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PubMed2003

Nurse supervisors' actions in relation to their decision-making style and ethical approach to clinical supervision.

AIM: The aim of the study was to explore the decision-making style and ethical approach of nurse supervisors by focusing on their priorities and interventions in the supervision process. BACKGROUND: Clinical supervision promotes ethical awareness and behaviour in the nursing profession. METHODS: A focus group comprised of four clinical nurse supervisors with considerable experience was studied using qualitative hermeneutic content analysis. FINDINGS: The essence of the nurse supervisors' decision-making style is deliberations and priorities. The nurse supervisors' willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors' ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors' interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings. CONCLUSION: Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees' professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.

Decision Making↗

PubMed1997

Leadership in British nursing: a historical dimension.

A historical overview of nurse leadership in the late 19th and late 20th centuries is presented, supported by relevant material from the literature. The 19th century material revealed the following main themes: emphasis on practical and domestic aspects of management; prominent input of religious ideals and social conscience and, autocratic and feminized style of leadership. The main themes in the contemporary literature examined were: role models in history, dysfunctional leadership styles, importance of knowledge, gender as an influencing factor on nurse leadership and threats to the autonomy of nurse leaders. It was concluded that formal nurse professionalization has progressed steadily during the past hundred years with associated evolution of nurse leaders to fit in with contemporary needs. It is hoped that future policies for nursing will encourage decision-making nearer the 'bed-side', more resource-driven care and value-based leadership.

Christianity↗

PubMed2002

Non-incarcerated psychopaths: why we need to know more about the psychopaths who live amongst us.

On 1 November 2000, Robert Stewart, aged 20, was jailed for life for bludgeoning to death his Asian cellmate, Zahid Mubarek, aged 19 years because 'he felt like it'. During the court hearing the term 'psychopathic personality' was used in relation to Stewart and, following this and other similar cases, the average man or woman could be forgiven for believing that psychopathy is inextricably linked with dangerousness and criminality. In the light of the Government consultation paper entitled Managing Dangerous People with Personality Disorder. Proposals for Policy Development and the Government White Paper Reforming the Mental Health Act -- Part II: High-risk patients, this article proposes that whilst studies conducted with incarcerated psychopaths will continue to increase our knowledge and understanding of criminality, non-incarcerated psychopaths have an arguably equal potential to illuminate our understanding of the emotional difficulties, such as lack of empathy and lack of conscience, which underlie psychopathy and which lead to offending behaviour. Although a range of obstacles have hindered progress in this field of study, this paper proposes that developing an understanding of the nature of the emotional difficulties of the psychopath, unconfounded by criminality, has the potential to make a valuable contribution to the field of child psychiatry in ways which have implications for mental health nurses and society as a whole. It theorizes that if the psychological constructs which underlie psychopathy were better understood, children who display those emotional difficulties could be more accurately identified and strategies be generated which carry the ultimate aim of minimizing the risk of those children developing the offending behaviour associated with psychopathy.

Adult↗

PubMed1992

Selective termination to a singleton pregnancy is ethically justified.

Consensus presently opposes selective termination of a multifetal pregnancy to a singleton. We reject this consensus because the arguments made in defense of it are deficient. We show that these arguments rely on the indefensible assumption that the previable fetus possesses independent moral status. We conclude that, since selective termination of a multifetal pregnancy of any order to a singleton is ethically justifiable, a pregnant woman's request for selective termination to a singleton from twins or a higher-order multiple gestation should be respected and implemented. Physicians who object to selective termination to a singleton in private conscience should not feel compelled to perform the procedure but are obligated to make an appropriate referral.

Journal Article↗

PubMed2006

The ethics of cesarean section by choice.

