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PubMed1993

Ethics in a short white coat: the ethical dilemmas that medical students confront.

Many existing ethics curricula fail to address the subtle yet critical ethical issues that medical students confront daily. The authors report on the kinds of dilemmas students face as clinical clerks, using cases that students submitted in 1991-92 during an innovative and well-received ethics class given at a tertiary care hospital as part of the internal medicine clerkship. Analysis of these cases reveals that many dilemmas are intimately tied to the student's unique role on the medical health care team. Recurring themes included the student's pursuit of experience, differing degrees of knowledge and ignorance among team members, and dealing with disagreement within the hierarchical authority structure of the medical team. The authors conclude that some components of ethical education must be participant-driven and developmentally stage-specific, focusing more attention on the kinds of ethical decisions made by medical students as opposed to those made by residents or practicing physicians.

Aged↗
PubMed1993

Integrity versus misconduct: learning the difference between right and wrong.

This article compares the concepts of scientific misconduct and scientific integrity as a basis for policy guidance, focusing on their relevance for educating scientists. It argues for preferring the concept of integrity, on the grounds that integrity promises positive guidance regarding good conduct in science, while misconduct only identifies prohibited behavior. Integrity provides better guidance for deliberating about what good conduct is in particular circumstances, and it draws upon a motivational source for encouraging good conduct that misconduct ignores. The article also discusses the inherent limitations of appealing to academic freedom as the grounds for protecting scientific practice from unwarranted intrusions. Finally, it explores the educational implications of how professional ethics in science might be conceived in terms of the idea of integrity, including both the merits and the challenges of such an approach.

Academic Medical Centers↗
PubMed1994

Cheating by students: findings, reflections, and remedies.

Cheating among students is surprisingly frequent and may be increasing. The 1991 study reported herein was prompted by an episode of cheating involving three second-year medical students at the University of New Mexico School of Medicine (UNM SOM) and was undertaken (1) to elicit the opinions of faculty members and students at that institution about whether selected descriptions of students' behaviors were unethical; (2) to document possible discrepancies between the opinions of the two groups concerning these behaviors; (3) to define the prevalence of unethical behavior among current students as estimated by faculty and students; and (4) to determine how best to approach future instances of unethical behavior. Questionnaires were distributed to all faculty and students. The first two parts, sent to both groups, concerned reactions to a series of described physician and student behaviors. For each described behavior, respondents were asked whether or not it was unethical and, for the described student behaviors, whether they had personal knowledge of such behavior by local medical students. The third portion of the questionnaire concerned faculty perceptions regarding students' behaviors over time. With the exception of the class involved in the cheating incident, faculty and students were surprisingly similar in their opinions regarding the ethical nature of the described behaviors. According to both faculty and students, there was a significant incidence ( > or = to 10% of the respondents) of unethical behavior at the school of medicine, most commonly in relation to cheating on examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗
PubMed1994

How medical students think about ethical issues.

BACKGROUND: Although bioethics has become an established part of medical school curricula, relatively little is known about how students apply didactic material to clinical problem-solving situations. METHOD: Each of 92 second-year students (54 men and 38 women) at the University of California, Irvine, College of Medicine in 1991-92 wrote a paper identifying and attempting to resolve a clinical ethical dilemma of his or her choice. The papers were then coded for content, use of ethical theories and principles, degree of resolution, and level of personal orientation (i.e., evidence of personal involvement in the dilemmas). Data were analyzed by student sex and age, using chi-square tests of significance and correlational analysis. RESULTS: The students had no difficulty in identifying a range of ethical dilemma. Most students appeared to have understood and become familiar with the major ethical theories and principles currently in use, and to have employed them correctly. A majority of the students were able to successfully resolve their ethical dilemmas. Differences between the men and the women students were found regarding choice of topic, ethical principles used (p = .03), and level of personal orientation (p < .01). CONCLUSION: The women tended to be interested in issues involving broad social perspectives; to favor arguments emphasizing the rights of patients and families; and to incorporate personal responses, as well as abstract theories, in their assays. The men tended to be interested in issues involving personal control, authority, and responsibility; to advocate utilitarian, cost-containment thinking, and to rely exclusively on abstract, logical arguments. Further research should determine whether these differences can be identified in actual clinical decision making, and whether the differences have implications for the nature or quality of clinical decisions.

Attitude↗
PubMedDate not supplied

Do student preceptorships affect moral reasoning?

