Experiences Of Ethical Issues Research Articles

Exploring ethical challenges in Singapore physiotherapy practice: Implications for ethics education

Introduction: Workplace contexts, including political and sociocultural systems influence health professions’ perception and experience of ethical issues. Although established health ethics principles are relevant guiding values, they may be experienced and interpreted differently within different health contexts. How should ethics education account for this? This paper presents ethical dilemmas and concerns encountered by physiotherapists practicing in Singapore and discusses the implications for ethics education. Methods: Qualitative methods informed by interpretivism and phenomenology were employed. In-depth interviews with 42 physiotherapists from different workplace settings in Singapore were conducted. Participants described everyday ethical challenges they encountered. Inductive content analysis was used to analyse the interview transcript data. Results: Ethical issues occurred within and across three spheres of ethics: micro, meso and macro. Ethical issues at the micro sphere centered around physiotherapist-patient relationships, interactions with colleagues, and therapists’ feelings of moral distress. In the meso sphere, ethical challenges related to influences arising from the organizational resources or systems. In the macro sphere, ethical challenges developed or were influenced by sociocultural, religious, economic, and political factors. Conclusion: The findings reflect current literature indicating that context can influence ethical situations, as experienced and perceived by physiotherapists in their unique settings. Such empirical data might inform the development of ethics curricula to ensure that universal ethical principles are situated within the realities of clinical practice. Locally relevant and realistic ethical case studies will better enable students to recognise and address these situations.

Ethics and ecotherapy: the shared experiences of ethical issues in practice

ABSTRACT The purpose of this qualitative phenomenological research study is to examine ethical issues that transpire for practicing ecotherapists. Ten participants share common ethical issues that emerge in their practices and ways they manage them. The research questions for this study are: 1. What are the ethical concerns that emerge most in ecotherapy practice? 2. What attitudes and beliefs do ecotherapists have about ethics in their practices? 3. How do ecotherapists manage ethical issues that emerge in practice? 4. What implications does this information have for the practice of ecotherapy? Moustakas’ eight step process for qualitative research is employed, and semi-structured interviews are collected and analyzed. The following superordinate themes emerge: 1. Confidentiality and Informed Consent, 2. Training Recommendations, 3. Assessment and Client Safety, 4. Dual Relationships, 5. Values Conflicts, and 6. Self-Awareness. Implications for ecotherapists and ecotherapy educators are presented, with limitations and recommendations for further research explored.

Into the Grey Zone: Retired Nurses’ Reflections on Ethics in Canadian Nursing Practice

Context: Nurses are often hesitant to talk about ethical issues in their practice for many unique and valid reasons. What if the burden of risk was lifted upon retirement, even if just slightly? The purpose of this study was to explore retired nurses’ reflections on their experiences of ethical issues and decision making in various nursing practice settings throughout their careers and to glean recommendations for ethics in contemporary nursing practice. Methods: Data were collected via in-depth, individual, semi-structured interviews. Guided by an interpretive, descriptive approach, data were managed with NVivo v.11 and analyzed with an inductive, comparative, thematic approach. In northern Ontario, two nurse researchers co-interviewed eight retired nurses with decades of practice experience across diverse Canadian health care settings. Ethics approval was obtained through Lakehead University’s Research Ethics Board. Findings: Three themes emerged to address ethical issues in practice; these are creativity, resourcefulness, and a strong sense of community with other nurses. Further, the retired nurses’ collated reflections on ethics in practice are presented as the FIG model: Fellowship, Ingenuity, and Gumption. Conclusions: This study identifies ethical underpinnings that retired nurses have used to effectively respond to ethical issues in their practice. Those who are currently nursing, and nursing as a profession, may wish to recognize and retain these strategies in order to continue to deliver a high standard of quality, ethical care. Recommendations for practice, research, and education are offered.

Nurses' tension-based ethical decision making in rural acute care settings.

Nurses in acute care are frequently involved in ethical decision making and experience a higher prevalence of ethical conflicts and dilemmas. Nurses in underresourced rural acute care settings also are likely to face unique ethical challenges. However, rarely have the particular contexts of these experiences in rural acute care settings been researched. A culture of silence and fear in small towns has made exploring these issues difficult. To explore registered nurses' experiences of ethical issues and ethical decision making in rural acute care hospitals in northern Ontario, Canada. Guided by an interpretive descriptive approach, data were collected by two nurse researchers using in-depth, individual, and semistructured telephone interviews. Data were managed with NVivo v.11 and analyzed using inductive, comparative, thematic analyses. The participants were eight registered nurses working in two acute care hospitals in northern Ontario. Ethical protocols were followed in accordance with ethics approval from the researchers' university and the hospitals. Results identified four themes that culminated in the development of a quadruple helix ethical decision-making framework of power, trust, care, and fear. The participants described complex ethical conflicts and dilemmas in acute care settings that were influenced by the context of working and living in small rural communities in northern Ontario. Nurses described navigating ethics in practice using a tension-based approach to ethical decision making, needing to carry these issues silently and often having no resolution to ethical challenges. These findings have important implications for nursing education, research, and practice. Nurses need safe spaces, formal ethics support, and improved access to resources. Additional ethics education and training specific to the unique contexts of rural settings are needed.

