Biomedical subjects
Publications and source records attributed to S T Fry.
In 1996, the Visiting Nurse Association of Boston established an Ethics Advisory Committee to address ethical issues that arise in patient care. This article describes the Committee's development from implementation of an ethics education plan for agency staff, to policy recommendations and consultation for ethical conflicts in patient care. Whether developing an ethics committee or evaluating your current one, this article can be helpful.
PURPOSE: To describe the Ethical Issues Scale (EIS), its conceptual development and psychometric evaluation, and its uses in determining how frequently nurses experience ethical issues in practice. DESIGN: The EIS was validated with a sample (N = 2,090) of New England registered nurses (RNs) currently in practice. The sample was randomly split into two approximately equal samples. The calibration sample was used to derive the underlying components; the validation sample was used to confirm the component structure. METHODS: Psychometric analysis of the 35-item EIS included: (a) item analysis, (b) confirmatory principal components analysis (PCA), and (c) internal consistency reliability using Cronbach's alpha. RESULTS: Three components (end-of-life-treatment issues, patient care issues, and human rights issues) were demonstrated, confirming the original conceptually-derived structure. The calibration sample accounted for 42.4% of initially extracted common variance; the validation sample accounted for 41.5% of initially extracted common variance. CONCLUSIONS: The three EIS subscales had satisfactory internal consistency reliability and factorial validity for use as independent scales in future studies.
The purpose of this article is to report what can be learned about nurses' ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as 'moral distress', the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse's advocacy role for patients.
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Decisions that are made near the end of life include consideration of withholding or withdrawing nutrition and/or hydration. These decisions present ethical challenges to health care providers who are caring for terminally ill patients. Clinical studies published during the last twenty years provide empirical data about the many factors that influence these decisions. The purpose of this systematic literature review is to synthesize the research findings related to provider decisions about withholding or withdrawing nutrition and/or hydration in adult patient care. The clinical, educational, and ethical implications of these decisions are proposed.
End-of-life decisions that focus on withholding or withdrawing nutrition and/or hydration present difficult choices at particularly vulnerable times for patients and families. Clinical ethics studies published in the last twenty years provide insight about the decision making process that can be useful to all parties involved. The purpose of the systematic research review is to synthesize empirical data about patient/surrogate decision making related to withholding or withdrawing nutritional sustenance toward the end of life, and contextual factors that influence their decision making. Future topics for clinical ethics research and clinical practice implications are posed.
The purpose of this article is to provide an overview of the philosophy of nursing. First, the ontological, epistemological, and ethical issues that comprise the field of inquiry are identified. Second, we discuss how some of these issues are being addressed as demonstrated by the articles in this issue of Scholarly Inquiry for Nursing Practice. Finally, suggestions are made for the further development of the philosophy of nursing in the 21st century.
The purpose of this study was to identify types of ethical conflicts reported by certified diabetes educators who are also registered nurses (RN/CDEs) and to examine their relationship with demographic, educational and practice setting variables. This study is a replication of an earlier pilot study. Ethical conflicts expressed by RN/CDEs in active practice in New York and Pennsylvania were analysed according to four themes. Disagreement with medical practice was by far the most dominant clinical context for the conflicts (61%), as it had been in the pilot study (75%). Participants believed that 32% of the ethical conflicts were resolved. Ethics committees and consultants were very rarely used. Of the relationships between the kinds of conflicts and their resolution, and demographic, educational and practice setting variables of the participants, only kind of position was significantly (P < 0.005) related to practice context of the ethical conflict.
OBJECTIVE: To provide an overview of the ethical and social concerns that are raised by the use of new genetic tests in asymptomatic persons. DATA SOURCES: Review articles, research studies and legislation related to genetic testing. CONCLUSIONS: Predisposition and presymptomatic testing is possible to any age for adult onset disorders if a mutation is known. Testing without early effective interventions is controversial, especially prenatally and in children. Issues of privacy, discrimination, stigmatization and emotional stress are potential problems. Informed consent is essential before deciding to test. Awareness of the implications of testing can enhance the nurse's advocacy role. IMPLICATIONS FOR NURSING PRACTICE: More studies are necessary to identify the impact of presymptomatic testing on adults and children. Nursing research to identify the family concerns, and to develop effective educational, counseling, and supportive interventions would make a valuable contribution.
OBJECTIVE: The purpose of the investigators was to describe and classify ethical conflicts experienced by Certified Nephrology Nurses (CNNs) practicing in dialysis settings in four eastern states and the District of Columbia, and to explore associated demographic, educational, and practice setting factors associated with these ethical conflicts. DESIGN: A descriptive survey design was used. SAMPLE/SETTING: All members of the American Nephrology Nurses Association (ANNA) who were CNNs working in Maryland, Virginia, and the District of Columbia, and a random sample of those in New York State and Pennsylvania were contacted. METHODS: Those CNNs working in dialysis settings were asked to complete the Demographic Data Form and the Moral Conflict Questionnaire developed by Fry (1990). Eighty-eight met inclusion criteria, agreed to participate, and described ethical conflicts. RESULTS: By far the most common practice context for the described ethical conflicts were decisions about discontinuation or initiation of dialysis (69%). Participants were clear about the moral problem and ethical principles involved. CONCLUSIONS: Participants reported being involved in serious ethical conflicts about patient care. Since two-thirds were not resolved, further research should investigate whether existing mechanisms in practice settings for resolution of ethical conflicts are not working or are not being used by nurses.
The purpose of this study was to identify the ethics and human rights issues encountered by Maryland perioperative nurses in their practice. The most frequently occurring issues, the most disturbing issues, and content for ethics education are identified. Implications for education, management, and future research are presented.
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Observational and interview data obtained from nurse caregivers and family members of patients with late-stage Alzheimer's disease were analyzed to explicate the nursing role in advance proxy planning. A four-phase model, Achieving Consensus: Decision Making to Determine Treatment Options for Patients with Alzheimer's Disease, was developed. Patient decline, family coping, professional development of nursing staff, and nursing unit philosophy were community characteristics found to be important antecedents to the process of reaching consensus. Achieving consensus constructs included interactive process components of patient, family, and staff adjustment, caring, and knowing. Timing and trust were influential catalysts to family and staff readiness factors for achieving consensus. Outcomes were the advice provided by staff and the family conference where treatment options were determined. Consequences included the advance proxy plan and patient care.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The development of nursing ethics as a field of inquiry has largely paralleled developments within the field of biomedical ethics. However, there is growing evidence that the development of a theory of nursing ethics might not necessarily follow a similar pattern. The value foundations of nursing ethics are derived from the nature of the nurse-patient relationship instead of from models of patient good, rights-based notions of autonomy, or the social contract of professional practice as articulated in prominent theories of medical ethics. The value foundations of nursing are analyzed, and a moral-point-of-view theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics.
A number of ethical issues have been created by the possibility of transplanting organs from anencephalic infants to other children who need an organ in order to live. The issues of moral justification of the practice, adequacy of informed consent procedures involved, and the potential constraints on female integrity are explored and the relevant arguments for and against transplantation efforts are discussed. Nurses are encouraged to become knowledgeable about the issues and to enter into public discussion of the issues as policy initiatives are proposed.