Practical Dilemmas Research Articles

Enhancing student nurses’ ethical skills via simulation-based learning: barriers and opportunities

BackgroundNurses lack skills to analyse ethical problems, and some feel powerless and frustrated when encountering and having to deal with ethical dilemmas in clinical practice. The lack of ethical competence among nurses might somewhat be related to the neglect and side-lining of ethics in the education system. For those nurse educators who are facilitating ethics within their curriculum, their strategies and practices are inefficient due to lack of resources. Lack of efficient strategies to facilitate ethical competence create threats to ethical values in healthcare with a potential to jeopardise patients’ health outcomes.MethodsThis was a qualitative, descriptive, exploratory, and contextual research that was done in one higher education institution among 9 nurse educators and clinical nurse preceptors. Online semi-structured interviews were conducted, data were transcribed and analysed following Giorgi’s thematic analysis method.ResultsTwo themes with 5 related subthemes emerged from the data. The theme of barriers that hinder the facilitation of ethical skills for nursing students indicated how Covid-19 pandemic lead to constraints that lead to facilitators focusing on clinical skills and procedures and side lining ethics education. While the theme transformative approaches to fostering ethical competency through simulation– based learning indicated some strategies that facilitators could adopt to ensure efficient ethics education for nursing students.ConclusionBarriers related to insufficient human resources and infrastructure made it almost impossible to facilitate ethics education among nursing students, especially during Covid-19 pandemic. This research offers some transformative solutions that could be adopted by higher education institutions to ensure that ethical competence is effectively facilitated.

The coloniality of gender expertise in professional environment and development contexts

As international environmental research for development organizations and their funders continue to build a requirement to 'mainstream' gender equality into their programming, disquiet surrounding gender expertise has emerged among those who bring reflections from feminist political ecology into professional development contexts. The perspective offered here builds from our earlier exploration alongside 'gender experts' of the uneasy navigation of epistemic and practical dilemmas necessary in environmental research-for-environment and development (R4ED) settings in the Global South. We consider the deeper trouble that comes from the embedding (and shaping) of gender expertise within the colonial project of development. Earlier postcolonial feminisms have demonstrated the difficulty in dislodging a hegemonic gaze on the "Third World woman", that has aligned a particular kind of feminism with international development's "civilizing mission." We suggest that gender expertise in professional environment and development contexts may be subsumed in the neutrality and universality of Eurocentric scientific knowledge, which has the effect of marginalizing non-Western perspectives and indigenous ways of knowing. Thus, the 'technocratization' of gender expertise for managerial purposes depoliticizes and blunts the potential for achieving the goals of social justice. We show how these issues take particular form in technical settings, where knowledge hierarchies, funding models and everyday exchanges may be shaped by coloniality. We argue that this amplifies the coloniality of gender, narrowing transformative agendas to those based around individualized entrepreneurial freedom, crowding out the generative and care-full possibilities offered from a plurality of contextualized and situated ecological feminisms. We conclude by considering "openings" in gender transformative thinking and action ('praxis') as waymarks for those navigating the complex ethics and politics inherent in professional feminist political ecology, built around the enduring salience of 'gender expertise.'

The diagnostic dilemma of adrenal vascular tumors: analysis of 21 cases and systematic review of the literature.

Adrenal vascular tumors are mainly represented by adrenal cavernous hemangiomas (ACHs) and adrenal cystic lymphangiomas (ACLs). Their radiological features often overlap with malignant tumors, therefore ruling out malignancy becomes mandatory. We analyzed clinical, radiological, and histopathological data to identify specific characteristics of these tumors. We reviewed 21 patients with ACHs (n = 12), ACLs (n = 8), or adrenal cysts (n = 1) confirmed by histopathology. We selected 82 papers from PubMed to provide a systematic review of the literature. In our cohort, median age at diagnosis was 58 years, with sex evenly distributed. All tumors were unilateral (median size = 44 mm), with 6 cases of increasing tumor size. All tumors exhibited non-contrast CT density > 10 Hounsfield Unit (HU). Calcifications were found in 5 cases. Hormonal studies revealed 11 non-functioning tumors and 2 cortisol-secreting tumors. Elevated urinary metanephrines were found in 2 cases. Immunostaining showed CD31/CD34/factor VIII expression in ACHs (n = 5, 24%) and podoplanin expression in ACLs (n = 6, 29%). The literature review revealed 71 reported cases of ACHs and 104 reported cases of ACLs. Median age at diagnosis was 46 years, with slightly female prevalence (63%). Median tumor size was 48 mm. 84 cases were symptomatic, with life-threatening hemorrhage reported in only 3 patients. Calcifications were found in 23% of cases. Surgical approaches varied, with open and laparoscopic adrenalectomy performed in 55 and 42 patients respectively. ACHs and ACLs represent a diagnostic dilemma in clinical practice due to their rarity and their misleading imaging features.

