Professional Obligations Research Articles

Moral Injury in Health Care: A Unified Definition and its Relationship to Burnout.

Moral injury had been discussed by health care professionals as a cause of occupational distress prior to COVID-19, but the pandemic expanded the appeal and investigation of the term. Moral injury incorporates more than the transdiagnostic symptoms of exhaustion and cynicism and goes beyond operational, demand-resource mismatches of corporatized systems. Moral injury describes the frustration, anger, and helplessness associated with existential threats to a clinician's professional identity as business interests erode their ability to put patients' needs ahead of corporate and health system obligations. We propose a framework that combines 2 moral injury definitions. An individual who experiences a betrayal by a legitimate authority has an opportunity to choose their response. Moral injury arises when a superior's actions or a system's policies and practices undermine one's professional obligations to prioritize the patient's best interest. Perceived as inescapable, the resignation or helplessness of moral injury may present with emotional exhaustion, ineffectiveness, and depersonalization, all hallmarks of burnout. Both moral injury and burnout can mediate and moderate the relationship between triggers for workplace distress and the resulting psychological, existential, and physical harm. Moral injury is increasingly recognized as a source of distress among health care professionals. It emerges from structural constraints on the ability of health care professionals to deliver optimal care and stand up for patients, their oaths, and their professions. A unified definition of moral injury must be integrated into the framing of clinician distress alongside burnout, recentering health care on ethical decision making rather than profit.

Exercise addiction: is it linked to eating disorders? A cross-sectional study in a sample of Tunisian athlete students

IntroductionEating disorders and sports addiction are becoming increasingly common among athletes.It’s important to be aware of these disorders in order to improve their overall prevention.ObjectivesThe aim of our study was to determine the links between exercise addiction (EA) and eating disorders in Tunisian students at the Institute of Physical Education and to examine the factors associated with these disorders.MethodsAn anonymous self-administered questionnaire was distributed to students in the Sfax and Gafsa sports sections during March 2023. The Exercise Addiction Inventory (EAI) was used to study exercise addiction. It is a scale whose purpose is to separate individuals into 3 groups: those at risk of exercise addiction (score ≥ 24), those non-addicts with symptoms (score 13 to 23) and those non-addicts without symptoms (score 0 to 12).Eating disorders were assessed using the SCOFF-F questionnaire ( Sick, Control, One stone, Fat, Food), with a score of 2 or more indicating possible eating disorders.ResultsWe collected 240 participants. The mean SCOFF-F and EAI scores were 1.7±1.3 and 16.6 ± 4.1 respectively. Among the participants, 52.9% of students were at risk of developing eating disorders and 2.5% of students were at risk of exercise addiction. In our study, 82.5% of students took part in regular physical activity in a gym. The main reasons for going to the gym were muscle strengthening (57.9%) and preparation for a sporting competition (37%).Among students exercising outside the institute, the mean SCOFF score was significantly higher for those doing so to prepare for a sports competition (p=0.001), for professional obligations (p=0.005) or for weight loss (p=0.001). Participants at risk of exercise addiction had a higher mean SCOFF score, but the difference was not significant (p=0.051).ConclusionsOur study shows that eating disorders were widespread among Tunisian athlete students, and were higher among students at risk of exercise addiction.Disclosure of InterestNone Declared

Family Mediators and Family Mediation: When Norms Collide

Abstract We consider the nature of family mediation and the role of the family mediator in England and Wales in situations in which the cultural and/or religious tradition(s) of those involved may collide, for example when understandings of the law of England and Wales and of Muslim law may appear to some to point in different directions. We examine issues such as the family mediator’s approach to negotiation facilitation, the role of the law and other norms including cultural and religious norms that are strongly held by one or more of those involved in the negotiation and the presence or absence of the voices of other members of the family within the mediation setting. We consider the ethical dilemmas the family mediator may face in a situation where there is an apparent power or knowledge imbalance and/or where the family mediator may be bound by competing expectations about their role including professional body obligations. Throughout we examine how the ethos of mediation, including its underpinning value of mutualism, and the challenges this can lead to where there is normative disagreement between the parties or substantial power imbalances, are evidenced within Sharia councils’ family mediation practices.