In responding to patient requests for cesarean section, physicians must consider ethical principles. Obstetricians have autonomy and beneficence-based obligations to the mother, and the mother and the obstetrician have beneficence-based obligations to the fetus. Maternal autonomy is usually accepted as the most compelling ethical canon. However, the physician has a right to refuse requests. Thus, when a patient requests surgery, the physician may attempt to dissuade her and failing that either acquiesce or, feeling that professional conscience would not allow him/her to honor that request, refuse. Which choice is made should reflect the provider's believe about the strength of the supporting data. Given the need to recognize patient autonomy, to respect patient values even as one tries to motivate patients to work toward the highest health values, and to acknowledge women's primacy as fetal champions, a physician should be loathe to refuse unless the data regarding cesarean section by choice are wholly tilted away from maternal-child interests. If the data are in the realm of equipoise, even if not at the tipping point, discussing options, attempting to dissuade patients but ultimately acquiescing to their judgment would not be incompatible with obstetrical ethics.

Cesarean Section↗

PubMed2001

Focus groups as a tool for critical social research in nurse education.

Focus groups are now widely adopted in qualitative health and social research, and have been increasingly used as a data-collection technique in nursing research. The focus group is not a new method, but its uses and procedures have been considerably revised in recent years. The aim of this paper is to present an overview of the focus group as a research tool in social science literature, followed by a more considered discussion on the use of focus groups in contemporary critical social science. It draws on this work to illustrate the potential of focus groups to address some of the political issues in social research, in particular the balance of power between researcher and researched, and the empowerment of under-represented groups. Advantages of the method in connecting the researcher with group perspectives and experiences that may be unexplored by other methods of data collection are discussed, and the 'collective conscience' is put forward as an appropriate resource in data analysis. It argues that the application of focus-group techniques can build on experiences and principles of working with or participating in groups. Focus groups are particularly applicable to research in nurse education, for involving diverse stakeholders in curriculum evaluation and development, and in ongoing appraisals of the student's perceptions of their experience, for which universities have tended to rely on survey approaches and structured questionnaires. The article ends by drawing some conclusions from the health and social research literature to inform nursing education research using focus groups.

Focus Groups↗

PubMed2000

[Negative delusional identity with schizophrenic psychoses. Case studies of phemonology and pathogenesis].

With schizophrenics negative delusional identities constitute one way of psychotic alteration of self-identification. The main notion is of being a personification of evil. In a cross-cultural comparison study we found in the Austrian sample 13 patients with negative delusional identities. Our present study is based on detailed interviews and evaluations of medical records of this sample. Our aim was to draft a typology of delusional identities as a basic requirement for a phenomenology of the negative manifestations. Further investigative goals were the efforts of self-explanation undertaken by the patients with regard to their altered condition, the search for a pathogenetic transitional series and the functional value of the new identities. According to our estimation the basic mood on which negative delusional identities are founded is timid and dejected. Further basic requirements are a disturbed conscience of the ego and the concurrence of grandeur and guilt ideas. Half of our patients imagined to be reincarnations of negative biblical figures, three regarded themselves as possessed, two attributed their identities to heredity. Despite of diverse situative points of departure a common pathogenetic transitional series emerged for all patients. From a functional point of view a negative delusional identity seems to offer some kind of protection from further structural disintegration as well as relief from feelings of guilt--all that however at the price of structural deformations with dynamic depletion.

Adult↗

PubMed2001

[Concepts of quality assurance in obstetrics and gynecology].

The safeguarding of quality has reached an essential position in medical area. The creation of corresponding concepts with definition of tasks for quality assessment is one of the most important challenges for public health organizations and politicians. The still established projects in gynecology and obstetrics in Germany now carried out that the conscience for the necessity of quality safeguarding is in high gear.A summary of the quality safeguarding projects and tools is given.

Female↗

PubMed1986

[Prognosis of cardiogenic cerebral embolism].