Does ‘What Works’ Work? The Quest for the Holy Grail in Physical Education

The ‘What Works’ agenda within education has become popular for its focus on accountability through data, advancing the aim of developing tangible principles to improve student performance. Nevertheless, this strategy has also been criticised for seeking to define education and missing key social, emotional, and developmental issues, often narrowly. This narrative review attempts to put in perspective the use of the agenda in physical education and to combine evidence to assess its claims and shortcomings. The main conclusions suggest a dilemma in pedagogical practice between paying attention to a narrow definition of students’ success in terms of physical fitness and motor skills acquisition and all the other central goals, including individual improvement, societal change, and interest in engaging in physical activity throughout life. This review takes a step towards identifying solutions to various issues in physical education by addressing evidence-based approaches and the need for interdependency with educational aims, improving the effectiveness of physical education towards students’ health and well-being.

Political Communication, Neuroscience and Ethics: Challenges for the power of managing and predicting political consumer behaviors

In the field of Political Communication, one of the most important tasks is the management of information, it is known that information is power and more so if it is about transmitting information for the creation of messages that may be able to identify with an electoral public, which then leads this to the decision of the voters. Hence, political campaigns seek to invest in the creation of more effective messages for the expected return of a winning candidate. Faced with these new challenges and trends in predicting the behavior of the electorate, a multidisciplinary science called political neuromarketing emerges that, based on specific techniques, messages and stimuli conquer the emotions of its audiences. It is for the above that this research presents a state of the art on the challenges of the power of management and the prediction of electoral consumer behavior under the multidisciplinary approach of Political Communication, Neuroscience and Ethics. Among the most important findings of this new paradigm of political neuromarketing is the presence of technical and ethical dilemmas in practice that must be considered for a framework of action that does not disrupt values ​​and health in the mind of the future electoral consumer.

Clinical and radiologic characteristics of ruptured epidermal inclusion cysts in the nipple and subareolar regions: A report of two cases.

Epidermal inclusion cysts (EICs) in the breast, particularly in the nipple and subareolar regions, are rare entities that pose significant diagnostic challenges and management dilemmas in clinical practice. This study retrospectively analyzes two case reports of women presenting with EICs located in these unusual breast areas. The subjects included a 35-year-old female with congested nipple symptoms and bilateral mastodynia, and a 58-year-old female with a palpable right breast nodule. Diagnostic efforts involved magnetic resonance imaging (MRI), sonography, and mammography, which highlighted the cysts' onion-like asymmetry and heterogeneous characteristics with posterior acoustic enhancement. Despite detailed imaging, distinguishing these cysts from malignancies or typical abscesses proved difficult. Both cases experienced spontaneous cyst rupture with subsequent resolution following antibiotic therapy. A literature review confirmed the rarity of such cases, emphasizing the importance of recognizing EICs to avoid unnecessary surgical interventions. These findings underscore the need for heightened clinical awareness and detailed imaging to accurately diagnose and manage EICs in atypical breast locations, and call for further research to explore their etiology and optimal treatment strategies.

