Biomedical subjects

J A Erlen

Publications and source records attributed to J A Erlen.

At least 37 records · Page 2Linked to original sources

PubMed1987

The child's choice: an essential component in treatment decisions.

Asking children for their opinions about and input into treatment decisions is an idea whose time has come. One way to implement this notion with school-aged children and adolescents is through the Participation in Treatment Decisions Model. This model is based on a child's rights and recognizes the varying levels of cognitive development and competency in children. Health professionals have a responsibility to be advocates for child patients, to protect their interests, values, and rights, and to include them in decisions affecting their health.

Adolescent↗

PubMedDate not supplied

Conflict of interest: its relationship to integrity in the academic setting.

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.

Conflict of Interest↗

PubMedDate not supplied

Adherence to combination therapy in persons living with HIV: balancing the hardships and the blessings.

Evidence from clinical trials demonstrates the benefits of combination therapy in persons living with HIV (PLWHIV); however, there is little information about the patient's experience when taking a complex regimen. Thus, the primary purpose of this preliminary study was to describe the everyday experience of PLWHIV who were prescribed combination therapy in order to identify a potential intervention to enhance adherence to this regimen. The secondary purpose was to examine the association between adherence to combination therapy and quality of life. The researchers purposively sampled six PLWHIV (two women and four men) to reflect the diverse demographic characteristics of the population of PLWHIV. The themes that evolved were decision making, difficulties, problem solving, and quality of life. Clinical indicators provide only one measure of the effectiveness of combination therapy. When the informants described the outcome of this therapy as "having their life back," they spoke of having quality in their lives that they viewed as more than their physical health.

Adaptation, Psychological↗

PubMedDate not supplied

HIV, self-transcendence, and quality of life.

Self-transcendence is a developmental characteristic that expands one's boundaries of the self to take on broader life perspectives, activities, and purposes that help one discover or make meaning of one's life. However, no quantitative studies were found in the research literature that focused on self-transcendence or on the relationship between self-transcendence and quality of life in people infected with HIV. To examine these variables in this population, 46 HIV-positive subjects completed Reed's Self-Transcendence Scale and Ferrans and Powers' Quality of Life Index. The results demonstrated that overall self-transcendence for this sample was relatively high; quality of life was higher than that reported in previous research; and there were some significant group differences among the three HIV clinical categories.

Adaptation, Psychological↗

PubMedDate not supplied

Multiple authorship: issues and recommendations.

The increase in multidisciplinary research has led to a subsequent expansion of multiple authored articles in nursing as well as other disciplines. Although there are benefits to multiple authorship, there also are areas of possible conflict. The lack of adequate guidelines to address issues that may arise from multiple authorship heightens the possibility of disputes. Developing a blueprint for the preparation and presentation of papers emanating from a research team's work early in the project can avoid conflicts and ensure that the efforts of the appropriate individuals are reflected in the publications. This article discusses several issues related to authorship, including the assignment of authorship credit, the increased pressures to publish, and the complexity of authorship issues associated with multisite studies. The authors offer recommendations to reduce problems that may arise among members of a research team because of authorship issues. In addition, they include the guidelines that their multidisciplinary research team developed early in their project.

Authorship↗

PubMedDate not supplied

Making an ethical decision in the home setting: the case of Stan.

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.

Aged↗

PubMedDate not supplied

Factors influencing ethical decision making in the home setting.

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.

Aged↗

PubMedDate not supplied

Empowering nurses through nursing ethics committees.

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.

Ethics Committees↗

PubMedDate not supplied

Respect for persons: the patient with AIDS.

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.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

The code for nurses: guidelines for ethical practice.

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.

American Nurses' Association↗

PubMedDate not supplied

Informed consent: the information component.

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.

Comprehension↗

PubMedDate not supplied

Informed consent: the consent component.

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.

Choice Behavior↗

PubMedDate not supplied

When the patient lacks decision-making capacity.

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.

Aged↗

PubMedDate not supplied

Managed care and the nurse's ethical obligations to patients.

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.

Beneficence↗

PubMedDate not supplied

Issues at the end of life.

A recent study by David Asch reported in the New England Journal of Medicine has intensified discussions about euthanasia and assisted suicide. That investigation has prompted nurses and other health care providers to raise questions about what is appropriate care for dying patients. To that end, this article provides an overview of relevant issues for nurses to consider when patients are at the end of life: quality of life, suffering, pain management, double effect, respect for autonomy, and trust and nonabandonment. Understanding these issues and enhancing communication between and among all relevant individuals when treatment decisions are being made will enable nurses to provide appropriate patient care at the end of life.

Ethics, Nursing↗

PubMedDate not supplied

Clinical research: what do patients understand?

An increasing amount of clinical research is being conducted to test the efficacy and effectiveness of new medications, therapies, and medical procedures. These studies often require that patients be invited to be subjects. However, what do patients really understand whenever they are asked to participate in clinical research? Are patients aware that research is clearly different from treatment? Are they aware that their participation in research is to benefit future patients? Despite the desire of clinical agencies to support research, there is the concern about how they can best protect the rights of patients who are subjects in this research. The author briefly discusses clinical research, patients as vulnerable subjects, the therapeutic misconception, and informed consent. In addition, recommendations are provided to help assure that the rights of patients who are research subjects are protected.

Attitude to Health↗

PubMedDate not supplied

When the family asks, 'what happened?'.

Because of the high level of acuity of hospitalized patients, untoward events can and do occur. Very often, nurses develop a caring relationship with the families of these patients. As a result, the family may approach the nurse about this negative turn of events. The questions that the family raises may create an ethical dilemma for the nurse. The nurse may wonder how to respond, feel powerless and "caught in the middle," and experience moral distress because of constraints in the health care system. This article discusses the ethical perspective of caring and the "nurse in the middle" phenomenon. Several strategies to help nurses manage this issue include consulting with a mentor, consulting with the institutional ethics committee, and promoting an ethical climate within the health care setting.

Communication↗

PubMedDate not supplied

Moral distress: a pervasive problem.

The shortage of nurses and the flaws within the structure of the current health care system are compromising the nurse's ability to provide competent, compassionate care. Nurses are increasingly disturbed because they see themselves as ineffective advocates for their patients. Nurses, unable to take the appropriate ethical actions, feel paralyzed by their situation. The author's recent conversations with staff nurses about their clinical practice suggest that moral distress has become a very pervasive problem. The purpose of this article is to describe ethical practice, moral distress, the imbalance of power, and the nature of an ethical environment. There is a discussion of potential strategies that will help to create and maintain an ethical environment thereby reducing moral distress such as facilitating dialogue, developing a support system, providing opportunities for professional development, and developing and revising institutional policies.

Ethics↗