Practicing responsible research assessment: Qualitative study of faculty hiring, promotion, and tenure assessments in the United States

Abstract Recent times have seen the growth in the number and scope of interacting professional reform movements in science, centered on themes such as open research, research integrity, responsible research assessment, and responsible metrics. The responsible metrics movement identifies the growing influence of quantitative performance indicators as a major problem and seeks to steer and improve practices around their use. It is a multi-actor, multi-disciplinary reform movement premised upon engendering a sense of responsibility among academic evaluators to approach metrics with caution and avoid certain poor practices. In this article we identify how academic evaluators engage with the responsible metrics agenda, via semi-structured interview and open-text survey responses on professorial hiring, tenure and promotion assessments among senior academics in the United States—a country that has so far been less visibly engaged with the responsible metrics reform agenda. We explore how notions of ‘responsibility’ are experienced and practiced among the very types of professionals international reform initiatives such as the San Francisco Declaration on Research Assessment (DORA) are hoping to mobilize into their cause. In doing so, we draw on concepts from science studies, including from literatures on Responsible Research and Innovation and ‘folk theories’ of citation. We argue that literature on citation folk theories should extend its scope beyond simply asking researchers how they view the role and validity of these tools as performance measures, by asking them also what they consider are their professional obligations to handle bibliometrics appropriately.

Utilizing the physical green care environment to support activities of daily living for nursing home residents: a focused ethnographic case study

BackgroundThe nursing home residents’ ability to carry out Activities of Daily Living (ADLs) is influenced by the physical care environment. One emerging area of interest in scientific research is the green care environment within nursing home care, where agricultural activities such as gardening and animal care are integrated alongside daily care. Previous research has neglected to explore how these environments can be employed to enhance ADL performance. This study, therefore, explores how a green care environment, specifically one with an animal shelter, can be used to support nursing home residents in their ADLs.MethodsA focused ethnographic case study was conducted in one nursing home. Data was collected employing participatory observations, informal conversations, and semi-structured interviews, which we analyzed by employing a thematic analysis.ResultsOverall, 25 residents were observed for a total time of 89h, and interviews were conducted with 10 staff members. The nursing home integrates activities in the green care environment into daily care for a broad scope of residents. The analysis revealed four themes: (1) The (in)visibility of ADL, (2) Reciprocal care dynamics: Fostering ADL performance through connection and teamwork, (3) Seized and missed opportunities for meaningful integration of ADL in the physical green care environment, and Theme (4) Professional fulfillment and ADL task obligation: Views from staff and management.ConclusionsThis physical green care environment carries the potential to enhance the residents’ daily activities and foster better staff-resident relationships. Yet, there are varying views among staff and management regarding its integration into the residents’ lives and care.

Does Engineering Undergraduate Education Under-utilize Human Factors / Ergonomics?

Human Factors or Ergonomics, (HFE) focuses on understanding interactions among humans and other elements of a system, to optimize human well-being and overall system performance. HFE is essential to ensuring engineers are prepared to meet ethical obligations for health, safety, welfare, environment protection, and cultural and societal sensitivity. Two studies measured exposure of graduates of accredited engineering programs to HFE content. Firstly, 37 engineering professors world-wide with knowledge of HFE teachings in their programs responded to a questionnaire. Most perceived HFE exposure as insufficient. Secondly, we searched for HFE keywords within required and technical elective course descriptions of 20 Canadian universities’ engineering programs. HFE keywords were absent from required courses for 68% of programs, and from elective course for 66% of programs; the highest required content was 7.5% of a program. We conclude that HFE is currently under-represented in engineering education to meet required professional obligations of engineers in Canada.

Misinformation and Disinformation in the Era of Social Media: The Need for Fact-Checking Skills

The paper explores the need for fact-checking skills in the era of misinformation and disinformation on social media. This paper employs a systematic review of literature through ResearchGate, Google Scholar and Web of Science databases to examine the need for fact-checking skills among media professionals. The paper indicates that the significance of factchecking skills among media professionals cannot be overstated in our contemporary information landscape. It is believed that media and information professionals hold a critical responsibility to ensure the accuracy and reliability of the information they disseminate. Fact-checking skills, encompassing rigorous verification, source scrutiny, and a commitment to transparency, stand as a bulwark against the tide of misinformation that pervades the digital era. Given this, the paper argues that misinformation has the potential to erode trust in institutions, sow discord, and influence public opinion. By actively engaging in fact-checking, media and information professionals become agents of truth, fortifying the foundations of a well-informed and resilient society. The paper concludes that the power to combat misinformation lies in the hands of those who shape narratives and tell the stories that define our world. The commitment to fact-checking is not merely a professional obligation but a moral imperative.