EXPERT COMMENTARY: Communication between Psychiatrists and Patients Regarding Placebo and Nocebo

<p dir="ltr"><span>In this insightful commentary, Prof. Dr. Michael Davidson delves into the nuanced dynamics of placebo and nocebo effects in psychiatric treatments, with a focus on communication strategies between psychiatrists and patients. He explores the balance required in presenting the benefits and potential adverse effects of psychotropic drugs while enhancing therapeutic outcomes and minimizing nocebo risks.</span></p><p dir="ltr"><span>The commentary highlights the critical role of non-specific factors such as physician communication, patient conditioning, and natural disease progression in amplifying treatment efficacy. Prof. Davidson also underscores the ethical and practical dilemmas faced by psychiatrists in daily practice, such as the fine line between full disclosure and mitigating nocebo effects, especially in conditions like Major Depressive Disorder (MDD), where placebo response can significantly influence outcomes. By examining established and emerging treatments, including SSRIs, ECT, and psychedelics, Prof. Davidson offers a comprehensive perspective on the evolving clinical skills required to manage placebo and nocebo effects effectively, ensuring both adherence to ethical standards and the best possible patient care.</span></p><div><span><br /></span></div>

Cultivation of Top Innovative Talents Leads the Formation of New Quality Productivity: Ideal Picture, Realistic Dilemma and Practical Way Forward

Top-tier innovative talents possess characteristics of innovation, leadership, sociality, timeliness, and openness, which meet the needs of the development of new quality productivity. Vigorously cultivating top-tier innovative talents is a key factor in leading the formation of new quality productivity. The cultivation of top-tier innovative talents generates the connotation of new quality productivity, and the formation of new quality productivity also influences the training concepts and quality structure of top-tier innovative talents. There is an inherent logic of two-way drive and mutual promotion between the two. With the acceleration of the current new round of scientific and technological revolution and industrial transformation, the cultivation of top-tier innovative talents leading to the formation of new quality productivity faces practical dilemmas such as the lack of future-oriented thinking in talent cultivation, insufficient coordination in the talent cultivation system, and a lack of diversity in the types of talent cultivation. It is necessary to take a holistic approach, focusing on integrating educational resources, incubating cross-border innovation, advancing human-machine cooperation, adhering to open training, and highlighting regional characteristics to continuously exert efforts, explore new paths for the cultivation of top-tier innovative talents, and lay a talent foundation for accelerating the formation of new quality productivity. aggressive behavior in older preschoolers has long been a nuisance to kindergarten teachers and parents, and it is a common yet difficult problem in society. This study recorded the proportion, context, and reasons for aggressive behavior in older preschoolers at the Tianfu New Area Experimental Kindergarten in Chengdu. Combining the physical and mental development patterns of older preschoolers, methods such as observation records and situational analysis were used. Through real confrontation, observation, analysis, and exploration, effective ways to reduce and correct aggressive behavior in older preschoolers were found, with the aim of helping teachers cope with such behaviors.

A study on teachers' practical dilemmas and countermeasures in family-school-society collaborative education

A study on teachers' practical dilemmas and countermeasures in family-school-society collaborative education

Discussion on the Legal Path of “Railway + Industry” Construction Mode Based on Green and Low Carbon Xiaoyi Geng

The transformation of established railways is encountering several practical dilemmas. Given the influence of aging rail infrastructure on urban development and the rule of law within society, it is evident that the low-carbon transformation of old railways represents an inevitable trend in social development. Consequently, this study proposes an integrated development model of ‘railway + industry,’ which emphasizes the green transformation of outdated railways while addressing the requirements of financial balance and reduced emissions. Furthermore, an in-depth examination of the policy and legal challenges associated with the regeneration of railways following the introduction of new industries is conducted. The findings suggest that, in the absence of effective nationwide legal support for carbon emission reduction at this time, establishing a carbon emission reduction fund may be a viable solution. This fund would provide financial assistance for carbon budgeting and establish a corresponding guarantee mechanism, alongside a clearly defined legislative pathway, thereby facilitating the green and low-carbon development of the engineering and construction sectors

Discussion on the Legal Path of “Railway + Industry” Construction Mode Based on Green and Low Carbon

The transformation of established railways is encountering several practical dilemmas. Given the influence of aging rail infrastructure on urban development and the rule of law within society, it is evident that the low-carbon transformation of old railways represents an inevitable trend in social development. Consequently, this study proposes an integrated development model of ‘railway + industry,’ which emphasizes the green transformation of outdated railways while addressing the requirements of financial balance and reduced emissions. Furthermore, an in-depth examination of the policy and legal challenges associated with the regeneration of railways following the introduction of new industries is conducted. The findings suggest that, in the absence of effective nationwide legal support for carbon emission reduction at this time, establishing a carbon emission reduction fund may be a viable solution. This fund would provide financial assistance for carbon budgeting and establish a corresponding guarantee mechanism, alongside a clearly defined legislative pathway, thereby facilitating the green and low-carbon development of the engineering and construction sectors