In a retrospective study the reports of 211 cases of cardiogenic cerebral embolism--diagnosed on the base of neurological and cardiological findings--were analyzed in view of signs and findings of prognostic value. There were 21 patients with TIA, 39 cases of RIND and 151 patients with cerebral infarction, 60 of which showed mild and 91 severe neurological symptoms. 38 patients died during the period of hospitalization. While sex of the patients as well as vascular risk factors (hypertension, diabetes mellitus, cigarette smoking) did not influence the clinical course of the disease, patients with TIA or RIND in general were younger (about 5 years) than those with severe stroke. Prognosis of cardiogenic cerebral embolism depended to a great degree on the underlying heart disease. Cerebral embolism after myocardial infarction showed a better remission of symptoms than embolism in atrial fibrillation. In the group of valvular diseases the course of embolic strokes in mitral lesions was worse than in aortal valve disease. Prognosis was worst in endocarditis, both in view of neurological deficit and of mortality. Mostly, the cardiogenic emboli lead to infarctions of the middle cerebral artery territory (78 per cent) with a predilection for the left hemisphere. In media-syndromes the clinical course was significantly worse in patients with additional homonymous visual defect compared to incomplete infarctions. Initial disturbance of conscience reduced prognosis quoad vitam et restitutionem significantly. Of the neuroradiological findings, the detection of arterial occlusion or circulatory disturbance in angiography as well as the finding of an ischemic lesion in computed axial tomography (CAT) was correlated with a severe course of the embolic stroke. While 7 patients with hemorrhagic infarction in CAT-Scan showed no differences in the clinical course, the 14 patients with pathological cerebral spinal fluid findings in embolism had an unfavourable prognosis. The development of epileptic seizures did not influence the further course of the infarction to a significant extent. Results are compared with the current world literature.

Cerebral Infarction↗

PubMed1981

[Amnesia and closed craniocerebral injury. A clinical study of 82 cases].

In this investigation 82 patients with various head traumas are examined with respect to time and duration of retrograde, congrade and anterograde amnesia, especially the dependence of their duration on the severity of trauma. The more severe the trauma, the longer the duration of all forms of amnesia, the retrograde being the shorter whether there is a loss of conscience (congrade amnesia) or not. A tendency of amnesias to shrink could only be examined following mild brain trauma and occurred seldom. Our findings suggest that short amnesias have less tendency to shrink than long ones. The distribution of amnesias support cybernetic memory models. As a consequence of our findings we give recommendations for the clinical evaluation of patients with head-brain trauma.

Adolescent↗

PubMed1994

[Inhuman practices in gynecology in national socialism and its victims. Study of concrete results].

In our opinion German gynaecology has failed to adequately face what came to pass during the Nazi period. This can be proved objectively, for there is no evidence that, after 1945, gynaecology had in any way cared to take notice--either thermatically or medically--of the thousands of victims of inhuman practices such as forced termination of pregnancy, compulsory sterilisation and the like. During the past 50 years recollections of enforced sterilisations, compulsory abortions, deliberate and hence criminal negligence and problematic approaches in research and teaching were almost completely banished from the area of conscious awareness and largely suppressed or silently ignored. Most of the medical directors of Departments of Gynaecology of German universities shared this view whenever they were questioned on the connections between gynaecology and Nazism. Now that two generations have passed it seems possible to examine and explore with less guilt feelings and shame the immensely fateful rôle of gynaecology in that context. Accent should be on the fate of the victims of that period. To bring back these events to memory, however, does not permit to conceal the part played by the physicians committing of these inhuman Nazi crimes. Data collected from a psychosomatically oriented examination of victims exemplify that to concretely recall gynaecology during Nazism a1-so offers a chance in several respects. One of the possibilities in this context is to signal "late apology" and regret to patients who had been victims, in one's own area of work, after one has psychically worked over their fate. Besides, a gynaecological-psychosomatic expertise will help e.g. that compulsorily sterilised women are granted financial aid that has at long last become a legal possibility and can be applied for since 1980. However, the relevant patient records do show very clearly that the inhuman practice of gynaecology during the so-called "Third Reich" was not only a collective problem but equally due to a failure of the individual conscience of numerous gynaecologists. Working over this complex may enhance our own sensitivity for psychosomatic and ethic problems and counteract any likelihood of a recurrence of an inhuman gynaecology.