Perceptions of caring behaviors: Experiences of nurses in Ethiopia.

Caring is a universal phenomenon that influences nurse-patient interactions and feelings, forming the foundation of the nursing profession. How nurses perceive and experience caring in low-income settings is not well understood. Therefore, the purpose of this study was to explore Ethiopian nurses' perceptions and experiences of caring using a qualitative descriptive design. Individual semi-structured interviews were conducted with 13 nurses aged 28-57. Interviews were analyzed inductively using reflexive thematic analysis guided by the recommendations of Braun and Clarke. The analysis resulted in three themes: caring is the heartbeat of patient care, constraints to the provision of care, and ways to overcome constraints. The results revealed that nurses were committed to fulfilling their professional obligations and meeting patients' needs despite experiencing multiple constraints. The findings provide a comprehensive perspective in understanding nurses' experiences of caring. Their narratives demonstrate that they face constraints in their clinical practice, which limit the quality of care, including rotation and lack of resources. Cooperation between health policymakers and nurse authorities is essential for shifting the clinical environment from the prevailing traditional task-oriented approach to patient-centered care.

The Reasons to Follow Conventional Practices

ABSTRACT This article challenges a reductive analysis of social practices by distinguishing five kinds of reason for following the rules of conventional practices. Depending on one’s preferred intellectual tradition, conventional practices enable coordination, facilitate cooperation, constitute activities, fulfil reciprocity, or specify abstract rights. Instead of being rival theories of social practices, these different models complement one another in a normative analysis of social practices. By distinguishing five kinds of reasons to follow conventional rules, this paper supports a more dynamic conventionalist analysis of subjects like property, the law, professional obligation, civic responsibility, and culture.

شروط السر الطبي بين الشريعة والقانون

This study addresses a delicate and profound concern about the intricate dynamics between the medical practitioner's professional responsibilities and the patient's need for privacy. The symbiotic nature of the doctor-patient relationship necessitates the disclosure of sensitive information, even classified as secrets, to the physician. However, there exists a paradoxical scenario where the patient desires to shield confidential information from the doctor, notwithstanding the professional obligation to disclose such details. Legal provisions further complicate this dynamic, delineating instances where divulging secrets is permissible. The convergence of the patient's interest and the broader societal welfare underscores the complexity of the matter, prompting a careful balance between maintaining confidentiality and averting potential harm. Islamic law, recognizing the gravity of safeguarding personal secrets, prohibits revealing such information unless there is an overriding imperative to do so. Fundamentally, the essence of secrecy rests on the confidentiality of the information and the patient's explicit desire to prevent its exposure. The realm of medical practice, encompassing procedures like examinations, laboratory tests, and X-ray imaging, inherently involves confidential information. In delving into pertinent legal literature, specific criteria emerge, elucidating the conditions under which information qualifies for classification as medical confidentiality. These criteria include the intrinsic nature of the information and its significance in the context of preserving the sanctity of the doctor-patient relationship.

Betwixt and between student and professional identities: UK medical students during COVID times

The COVID-19 pandemic lockdown in Spring 2020 brought about unprecedented disruption to medical education in the United Kingdom (UK). Medical students were encouraged to take up paid roles in the National Health Service to help with workforce shortages. This article explores medical students’ views and experiences of the COVID-19 pandemic vis-à-vis their professional identity formation. Semi-structured interviews were conducted with 22 medical students from all five undergraduate years in one UK medical school, between April and June 2020. Three themes were generated: (1) disruption to medical education involving suspension of clinical placements, cancellation of assessments and ceremonial markers; (2) decision-making around joining the clinical workforce, decisions which were influenced by students’ sense of professional obligation, perceived personal gains, and health and safety considerations; (3) experiences of working in clinical settings during the pandemic, including reflections about managing risks and challenges, learning on the job and becoming a better doctor. The findings provide evidence that the UK’s first lockdown destabilised many medical students’ expectations tied to their educational and career trajectory, requiring them to improvise to address gaps in learning and professional development. Taking on a paid healthcare role catapulted them into a liminal period, working in a space ‘betwixt and between’ a medical student and healthcare professional. This swift readjustment of roles and responsibilities accelerated their identity formation as ‘future doctors’. Support for medical students around negotiating such dual role is important in present and future public health crises.