Strategies for applying noninvasive brain stimulation techniques to treat psychiatric disorders

With the continuous development of science and technology, medical science, and bioengineering technology, various neuromodulation techniques, such as electrical, magnetic, acoustic, and optical modalities, are rapidly emerging in the therapeutic regime of psychiatric disorders. How to choose the appropriate noninvasive brain stimulation techniques for different psychiatric disorders and their clinical features is becoming a practical dilemma in clinical setting. In this paper, by describing the complex pathogenesis of psychiatric disorders and the limitations of existing therapeutic approaches on psychiatric disorders, combining with the characteristics of different neuromodulation techniques, we propose a new strategy of combined noninvasive brain stimulation to intervene in psychiatric disorders: high-intensity stimulation modulating the whole brain without inducing epilepsy should be as the basic treatment of psychiatric disorders, applying low-intensity stimulation with the advantage of specific targets/brain regions to modulate the residual symptoms or/and single symptom, and for refractory and acute psychiatric disorders, ECT/MECT is preferred for rapid symptom control; different noninvasive brain stimulation techniques can be combined with pharmacological and psychotherapeutic treatments, which will provide a new idea for the future development of this field.

Digital Transformation of Physical Education in Colleges and Universities: Theoretical Logic, Practical Dilemma and Practical Approach

With the rapid development of information technology, the digital transformation of education has provided new ideas, new resources and new methods for the practice of physical education in colleges and universities, and has become an important support and power source for the high-quality development of physical education in colleges and universities in the new era. By using the methods of literature and logical analysis, this paper analyzes the theoretical logic, practical dilemma and practical path of educational digitization in the practice of physical education curriculum in colleges and universities. The research holds that the theoretical logic includes conforming to the concept of education modernization, adapting to the individual needs of students, helping to improve the quality of physical education and promoting the fairness of physical education. This paper analyzes the practical difficulties faced in the process of transformation, such as uneven digital literacy of teachers, insufficient integration of digital resources, imperfect teaching evaluation system and weak infrastructure construction. It also puts forward the corresponding practical approaches, including improving teachers’ digital ability, optimizing the construction of digital resources, and constructing a scientific evaluation system, aiming to provide a useful reference for promoting the digital transformation of physical education in colleges and universities.

Home-based nursing care for clients carrying multidrug-resistant organisms: a focus group study

Abstract Background The growing population of vulnerable clients receiving home-based nursing care, combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study aimed to gain insight into the experiences, attitudes, perceptions, dilemmas in daily practice and needs of nursing staff providing home-based nursing care for clients carrying MDROs. Methods Seven focus group discussions with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semi-structured, open-ended topic list based on the I-change model and seven domains synthesized by Flottorp et al. Data were analysed using thematic analysis. Results Home-based nursing staff often considered infection prevention and control recommendations inconsistent, unclear or inapplicable in daily practice. Although participants acknowledged the importance of these precaution measures, their proportionality was sometimes questioned. Participants indicated to be influenced by perceptions, knowledge and behaviour of their colleagues and clients. In addition, they frequently experienced untimely, incomplete or inconspicuous information transfers about clients carrying MDROs. Concerns were expressed that clients were often insufficiently informed, debating the roles and responsibilities of involved healthcare professionals in providing and exchanging information. Finally, participants elaborated on the effect of the covid-19 pandemic and expressed the need for organisational support in providing education and sufficient resources regarding MDROs. Conclusions Insights of this study have aided in aligning upcoming MDRO guidelines for home-based nursing care in the Netherlands. Organisational support in expanding knowledge and providing sufficient resources is essential and clarity about roles and responsibilities of involved healthcare professionals regarding information transfer and informing patients is needed. Key messages • Expanding knowledge, sufficient resources and adequate information transfer about MDRO carriage are essential to ultimately prevent transmission and spread of MDROs. • The specific context of home-based nursing care for clients carrying MDROs should be acknowledged in MDRO guidelines.