Abortion, Illegal↗

PubMed1985

[New life: God's call--human responsibility].

After considering the relationship between ethical principles and their concretization in the decision of the conscience, the author names human dignity as a formal principle, and tutiorism as a material principle in the face of the beginning and end of human life. The debate which has flared up in the Federal Republic of Germany concerning abortion may be illustrated by the diverse stances adopted by bishops, physicians, legal experts and women toward the statutory provisions. A number of suggestions for help of a general nature, based on the commandment to love, and for concrete action, follow. These find their final expression in 12 synoptic theses.

Abortion, Legal↗

PubMed1983

[Duty of the gynecologist to inform a pregnant patient about the need for or desirability of amniocentesis].

When a woman above age 35 even a multiparous women asks her obstetrician about the necessity or desirability of a genetic amniocentesis the obstetrician is obliged to inform the patient comprehensively about the risks of amniocentesis and the advantages of amniocentesis. Advantages are detection of chromosomal abnormalities, risks are premature rupture of the membranes or abortion. The obstetricians contract obliges him to recommend or not recommend such tests. If the obstetrician does not give the information to the patient because he is not familiar with the newest scientific standards or because his personal conscience is against amniocentesis because of the possibility of a subsequent eugenic therapeutic abortion the obstetrician must refer the patient to another obstetrician. If the obstetrician does not inform the parents he is liable for the total cost of maintaining a mongoloid infant.

Adult↗

PubMed1996

Oedipal themes in latency. Analysis of the "farmer's daughter" joke.

A sample of "farmer's daughter" jokes, gathered from archives, personal informants, and published collections, is examined in relation to the developmental progress of the latency-age boys who most often tell them. The joke texts are divided into three categories-oedipal triumph, castration, and feminization-each of which represents a different regressive fantasy. Through these fantasied scenarios, the joke teller can safely work through some of the anxieties he experiences as a result of the recent repression of the oedipal conflict. Common themes of latency fantasies such as separation from the family, confusion of gender identity, and incestuous desires are all present in the texts. Repetition of the farmer's daughter joke not only motivates the child's individual psychological progress but also reinforces his or her awareness of taboos and socially appropriate behavior. Because the parental injunctions are internalized to help consolidate superego formation at the onset of latency and the child must now displace incestuous urges with manifestations of conscience, the retesting of values through joke telling is important during this developmental period.

Adolescent↗

PubMedDate not supplied

Sexual morality of Christianity.

After discussing the origin of religion, functions of religion, and the construction of meaning by religion, the author focuses on the connection between religion and anxiety. The permanent anxiety in religion is determined by guilt feelings that arise for example from the violation of norms in the area of sexuality. In a religion at enmity with sexuality, such as Christianity, the satisfaction of sexual desires is considered bad and sinful; the permanent production of anxiety and a guilty conscience are the result of it. Christian sexual suppression leads to the propagation of asceticism as the taming of corrupt sensuality that only religious virtuosi can maintain. One result of asceticism is celibacy, although passages from the Bible demand monogamy for bishops without prohibiting celibacy. In Catholicism, celibacy institutionalizes the enmity with sexuality and causes a permanent depreciation of real sexuality in favor of one projected onto the mother church and the Virgin Mary. A further consequence of asceticism is the reduction of sexuality to reproduction. In the section about the factual consequences of Christian sexual morality, the author connects sexual instinctual gratification with religious affiliation on the basis of an analysis of the sexual behavior of Germans. The weekly frequency rate of sexual intercourse amounts to 3.1 with male and female nondenominationals, 2.6 with Protestants, and 2.3 with Catholics; 39% of nondenominational men, 20% of Protestant men, and 12% of Catholic men in Germany use condoms. The connection of religion and aggression is empirically significant as well. The religiously most active men feel more inclined to use aggression to reach sexual goals than religiously indifferent ones.

Adult↗

PubMed2004

Prescribing viagra in an ethically responsible fashion.

