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Biomedical subjects

P Crisham

Publications and source records attributed to P Crisham.

14 recordsLinked to original sources
PubMed1996

Health care management of children with cognitive and physical disabilities: to treat or not to treat.

Advanced medical technology has provided life support and maintenance for high risk infants. In dramatically increasing numbers, children surviving aggressive intervention as neonates and infants suffer from varying degrees of physical and mental disability. Once these children are stable and grow older difficult medical intervention decisions need to be made. As nurses, we are often in situations involving difficult treatment decisions made by the family and health care team. We need to be aware of our personal beliefs and ethical principles to effectively support family members and participate in decision making. Ethical principles serve as a guide to the decision making process.

Child↗
PubMed1989

Multi-course sequential learning as a model for content integration: ethics as a prototype.

Multi-course sequential learning (MCSL), a model for integrating content throughout the curriculum, is described using ethics education as a prototype. In this model, content is presented via a vertical course, with units embedded in existing courses across various levels of the nursing program, which is designed to provide coherent organization of content, visibility, and accountability, and to prevent gaps and unnecessary duplication. This article describes the process of developing an Ethics MCSL, which is being implemented and evaluated with support from a three-year grant from the Fund for the Improvement of Postsecondary Education (FIPSE).

Curriculum↗
PubMed1989

Developing case situations for ethics education in nursing.

Developing cases for the clinical teaching of ethics can be extremely time-consuming. Often, the cases that are developed either represent unrealistic situations or mere technical puzzles rather than genuine ethical problems. This article describes how faculty at the University of Minnesota modified a simple, quick and inexpensive think tank technique, the Crawford Slip Method, for use with nursing educators to generate an extensive list of ethical issues within each clinical specialty. Selecting from these lists, faculty in each specialty developed one realistic nursing case situation to illustrate selected ethical issues. Faculty were asked to use the Alverno College criteria for designing a moral dilemma when writing their cases. Suggestions for adapting the cases for multiple uses are presented.

Education, Nursing↗
PubMed1989

Wrestling with the larger picture: placing ethical behavior in clinical situations in context.

This article provides an account of the use of a model-building process as an educational strategy for the teaching of ethics. Designed to integrate students' growing knowledge and skill in nursing with their intellectual and professional development, this model-building process has its theoretical foundations in cognitive moral development theory, and in an integrative approach to nursing education called Multi-Course Sequential Learning (MCSL).

Clinical Competence↗
PubMedDate not supplied

The basic nature of ethical problems experienced by persons with acquired immunodeficiency syndrome: implications for nursing ethics education and practice.

The purpose of this research was to describe and examine the basic nature of ethical problems that are experienced by persons with acquired immunodeficiency syndrome (AIDS). The participants were 25 persons with AIDS and 5 significant persons, not infected with the human immunodeficiency virus, who provided contextual understanding. The conceptual framework and method combined ethical inquiry and phenomenology. During an in-depth audiotaped interview, each participant answered the question, "What situation involving AIDS has caused you the most conflict about the right thing to do?" To assure scientific adequacy, the participant validated the analysis of the first interview in a second interview 2 weeks later, and five experts and two independent judges validated the combined analyses. From 117 ethical problems emerged a basic nature consisting of (1) conflict of values about what to believe, who to be, and what to do; (2) resolutions based on intuitive beliefs, desire to be a good person, and rational choice; and (3) rationale revolving around a desire for integrity and meaning. The findings suggest strategies for improving nursing ethics education and, ultimately, nursing practice: (1) base content on ethics research and philosophical analysis, (2) address real-life ethical problems, (3) discuss virtue ethics in addition to principled thinking and ethical caring, and (4) teach ethical listening.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Development and operation of a program to obtain volunteer bone marrow donors unrelated to the patient.