Teacher’s Code of Ethics: Implementation by Mathematics Teachers in Cirebon City and Regency

A teacher must uphold the teacher’s code of ethics, both when carrying out professional obligations in the school environment or outside the school, so that he can carry out his duties and responsibilities as a professional teacher well. This research aims to (1) find out how the teacher code of ethics is implemented in SMP/MTs and SMA/MA/SMK in Cirebon Regency and City, and (2) find out the obstacles faced by teachers in implementing the teacher code of ethics. The method used in this research is a descriptive method with data collection using questionnaires, observation and interviews. The subjects of this research were 125 Mathematics teachers in SMP/MTs and SMA/MA/SMK in Cirebon Regency and City. The research results show that Mathematics teachers in Cirebon Regency and City have implemented the teacher code of ethics very well with average questionnaire scores of 4.62 and 4.52 respectively. Mathematics teachers in Cirebon Regency and City also show a very good category in implementing each aspect of the code of ethics, namely the relationship between teachers and students, with parents/guardians of students, with the community, with colleagues, and with their profession. Obstacles faced by teachers in implementing the teacher's code of ethics include (1) the diversity of students' characters and backgrounds in one class, (2) differences in educational patterns between parents/guardians and difficulties in communicating with parents/ student guardians, (3) a feeling of reluctance to remind teachers not to take actions that demean the dignity of the teaching profession, (4) lack of opportunities for some teachers to develop the quality of the teaching profession, and (5) communities seem indifferent and don't care about the development of education around them.

Sociological Study of the Legal Patterns in Therapeutic Agreement Relationships

This study examines the therapeutic agreement relationship between doctors and patients within the context of healthcare services from the perspective of legal sociology and applicable regulations. Health, as a fundamental right guaranteed by the Indonesian Constitution, requires a supporting legal framework, as regulated in Law No. 17 of 2023 on Health. The therapeutic relationship, built on a mutual agreement between therapists and patients, is strengthened by factors such as trust, empathy, and openness, affecting the effectiveness of therapy. This research employs a normative legal method to elucidate existing legal issues, identify gaps between legal theory and practice, and propose solutions. The results indicate the importance of a deep understanding of social interaction in a legal context and the significant role of law in ensuring the application of ethical and responsible medical practices. This research aims to enhance patient awareness of their rights, expand the understanding of doctors and healthcare professionals about their professional obligations, and assist hospitals in improving service quality and reducing litigation risks.

Should I Stay or Should I Go? Auditor Ethical Conflict and Turnover Intention

Ethical conflicts (ECs), dilemmas auditors face when personal values or professional obligations clash with their actions, pose significant challenges to the auditing profession, potentially influencing turnover intention (TI). This study addresses a knowledge gap in the related research by focusing on two critical EC triggers: workload (WL) and perceived auditor ethical failure (PAEF: ethical sensitivity), which refers to auditors’ perceptions of ethical violations within their profession. Grounded in role theory and ethical climate theory, our study investigates the impact of WL and PAEF on ECs and explores how these conflicts mediate the relationship between PAEF/WL and TI. Additionally, we examine the moderating role of organisational ethical climate (EtC) in these relationships. Using a survey of auditors and employing partial least squares structural equation modelling (PLS-SEM), our results reveal that both WL and PAEF increase ECs, thus escalating TI. The findings suggest that a firm’s perceived EtC can negatively moderate the relationship between PAEF and ECs. The study underlines the importance of fostering a strong EtC to manage ECs effectively and provides valuable implications for professionals, regulators, and academics seeking to improve ethical practices within auditing firms and to reduce auditor turnover.