4.C. Scientific session: Navigating through complex challenges of responding to outbreaks of multidrug-resistant organisms

Abstract Antimicrobial resistance is one of the top ten global public health threats according to the WHO, contributing to millions of deaths each year. While outbreaks of multidrug-resistant organisms (MDROs) are well studied in hospital and nursing home settings, knowledge gaps exist concerning the complex challenges of outbreaks of MDROs among vulnerable patient populations, such as patients with intellectual disabilities or elderly patients living longer at home with multiple comorbidities. The coordination of such outbreaks requires a multidisciplinary approach as these patients often receive care throughout different healthcare settings, including long-term care and home-based nursing care. We delve into the complexities of coordinating an MDRO outbreak response involving healthcare professionals from various healthcare settings. The challenges inherent to the coordination of multidisciplinary involvement and the use of innovative strategies for outbreak preparedness and surveillance, will be thoroughly examined based on scientific evidence and practice based experiences. Workshop objectives • To exchange experiences on managing cross-institutional outbreaks of MDROs • To foster deeper understanding of the complexities of multidisciplinary involvement during MDRO outbreaks among vulnerable patient populations The workshop structure: - A brief introduction will be provided on the generic challenges in providing long-term care to vulnerable patient populations carrying MDROs. We will subsequently illustrate potential challenges faced during a cross-institutional MDRO outbreak among these patients through a realistic scenario (5 min): A patient with severe intellectual and physical disabilities living in both a long-term care facility as well as with family at home, unexpectedly turns out to be carrying an MDRO after recent hospital admission. As the patient receives nursing care from both from family members and nursing staff in different healthcare settings, a cross-institutional MDRO outbreak has occurred requiring a coordinated response. - Hereafter, individual presenters will address evidence- and experience-based challenges faced in MDRO outbreak responses within the specific healthcare settings covered in the previously presented scenario. We will navigate through the scenario together with the participants, discussing practical and ethical dilemmas, and explore ways for containing the MDRO outbreak while maintaining effective and compassionate healthcare delivery. In addition, we will discuss the use of public health innovations, such as social network analysis as a basis for the development of a stress test exercise to improve preparedness for MDRO outbreaks, and the role of wastewater surveillance in MDRO outbreaks. Discussions will be facilitated by (online) voting tools to invite participants to exchange experiences (40 min). We conclude with an exciting quiz to summarize the key messages of this workshop (10 min). Key messages • Healthcare setting, knowledge, proportionality and well-being of vulnerable patients populations are important to acknowledge during cross-institutional MDRO outbreaks. • Novel stress test exercise and wastewater surveillance are potential methods to improve preparedness and surveillance, respectively, during cross-institutional MDRO outbreak responses.

Understanding mealtime behavioral problems in nursing home residents living with dementia: a group concept mapping approach

BackgroundPersons with dementia frequently experience mealtime behavioral problems that can result in reduced or lack of intake of food or fluids. Multiple underlying causes and expressions of mealtime behavioral problems complicate its interpretation and intervention, because problems originating from cognitive and functional decline and behavioral changes may interact. Healthcare professionals and family caregivers may encounter a variety of practical and moral dilemmas in dealing with these problems. We aimed at a better understanding of mealtime behavioral problems and related complex issues in nursing home residents with dementia from a daily practice perspective.MethodsWe used a mixed-method Group Concept Mapping approach in this study, and collected data online with a panel of 67 healthcare professionals, researchers and relatives from across The Netherlands. The participants contributed to either or all of the following phases: (1) the generation of ideas (brainstorm), (2) sorting, and (3) rating of the ideas. Subsequent phases included data analysis with Groupwisdom® software and interpretation of the results. Multidimensional scaling and hierarchical cluster analysis resulted in a concept map visualizing the coherence and importance of ideas. Bridging values were calculated, with low values indicating a distinct, clear concept.ResultsBrainstorming resulted in 285 statements representing 85 ideas. The concept map visualized three categories capturing ten clusters which describe the management of mealtime behavioral problems, causes of mealtime behavioral problems, and expressions and interpretations of mealtime behavioral problems. Concepts reflecting direct consequences, ethical components, and considerations to handle challenging situations overlapped on the concept map with the highest bridging values (range 0.58–0.87).ConclusionThis study added to unraveling the complex nature of mealtime behavioral problems, as perceived in practice. It is recommended to comprehensively analyze all components in the management of these problems, in particular being aware of ethical factors and align care for residents with dementia accordingly.

