaluating them? How can we tell if a touted program-even one that is alleged to be "research based"-is really a worthy prospect or is, instead, only a fl ash in the pan? …

Ethics and Social Welfare: The State of Play

This extended editorial takes stock of the first volume of the journal Ethics and Social Welfare, offering an overview of the types of contributions in the first four issues and suggesting future themes. A critical summary is given of the contributions so far, which have included: moral philosophical theorizing; analysis of key ethical concepts; exploration of contested areas of policy and practice; empirical studies of living conditions, perceptions, attitudes and professional interventions; accounts of ethical issues in practice; ethical issues in research; and models of professional ethical decision making. Themes identified for future consideration include: service user perspectives on aspects of social welfare practice; development of practice-based ethical theories for the social welfare professions; ideas about teaching professional and practical ethics; ethical issues in managing and distributing resources; critical analysis of the ethical implications of public policies; further contributions offering moral, political and social philosophical perspectives on issues of social justice, cultural diversity, global and local policies for tackling environmental and humanitarian crises.