Because of recent increases in bone marrow transplantation, the lack of available matched sibling donors has become a problem. This study investigated the feasibility of obtaining volunteer bone marrow donors unrelated to the patient. A program was developed to inform potential donors and obtain their consent for listing in a bone marrow donor registry. Sixty-six percent of whole blood or apheresis donors agreed to participate in the program. There were no demographic differences between those who accepted or declined to participate. Religion, experiences with medical practices, and the attitude of the potential donor's spouse were important factors in the decision to participate. A search for donors was initiated for 127 patients. Thirty searches were not completed, primarily because of patient-related problems. A total of 713 HLA-A and -B antigen-identical donors was located for 63 of the 97 (65%) patients. A total of 40 HLA-A, -B, and -DR antigen-identical donors was located for 18 of these 63 patients. Six of these 18 patients then had one or more donors (total, 9) whose lymphocytes did not react in mixed lymphocyte culture. Thus, using the file of 2147 donors, an HLA-identical donor was located for 6 percent of the 97 patients. None of these patients has yet received a transplant; in four cases this was due to patient-related and in two cases donor-related reasons. The cost to establish the donor program averaged $33.46 (1984) per donor for donors already typed for HLA-A and -B antigens. This experience indicated that, given thorough information about bone marrow donation and transplantation, a majority of blood and apheresis donors will volunteer to donate bone marrow, without feeling pressure to do so. A relatively small donor file provided donors for 6 percent of patients. The long-term value of bone marrow transplantation using unrelated donors and the optimum size of the donor file remain to be established.

Adult↗
PubMedDate not supplied

Challenging misperceptions about nurses' moral reasoning.

Discussions in the nursing literature about the usefulness of Kohlberg's theory of moral reasoning for women and nurses, and assertions about the level of moral reasoning scores of nurses have been clouded by inaccuracies and misperceptions. In this article, theoretical and measurement issues related to moral reasoning are clarified and a critical review of the literature is provided about the moral reasoning of nursing students and nurses as measured by the Defining Issues Test (DIT). The review indicates the need for greater rigor in studies of moral reasoning among nurses and the need for accuracy in interpreting and reporting moral reasoning scores. The data show that the moral reasoning of nurses, like that of other groups, tends to increase with formal education. Nurses' scores are usually comparable to, and sometimes higher than, scores of their academic peers.

Ethics, Nursing↗
PubMedDate not supplied

Measuring moral judgment in nursing dilemmas.

Based on cognitive theory of moral development, this research investigated the difference between nurses' responses to general, hypothetical moral dilemmas and their responses to real-life nursing dilemmas. The purpose of the research was to: identify recurrent moral dilemmas experienced by staff nurses; develop an instrument (Nursing Dilemma Test [NDT]) to measure nurses' responses to nursing dilemmas and the importance given to moral issues and practical considerations; relate staff nurses' responses to nursing dilemmas in the NDT and responses to hypothetical moral dilemmas in the Defining Issues Test to two subject variables (level of nursing education and length of clinical nursing experience); and compare moral judgments, both hypothetical general and nursing specific, of five subject groups (N = 225): staff nurses with associate degrees (57) and baccalaureate degrees (85) in nursing, nurses with masters degrees in nursing (10), college junior prenurses (36), and graduate level nonnurses (37). Findings verified the significance of formal education and previous involvement with similar dilemmas in enhancing principled thinking and raised questions about the relative strength of practical considerations in the hospital milieu.

Adult↗
PubMedDate not supplied

The content of ethical problems experienced by persons with AIDS.

The purpose of this research was to describe and examine the basic nature (essences) and content (subject-matter) of ethical problems involving AIDS that are experienced by persons with AIDS (PWAs). The participants were 25 PWAs and 5 significant others, the latter included to provide contextual understanding. During audiotaped interviews, the PWAs described 45 different ethical problems from which emerged a three-component basic nature and 10 content categories. This paper reports the content categories. The findings provide understanding of the content of PWAs' ethical problems and suggest the importance of ethical listening as an independent nursing intervention.

Acquired Immunodeficiency Syndrome↗