The author examines the effects of a senior preceptorship course on the moral reasoning of senior nursing students. The findings suggest a broadening gap between education and practice resulting from changes in the health care industry, more specifically, in the acute care facility and a compromise of professional role enactment in the hospital. The author suggests we reconsider the following questions: Is the patient still the first priority in nursing? Is the hospital setting an appropriate placement for nursing students?

Adult↗
PubMedDate not supplied

A different kind of clinical experience: poverty up close and personal.

Nursing faculty are faced with the dilemma of how to teach the complex health and social issues about poverty to students because most nursing students have limited exposure to the impoverished. A seminar-driven clinical experience at a crisis center was implemented to address this challenge. Preclinical and postclinical exposure questions helped both students and faculty alike identify growth in students' awareness of social responsibility, client advocacy, and ethical issues.

Attitude of Health Personnel↗
PubMed2005

How do you measure workforce integrity?

Behavioral hallmarks such as honesty, high ethical standards, and maintained moral principles define workforce integrity. Here, learn methods for integrating them into management practices.

American Nurses' Association↗
PubMed1988

Limitations and alternatives: ethical practice theory in nursing.

Limitations in findings are encountered when a theoretical framework is selected prematurely to guide theory building. Kohlberg's theory, chosen by Ketefian as the framework for an ethical practice theory of nursing may not reflect the life experiences of nurses. While Kohlberg's theory calls for an ethic of justice, Gilligan's research suggests that most women make ethical decisions based on an ethic of care. An alternative to the premature selection of a guiding framework is first to describe the moral decision making of nurses and then to choose the framework that best fits the reality of nursing.

Attitude↗
PubMed1989

Nursing theorizing as an ethical endeavor.

This article addresses the ethical dimensions of nursing theorizing. Nursing theorizing, whether it occurs primarily at the outset or emerges during the process of inquiry, is inescapably linked to the theorist's value choices and beliefs about human beings, the environment, and health. These choices are reflected in the conceptual frame of one's research. The normative commitment of the conceptual frame is explored using examples from nursing and nonnursing research. Elements of critical ethical reflection are outlined. It is suggested that the discipline's understanding of what constitutes health and how best to promote health, as well as solutions to ethical dilemmas posed by research, may be enhanced by purposeful ethical inquiry that occurs as an integral component of theorizing activities.

Bioethical Issues↗
PubMed1990

Nurses' stories: the search for a relational ethic of care.

The author begins by telling "Mike's story," a personal narrative account of an interaction with a patient. "Mike's story" provides a lens through which the author explores an alternative paradigm for nursing ethics--a paradigm grounded in a relational ethic of care. Mike's case is used to demonstrate how the moral experience of the nurse is distorted by the standard of moral rationality in traditional biomedical ethics. An interpretive analysis of "Mike's story" attempts to capture some of the fundamental assumptions of a relational ethic of care. The author identifies the benefits of grounding a theory of nursing ethics in nurses' conflicting stories of caregiving and encourages nurses to claim those stories that reflect the moral foundation of nursing.

Anecdotes as Topic↗
PubMed1994

Clinical judgment: an integrated model.

Literature on clinical judgment is discussed as a background for proposing an integrated model of diagnostic-therapeutic and ethical reasoning. Information processing and nursing process components related to problem identification and problem solving serve as a framework for the integration of the two domains of clinical reasoning. Discussion focuses on the integration of process components, identification of areas of research, and the use of the model in education and practice.

Clinical Competence↗
PubMedDate not supplied

Accepting leadership responsibility: preparing yourself to lead honestly, humanely, and effectively.

Many who enter management are ready and willing to accept the benefits of their positions, but not all are readily accepting of the full responsibilities of leadership. All too frequently, modern leadership appears self-serving, with the needs and desires of the leaders taking precedence over the needs of the followers and even the needs of the clients or customers. True leadership, however, should primarily benefit the followers rather than the leader. Leaders lead and followers follow for essentially the same reason, fulfillment of needs, so leaders and followers are fundamentally little different from each other. Every manager at every level has organizational superiors, so every leader is a follower as well. A true leader among managers is one who subordinates personal needs to the organization's needs, places employees well above self in importance, models appropriate behavior for employees, and functions as a facilitator in the employees' continuing efforts to get the necessary work done efficiently and effectively.

Administrative Personnel↗