Addressing student non-compliance in AI use declarations: implications for academic integrity and assessment in higher education

This study examines the factors driving student non-compliance with AI use declarations in academic assessments at King’s Business School, where 74% of students failed to declare AI usage despite declaration being a requirement of a mandatory coursework coversheet. Utilising the Theory of Planned Behaviour (TPB) as a framework, the research combines service evaluation survey data and semi-structured interviews to explore how attitudes, subjective norms, and perceived behavioural control influence compliance. Findings reveal that fear of academic repercussions, ambiguous guidelines, inconsistent enforcement, and peer influence are key barriers to AI use declaration. These factors complicate the declaration process, undermine transparency, and challenge academic integrity. The study extends the TPB model by highlighting the ethical and practical dilemmas posed by generative AI, which blur traditional norms of academic integrity. This research offers critical insights for policymakers, suggesting that clear, consistent, and trust-based policies are crucial in fostering ethical AI use. The findings underscore the importance of transparent communication and supportive institutional cultures to improve compliance. Ultimately, this study informs policy development by evaluating the effectiveness of declaration mechanisms and providing actionable recommendations to promote a culture of academic integrity in the evolving landscape of AI technologies.

Customized Statistically Downscaled CMIP5 and CMIP6 Projections: Application in the Edwards Aquifer Region in South‐Central Texas

AbstractClimate projections are being used for decision‐making related to climate mitigation and adaptation and as inputs for impacts modeling related to climate change. The plethora of available projections presents end users with the challenge of how to select climate projections, known as the “practitioner's dilemma.” In addition, if an end‐user determines that existing projections cannot be used, then they face the additional challenge of producing climate projections for their region that are useful for their needs. We present a methodology with novel features to address the “practitioner's dilemma” for generating downscaled climate projections for specific applications. We use the Edwards Aquifer region (EAR) in south‐central Texas to demonstrate a process to select a subset of global climate models from both the CMIP5 and CMIP6 ensembles, followed by downscaling and verification of the accuracy of downscaled data against historical data. The results show that average precipitation changes range from a decrease of 10.4 mm to an increase of 25.6 mm, average temperature increases from 2.0°C to 4.3°C, and the number of days exceeding 37.8°C (100°F) increase by 35–70 days annually by the end of century. The findings enhance our understanding of the potential impacts of climate change on the EAR, essential for developing effective regional management strategies. Additionally, the results provide valuable scenario‐based projected data to be used for groundwater and spring flow modeling and present a clearly documented example addressing the “practitioner's dilemma” in the EAR.

Meerpersoonscelgebruik in Nederland

Multi-person cells in the Netherlands: Challenges from a legal and social science perspective The Dutch policy of cell sharing in prisons brings about various problems: first, it is difficult to establish whether people are fit to share a cell. Second, the process of matching cellmates is burdensome. Third, there are safety risks associated with cell sharing. Fourth, refusal of placement in a double cell raises practical and ethical dilemmas. Fifth, cell sharing poses challenges to reward and punishment practices. Finally, there are problems associated with capacity and facilities. An analysis of different sources shows that careful decision-making by staff is at least as important for ensuring safety than the legal guidelines.

Synergy between “Ideological and Political Courses” and “Courses with Ideological-political Elements” in Private Colleges and Universities Path Study

The synergistic development of ideological and political courses and courses with ideological-political elements in colleges and universities is the basis for constructing the pattern of “Great Ideology and Politics” and realizing the “Three-Whole Parenting”. However, private colleges and universities are still facing various challenges in building a synergistic path between ideological and political courses and courses with ideological-political elements. In-depth exploration of the practical dilemmas and solution paths will help to eliminate the ideological misunderstandings between the two, and effectively enhance the effectiveness of the synergistic cultivation of students by ideological and political courses and courses with ideological-political elements.