Sildenafil citrate (Viagra) and other newly released pharmaceuticals that assist erectile dysfunction may be one of the most important categories of drugs released in the past decade. Sildenafil is distinctive because it creates a new therapeutic relationship not only between patient and physician, but also with sexual partner(s). Physicians must first evaluate the patient comprehensively, addressing not only erectile function and sexual performance, but overall physical and mental health. Since the drug does impact others, an expanded model for informed consent needs to be considered. Three models to consider include the public health one, ethically justified limits on confidentiality, and a biopsychosocial one. The biopsychosocial model may be preferred because it expands the patient-physician dyad to directly include others. Physicians also need to distinguish between professional, role-related obligations and personal conscience when treating patients whose sexual beliefs and practices differ from their own. Other ethical issues include inappropriate prescribing over the Internet, dealing with unrealistic patient expectations, and fairness in paying for treatment for sexual conditions in both men and women. With these proposed guidelines, physicians can continue to provide steady, reliable guidance for patients while working with yet another scientific advance in medicine.

Counseling↗

PubMedDate not supplied

The condition of health services in the Gaza Strip.

The Association of Israeli and Palestinian Physicians for Human Rights was established during the first months of the uprising, against the background of a severe situation in which people were killed and wounded daily. AIPPHR works for the protection of human dignity and human life; defending physicians and patients in a state of political conflict out of loyalty to the principles of universal morality which constitute an inseparable part of the medical profession. This report, which is the result of months of research and investigation, is aimed, among other purposes, at bringing reliable information to the knowledge of the medical community in Israel and the Israeli Medical Association (IMA)--the body which organizes them. The silence of the medical community in the face of the phenomena described above is foreign to the spirit of doctors and medicine. The association's activity is aimed at creating a change in this situation out of the belief that the silence on the part of a large section of the medical community in Israel stems from a lack of regular and reliable information. In order to describe the situation of the medical services in the Gaza Strip, one must note two contrasting trends: on one hand, there is advancement in the population's health conditions, which is expressed by a decline in the infant mortality rate (from 86/1000 in 1970 to 28.1/1000 in 1988); a decline in the number of cases of whooping cough among children (30.1 in 1970 in contrast to 0 in 1988); and a decline in the number of cases of polio (14.3 in 1970 in contrast to 1 in 1980). On the other hand, the tendency of stagnation must be noted, especially in the development of independent local health services. Medicine in the Gaza Strip has been during the entire period of the occupation, and remains, completely dependent on Israeli medicine. Modern equipment and modern medical technology have been at the service of the residents of the Gaza Strip in Israeli hospitals, but they were not given the chance to develop high-standard medicine in their own hospitals. The Gaza Strip population has no representation at the decision-making level on issues of budget, development and distribution of resources--which are completely in the hands of the Civil Administration and the Israeli authorities. During the uprising there was a steep rise in medical needs. Residents in need of medical services are completely dependent on the decisions of the military government and the state leadership and the giving of these services is tied to political, not medical/professional policy. Since the beginning of the uprising in the Occupied Territories, a new tendency has appeared; the use of medicine as an additional means of repression against the population. This means that medicine has been removed from the status of a basic human right and recruited as a means of punishment. This is a phenomenon which no physician or person of conscience can accept.

Equipment and Supplies↗

PubMedDate not supplied

Why we must leave our organs to others.

Organ procurement presents several ethical concerns (from what constitutes acceptable criteria for death to issues involved in specifically designating to whom an organ can be given), but none is more central than the concern for what are appropriate means for acquiring organs. The following discussion attempts a different perspective on the issue of organ procurement by arguing that, rather than appealing to our charitable consciences or our pocketbooks, relinquishing our organs after death in this day and age is, in fact, obligatory for most people. Each of us is pressed by the growing demand for our organs should we die "rightly," and that desperate need has risen to such a level that not to release our organs for transplantation would constitute a serious moral wrong.

Cadaver↗