Analysis on Medical Negligence Under Consumer Protection Act 2019 and Indian Contract Act 1872

Medical negligence occurs when medical care providers fail to fulfil their professional obligations. All healthcare practitioners must provide a standard of care to their patients. It may be considered medical negligence if they don't fulfil that duty. When patients go to a doctor, they expect to receive medical care using all of the doctor's expertise to solve their medical issues. The arrangement retains the fundamental components of a tort while taking the form of a contract. A physician has obligations to his patients, and any carelessness on the part of the physician may give rise to legal action. Before performing diagnostic procedures or administering therapeutic care, the physician must get the patient's informed consent. The Consumer Protection Act of 1986 covers the services provided by doctors, and patients can file complaints with the Consumer Courts for resolution. Case laws are a valuable resource law for resolving different issues. Before the adoption of the Consumer Protection Act, claims of medical negligence were made under Contract law, and even today, damages can be made under civil law ; however, since implementing the Consumer Protection Act, the civil law remedy has become less critical. The doctor and the patient have a specific relationship, which can be oral, written, or implicit agreements agreed upon by the patient or his representatives and the doctor or hospital. Anyone who has suffered losses due to a doctor's negligence can register a complaint with the appropriate authority. Despite this, the council can sanction the doctor and revoke their registration for their careless actions, but it cannot compensate the victim of such misbehaviour. The Indian Medical Council has enforced stricter measures to raise the bar for medical ethics and practice standards for the past few years.

Separate theoretical and legal aspects of tax control of a lawyer in Ukraine

Professional activity in Ukraine, which involves the receipt of profit, income or fees, is subject to control by the state. Such control has a number of tasks, among which is the verification of the correctness of calculation and payment of the tax liability, the good faith performance of which depends on the success of the state and its financial stability. The financial interests of the state must be protected. Therefore, domestic national legislation contains the institution of tax control, which covers interaction with the control bodies of other states.
 Filling the budget is one of the priority tasks, thanks to which the financial basis of the state is established. Legal mechanisms are used, including tax audits. General conditions and rules are defined, compliance with which is a necessary condition for preventing the application of financial sanctions for violation of tax legislation. The object of inspection and the subject to be inspected are highlighted.
 A lawyer in Ukraine receives a fee from carrying out his professional activity, which means that he must keep tax and accounting records, fulfill his tax obligations in a timely manner and in full. A lawyer, like any other business entity, may be subjected to tax control measures through a tax audit of his activities. At the same time, taking into account the professional status, the tax audit of a lawyer may have its own characteristics, which directly relate to professional obligations, including in the area of attorney confidentiality. The lawyer’s proper performance of his professional duties is a guarantee of quality legal assistance and a measure of the client’s trust in the lawyer. Ensuring the conditions for the lawyer to fulfill and comply with his professional obligations meets the interests of the client and affirms the role of the legal profession in society. Conducting a tax audit and complying with the requirements of the tax inspector should not create threats or risks for the client, who reasonably expects that his confidentiality will be preserved by the lawyer. Therefore, this article is an attempt to outline and define certain theoretical and legal aspects of tax control of a lawyer in Ukraine.

A Survey of How Archaeological Repositories Are Managing Digital Associated Records and Data

ABSTRACTArchaeologists are taught about the importance of professional recordation and our ethical obligations to those associated records and data. These teachings imply that practitioners are meeting a professional standard of recordation that will stand the test of time, but the ongoing digital revolution is changing the way records and data are created and preserved. Best practices for the management and use of digital archaeological records have been published, and devoted digital archives offer these services. However, the ability of traditional archaeological repositories to adopt best practices or pay for digital curation is poorly understood. This article presents the results of a survey asking how the flood of digital records and data has impacted the ability of archaeological repositories to collect, manage, preserve, use, and make accessible digital archaeological records and data. Are repositories adopting the best practices that have been outlined? What kinds of challenges do repositories face regarding digital records and data? Are they being overcome successfully? The survey results offer a snapshot of current practice and point to future directions that should be pursued to ensure that the discipline is meeting its professional obligations.

OPCAT: How an international treaty regarding torture is relevant to the Australian mental health system.