Ethical issues experienced during palliative care provision in nursing homes.

Palliative care is acknowledged as an appropriate approach to support older people in nursing homes. Ethical issues arise from many aspects of palliative care provision in nursing homes; however, they have not been investigated in this context. To explore the ethical issues associated with palliative care in nursing homes in the United Kingdom. Exploratory, sequential, mixed-methods design. Semi-structured interviews with 13 registered nurses and 10 healthcare assistants (HCAs) working in 13 nursing homes in the United Kingdom were used to explore ethical issues in palliative care. The 'Ethical Issues in Palliative Care for Nursing Homes' instrument was used to measure the frequency and level of distress arising from ethical issues through a cross-sectional survey with 69 registered nurses and 129 healthcare assistants. Data collection occurred between December 2014 and November 2015. Ethical approval was granted by Queen's University's School of Nursing and Midwifery Research Ethics Committee and governance sought from each nursing home's manager. The interviews revealed three themes: ethical issues in practice; relational issues; and organisational issues. No significant differences between registered nurses and healthcare assistants were evident, confirming the patterns emerging from the interviews. Relational issues, primarily issues with residents and families, occurred most frequently and caused greater distress. The shared environment is key in the experience of ethical issues; therefore, multidisciplinary education is needed for ethical decision making in palliative care. Addressing staff knowledge and service organisation may reduce ethical issues locally and provide a benchmark for global change.

A qualitative description of service providers' experiences of ethical issues in HIV care.

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Ethical issues experienced by healthcare workers in nursing homes: Literature review.

Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress. The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs' experiences of ethical issues. Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home. The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work. The review highlighted a need for improved ethics education for care-providers.

Nursing students' experiences of ethical issues in clinical practice: A New Zealand study

Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately.

Current Status of Korean Counselors' Experience of Ethical Issues and Ethics Education

Current Status of Korean Counselors' Experience of Ethical Issues and Ethics Education

Experiences of ethical issues when caring for children with cancer.

The treatment for pediatric cancer is often physically, socially, and psychologically demanding and often gives rise to ethical issues. The purpose of this study was to describe healthcare professionals' experiences of ethical issues and ways to deal with these when caring for children with cancer. A study-specific questionnaire was given to healthcare professionals at a pediatric hospital in Sweden. Qualitative content analysis was used to analyze answers to open-ended questions. The data were sorted into 2 domains based on the objective of the study. In the next step, the data in each domain were inductively coded, generating categories and subcategories. The main ethical issues included concerns of (1) infringing on autonomy, (2) deciding on treatment levels, and (3) conflicting perspectives that constituted a challenge to collaboration. Professionals desired teamwork and reflection to deal with ethical concerns, and they needed resources for dealing with ethics. Interprofessional consideration needs to be improved. Forums and time for ethics reflections need to be offered to deal with ethical concerns in childhood cancer care. Experiences of ethical concerns and dealing with these in caring for children with cancer evoked strong feelings and moral perplexity among nursing staff. The study raises a challenging question: How can conflicting perspectives, lack of interprofessional consideration, and obstacles related to parents' involvement be "turned around," that is, contribute to a holistic perspective of ethics in cancer care of children?

An investigation of how university sports team athletic therapists and physical therapists experience ethical issues.

Qualitative study using interpretive description methodology. The purpose of this study was to better understand how ethical issues are experienced by university sports team athletic therapists and physical therapists. In clinical practice, sports teams are associated with a range of ethical issues. Issues commonly reported in the literature include confidentiality, return-to-play decisions, conflicts of interest, advertising, doping, and use of local anesthetic. To date, there has been limited examination of how athletic therapists and physical therapists involved with sports teams experience these ethical issues, and limited exploration of how these ethical issues, when encountered, are shaped by therapists' professional roles and responsibilities. Semi-structured interviews were conducted with 11 athletic or physical therapists working with sports teams in 5 Canadian provinces. The data were analyzed inductively, using a recursive approach and constant comparative techniques. Four key themes were developed relating to the participants' experiences of ethical issues: establishing and maintaining professional boundaries, striving for respectful and effective collaboration, seeking answers to ethical concerns, and living with the repercussions of challenging decisions. While many ethical issues reported by participants resemble those faced by sports medicine physicians, they are experienced in distinctive ways, due to differences in professional roles and identities. Issues concerning professional boundaries were also more prominent for the study participants than the literature has reported them to be for sports medicine physicians. Effective communication and enhanced collaboration appear to be key elements in managing these ethical challenges.

