Biomedical subjects
Publications and source records attributed to J A Erlen.
Ethical dilemmas in the high-risk nursery are similar to wilderness experiences. Reinforcers of these experiences for nurses include a lack of knowledge of ethics, communication failures, and the immediacy of the situation. Recommendations are presented to enable nurses to address these ethical dilemmas and to become more actively involved in the decision-making process.
This study analyzed the pledges received from all U.S. medical schools accredited in 1989 by the Liaison Committee on Medical Education of both the Association of American Medical Colleges and the American Medical Association to determine what pledges were affirmed and what ethical principles they contained. The Oath of Hippocrates was the most frequently affirmed pledge (the wording of which was used by 60 schools). Few oaths clearly demonstrated respect for patients' autonomy. The principle of veracity was not evident in any oath. However, nonmaleficence, beneficence, and justice were evident in half of the pledges, and confidentiality was included in three-fourths of them. The authors conclude that the medical oaths failed to address the changing doctor-patient relationship emerging in the 1990s, whereas they continued to affirm traditional principles of nonmaleficence and beneficence.
Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stigma might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed.
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Surrogate mothering is an arrangement whereby a woman who gives birth to an infant intends--through a contractual agreement--to give that baby to another couple. The recent Baby M case in the United States has raised numerous legal concerns causing many legislative bodies to consider possible statutes to regulate or prohibit surrogacy. The competing interests among and between the individuals involved in this relationship (i.e., the surrogate mother, the couple, the baby, and society) suggest various ethical issues related to benefits, risks, and autonomy. Legal and ethical concerns surrounding the technologically possible procedure of surrogate motherhood are discussed.
Conflict of interest is an issue not only for business leaders, government officials, and researchers, but also academicians. As an ethical issue, conflict of interest involves competing interests as well as raises questions related to an individual's integrity. A case is used to discuss these ethical issues in the academic setting. Recommendations are provided to prevent, reduce, or avoid these ethical tensions, with particular attention to the development of policies to support institutional and, thereby, personal and professional relationships among faculty and students.
Home health nurses are not immune to ethical dilemmas in their practices. In fact, the ethical dilemmas that are encountered in home health present a unique challenge to these nurses because of the relationship of the home care agency to the patient.
The process of ethical decision making does not differ according to the patient care setting. However, various factors in home care affect the way in which decisions are made. The factors to consider are the amount of time needed to make a decision, the involvement of the patient and family, the need for support systems, the difficulties with interdisciplinary communication, and the lack of an ethics committee. Recognizing the ways in which these variables affect the decision making can help home healthcare nurses resolve the ethical dilemmas they face. In addition, staff education programs, the use of consultants, and the development of ethics committees are possible strategies to facilitate ethical decision making.
Nurses are patient advocates who often feel powerless when implementing that role in ethical situations. One strategy to empower nurses in their advocacy role is the development and use of nursing ethics committees within health care institutions.
Even though the Code for Nurses calls for nurses to provide nondiscriminatory care and to treat patients with respect, research shows that nurses (1) are reluctant to provide care to and (2) believe that they should have the right to refuse to care for patients with AIDS. This article presents two contrasting situations and focuses on the ethical principle of respect for persons. Nurses need to examine their own practice to determine if they are providing care that respects the uniqueness and rights of their patients.
Nurses regularly are faced with ethical situations in their practice. Despite potentially having had as part of their educational programs an ethics course or specific classes addressing ethical issues, many nurses still feel ill-equipped when ethical dilemmas occur. This article discusses the Code for Nurses as a resource that nurses can use for determining the appropriate action(s) when an ethical dilemma arises.
Patients are asked to give informed consent for both treatment and research protocols. Yet, is their consent really informed? This article focuses on the information component of informed consent. The author discusses informed consent as it relates to the ethical principle of respect for autonomy, presents nurses' perceptions of informed consent, and makes several recommendations that nurses can use to ensure that consent is informed.
Individuals who participate in treatment or research protocols should perceive that their decision is a free choice and that they are acting of their own accord. However, these persons may feel as if they are being pressured to participate in the protocol being described. The author discusses the two components of consent: voluntariness and authorization and offers suggestions to nurses to fulfill their moral responsibility to be patient advocates.
Our society supports the right of its members to be self-determining and to make decisions based on their personal values and beliefs. However, what happens when a person lacks the capacity to make decisions? The author identifies criteria for determining decision-making capacity and discusses the surrogate decision maker, the best interests standard, and the substituted judgment standard. Nursing implications focusing on treating the patient with dignity and respect and protecting the patient's rights are discussed.
The goal of managed care is to control health care costs by such means as keeping people healthy and decreasing the length of hospital stays. This change in health care delivery has resulted in work redesign programs, lay-offs, cross-training, and the use of an increasing number of nonprofessional care providers. The challenge for nursing, as a result of these changes, is how to fulfill its obligations of fidelity and due care. The authors discuss these ethical responsibilities and the impact that managed care is having on the fiduciary relationship between nurse and patient. Four strategies that nurses can use to fulfill their obligations include engaging in personal reflection, communicating and collaborating, protecting patient's rights, and evaluating patient outcomes.
This article discusses anencephalic infants as potential sources of organs for infants and young children. Ethical issues relating to screening pregnant women, parental consent for organ donation, and the postnatal care of anencephalic infants are addressed. Professional responsibilities are identified to enable nurses to act ethically when confronted by these issues in caring for mothers and their infants.
Vaginal birth after cesarean is still an uncommon practice in the United States despite fewer contraindications to it. This article examines issues related to cesarean section practice patterns, malpractice, rising health care costs, changing childbearing patterns, and risks and benefits to mother and baby. Implications for nurses are discussed as they relate to nursing education, practice, and research.