The United Nations Subcommittee on the Prevention of Torture visits signatory nations to the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). Its role is to monitor and support signatory nations in implementing and complying with the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). In October 2022, the United Nations Subcommittee on the Prevention of Torture visited Australia but was barred from visiting mental health wards in Queensland and all detention facilities in New South Wales leading to the termination of its visit. This breach of Australia's obligations under the OPCAT presents a significant setback for the rights of people with mental illness and other involuntarily detained populations. This piece sets out to demonstrate the relevance of OPCAT to the mental health system in Australia. Individuals who are detained for compulsory treatment in locked facilities such as acute psychiatric inpatient wards and forensic mental health facilities are deprived of their liberty, often out of public view. Thus, it highlights the ethical and professional obligations of all mental health professionals, especially psychiatrists, to safeguard the human rights of individuals being detained in mental health facilities as enshrined in Australia's international legal obligations under the OPCAT. Adhering to these obligations diminishes the risk of future human rights violations of people with mental illness.

What is Spanish regulation on the application of artificial intelligence to medicine like?

This article will attempt to analyze the current impact of Artificial Intelligence in Spanish healthcare, as well as the challenges that its application poses both from an ethical and legal point of view. Technological advances, which are already being applied in healthcare, make it necessary to adapt the legal system to the new trends that are emerging in society and force healthcare professionals to review their codes of ethics in the face of new ethical dilemmas, since these codes of ethics do not have clear guidelines for action on AI that raise relevant ethical problems to which no response is being given, except for the code of ethics for medicine, which has recently been included. After a review of the last 5 years of Spanish and European regulations in medicine, it can be concluded that the regulation and legislation of the application of AI is very deficient, both in the EU and in Spain. In order to try to identify different ways of resolving conflicts related to AI in medicine, jurisprudential sentences related to the rights and obligations of health professionals, patients and users have been analyzed and reviewed. Therefore, the paper concludes with the proposal of a series of aspects to be taken into account for the future regulation of the application of AI in medicine.

The Validity Of The Additional Obligations Of The Notary Profession Through PP Number 43 Of 2015 Of The Notary As The Reporting Party

The Indonesian government has enacted Law Number 8 of 2010 concerning the Prevention and Eradication of Money Laundering, along with its implementing regulation, Government Regulation Number 43 of 2015 on Reporting Parties in the Prevention and Eradication of Money Laundering Crimes. This regulation designates Notaries as one of the reporting parties in Suspicious Financial Transactions related to Money Laundering (TFM), obligated to submit reports to the Financial Transaction Reports and Analysis Center (PPATK). Meanwhile, Article 16 paragraph (1) letter f of the Notary Law states that in carrying out their duties, Notaries must maintain the confidentiality of deed contents. Here, there is a contradiction between legal regulations. This study aims to examine and analyze the validity and legal consequences of the additional professional obligations for Notaries as stipulated in the Notary Law, supplemented by Government Regulation Number 43 of 2015, designating Notaries as reporting parties in TFM related to Money Laundering. The research indicates that the confidentiality duty of Notaries is not absolute; in other words, the obligation to maintain confidentiality in the Notary Law can be set aside by other laws, in this case, the Law on the Prevention and Eradication of Money Laundering through Government Regulation Number 43 of 2015, a directly authorized implementing regulation. The additional obligation as a reporting party cannot be considered a violation of the principle of notary confidentiality but rather a form of protection, with Minister of Law and Human Rights Regulation Number 9 of 2017 serving as an implementation of the prudence principle for Notaries in performing their duties. Furthermore, the legal consequences for Notaries, if they breach their duty as keepers of official secrets, may include criminal sanctions based on Article 322 of the Criminal Code and Law Number 43 of 2009 concerning Archives, civil sanctions under Article 1365 of the Civil Code, and administrative sanctions under Article 85 of the Notary Law. Additionally, if a Notary fails to report suspicious financial transactions resulting in criminal activities, the Notary faces the threat of punishment as regulated in Article 5 of the Law on the Prevention and Eradication of Money Laundering, which includes passive involvement in money laundering crimes (Article 55 of the Criminal Code) and active assistance in criminal activities (Article 56 of the Criminal Code).