Experiences of Ethical Issues and Needs for Ethics Education in Clinical Nurses

Purpose: This study was done to identify the experiences of ethical issues and needs for ethics education in clinical nurses. Methods: A cross-sectional survey was used and data were collected in 2013. Participants were 428 clinical nurses working in the general units of seven medical hospitals. The Ethical Issues in Clinical Practice Tool was used. Data analysis was performed using SPSS/WIN 19.0. Results: ‘Providing care with a possible risk to your health’ was the most frequent and disturbing ethical problems for nurses. The highest helpful ethical topic was ‘the patients’ right, autonomy and informed consent’. The ethical issue experience was significantly different according to education level, work units, and type of employment. The necessity of ethics education was statistically different according to age, religion, level of education, duration of working as RN, position, shift type, and continuing education about nursing ethics. Conclusion: The results of this study show that nursing educators need to provide practical ethics education based on frequent ethical issues and helpful education topics. These findings can be used in developing effective education strategies for clinical nurses and nursing organizations to improve nurses’ ethical decision-making abilities.

Nurses' experiences of ethical preparedness for catastrophic public health emergencies and health care disasters; a systematic review of qualitative evidence.

Review Question: This review aims to answer the following specific question: What are nurses’ experiences of preparing for and managing the ethical challenges posed by catastrophic public health emergencies and health care disasters? Review Purpose/Objectives: The purpose of this systematic review is to systematically review and synthesise research literature reporting nurses’ experiences of ethical preparedness for dealing with catastrophic public health emergencies and health care disasters and the ethical quandaries that may arise during such events. INCLUSION CRITERIA: Types of Participants: The review will consider publications that include nurses registered or authorised under a given country’s state of emergency provisions to practice in jurisdictions in which a public health emergency (e.g. pandemic influenza) or sudden‐onset mass casualty health care disaster (e.g. flood, hurricane, earthquake, tsunami, volcanic eruption, terrorist attack) have occurred, or may occur. Phenomena of interest: This review will examine the phenomenon of nurses’ experiences of preparing for and/or managing ethical issues arising during a public health emergency or health care disaster. Consideration will be given to, but not be limited to nurse preparation for and management of ethical issues associated with: development of local public health emergency (including pandemic influenza) and sudden‐onset health care disaster plans provision of first health care contact for the general public personal protection and correct use of safety equipment providing front line clinical care providing community and primary health care assistance with containment measures triaging in a range of settings, including general practices, community health centres, and local hospitals maintaining infection control vaccinations informing the public work attendance.

Understanding pharmacists' values: A qualitative study of ideals and dilemmas in UK pharmacy practice

Pharmacy, like other health care professions, is both a knowledge-based and a value-based profession. However, the values that inform practice activities are rarely made explicit. We sought to identify the values drawn on by UK pharmacists through qualitative interviews on day-to-day practice activities focused around practitioners' conceptions of 'the good pharmacist', good practice and their experiences of ethical issues and dilemmas. The study was based upon loosely structured, one-to-one interviews of 38 selected practitioners reflecting a range of practice roles and settings. The interviews were recorded, transcribed and analysed following the principles of grounded theory. The accounts of practice (of self and colleagues) in the data showed pharmacists to be very dedicated and conscientious. Practice was predominantly discussed and presented by practitioners drawing upon a scientific mode of rationality. Value and ethical judgements were typically presented within this mode, with more open-ended and complex discussion of values and ethics appearing quite rarely. Two core values generally drawn on in reported practice emerged from the analysis--these were, 'the patient's best interests' and a value we labelled 'respect for medicines'. Common dilemmas arose from conflicting values, for example competing obligations to different parties, sometimes brought to a head by the conflicting demands of 'rules' of various sorts. Reported dilemmas related to rule breaking, resource allocation, patient communication and teamwork. There was a tendency for practitioners to 'fall back', often unreflectively, on their own personal value judgements when addressing these dilemmas. However, in the main, the values and dilemmas reported clearly show the socially embedded nature of professional ethics and, thereby, contribute to the social science re-theorisations of professional ethics needed if work on ethics development is to be realistic.

The Effect of Context on Moral Intensity of Ethical Issues: Revising Jones's Issue-Contingent Model

Jones's (1991) issue-contingent model of ethical decision making posits that six dimensions of moral intensity influence decision makers' recognition of an issue as a moral problem and subsequent behavior. He notes that "organizational settings present special challenges to moral agents" (1991, p. 390) and that organizational factors affect "moral decision making and behavior at two points: establishing moral intent and engaging in moral behavior" (1991, p. 391). This model, however, minimizes both the impact of organizational setting and organizational factors on these experiences of ethical issues. In this theory, context is modeled as affecting the moral intent and behavior of the actor rather than directly affecting the issue's moral intensity. Here we look specifically at the effect of context on the moral intensity of ethical issues through a phenomenological study. Our results indicate that in certain environments, context may be critical in affecting the moral intensity of ethical issues. Thus, researchers should consider it more fully when assessing these issues' moral intensity.