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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↗
PubMed2002

Staff development and long-term care of patients with dementia.

Staff development and training programs focusing on the care of patients with dementia is important in providing staff with the specialized knowledge and skills essential in the management of these patients. In this article, the nature of staff development is explored with an analysis of conceptual visions or definitions of staff development. Secondly, the Cervero (1985) framework for continuing professional education and behavioral change is used as a guide to describe the factors that influence the effectiveness of staff development (i.e., social system, individual learner characteristics, type or design of program). Next, the literature related to the outcomes of staff development programs is analyzed. In particular, do staff development programs lead to increased staff morale and job satisfaction and improved client care? An analysis of orientation and educational programs developed for staff working with patients with dementia in long-term care settings is conducted. Using aspects of the RSA evaluation model (Abruzzese, 1996), each program is examined in terms of its process, content, outcome, and impact, along with its feasibility in clinical settings. This critical analysis provides some direction for the development and evaluation of staff development programs in long-term care settings for those staff who work with patients with dementia.

Aged↗
PubMed2004

Moral conflict, religiosity, and neuroticism in an outpatient sample.

Our sense of identity is inextricably connected to our sense of ourselves as moral beings. However, concerns about the rightness and wrongfulness of our own actions, and a range of emotions connected to moral worry, such as regret and remorse, rarely receive clinical attention. The present study sought to develop and operationalize the construct of moral concern or worry in a psychiatric outpatient sample and to investigate relationships between moral worry and age, gender, religiosity, and the tendency to worry in general. The Eysenck Personality Inventory, Duke Religiosity Scale, and a 20-item Worry Scale (containing eight moral worry items) were administered to 225 psychiatric outpatients. Data analysis included principal components analysis, repeated measures MANOVA to examine extent of worry among factor scales and interactions between age and sex, and multiple regression to identify significant correlates of each factor scale. Worry about moral issues emerged as a domain distinct from worry about practical matters. Although respondents reported more worry about practical matters than about moral concerns, worry about the former declined with age, whereas worry about the latter did not. Intrinsic religiosity was negatively correlated and neuroticism positively correlated with both scales. Because patients are concerned about the moral aspects of their character and behavior, this area deserves further research and consideration.

Adolescent↗
PubMed2006

Long-term evaluation of orofacial function in children with Down syndrome after treatment with a stimulating plate according to Castillo Morales.

The aim of this investigation was to evaluate the long-term orofacial development of Down children who received plate therapy according to Castillo Morales in their early childhood. The orofacial development of 27 Down children was documented before and after plate therapy and at a follow-up examination 13 years +/- 6 months after initiation of therapy. The orofacial appearance significantly improved during therapy (p = 0.00). During the follow-up, mouth posture remained stable (p = 0.259), whereas tongue position further improved (p = 0.034). A better long-term development was documented in children with initial severe orofacial dysfunctions.

Adolescent↗
PubMed2000

Should moral reasoning serve as a criterion for student and resident selection?

The aim of medical school and residency training is to produce well-trained physicians. One problem has been in knowing which applicants to select. Academic criteria have not correlated well with clinical performance. The current study suggests consideration of an important variable that has been found to be associated with exemplary clinical performance. In recent studies a significant relationship between moral reasoning skills and clinical performance has been found for medical students and residents and dental and nursing students. A similar relationship has been found between levels of moral reasoning and malpractice claims among practicing orthopaedic surgeons. Rest has developed the Defining Issues Test, as a paper and pencil, objective test for assessing moral reasoning. With it being deemed appropriate to assess applicants' scientific reasoning, the authors support the development of an assessment of moral reasoning as a selection criterion for medical school and residency training. More research is required. If additional research confirms the relationship of moral reasoning and superior clinical performance, then the results of moral reasoning tests might legitimately be used in the selection process.

Humans↗
PubMed1983

[Fetal indication for the termination of pregnancy from an ethical viewpoint].

The author goes into five ethical problems involved in foetal indication for termination of pregnancy: 1. The method of prenatal diagnosis is considered to be ethically neutral. 2. Arguments and indication for termination of pregnancy in case of foetal indication are critically reviewed. Four degrees of severity are distinguished in the field of prenatal damage. 3. After expounding the arguments for a continuation of pregnancy, the only case in which termination is declared as ethically justifiable is the occurrence of "total malformation" of the foetus (anencephaly). 4. In everyday practice, great importance must be attached to a differentiation between judgement of what can be considered as correct from the viewpoint of morals as tolerated by society on the one hand, and the moral value attached to a concrete action on the other. 5. Termination of pregnancy in case of foetal indication, which has largely become a matter of course, is examined and reflected with regard to its importance for the development of (medical and social) moral awareness.

Abortion, Induced↗
PubMed2004

Medical ethics and double effect: the case of terminal sedation.

The use of terminal sedation to control the intense discomfort of dying patients appears both to be an established practice in palliative care and to run counter to the moral and legal norm that forbids health care professionals from intentionally killing patients. This raises the worry that the requirements of established palliative care are incompatible with moral and legal opposition to euthanasia. This paper explains how the doctrine of double effect can be relied on to distinguish terminal sedation from euthanasia. The doctrine of double effect is rooted in Catholic moral casuistry, but its application in law and morality need not depend on the particular framework in which it was developed. The paper further explains how the moral weight of the distinction between intended harms and merely foreseen harms in the doctrine of double effect can be justified by appeal to a limitation on the human capacity to pursue good.

Casuistry↗
PubMed1997

The patient as moral agent in psychotherapy.

Psychotherapists may be uncertain whether the morality of the patient is their concern. Philosophically, we can distinguish between two kinds of morality: relativistic and universal. Relativistic morality is concerned with the conventions of a particular society and is authoritarian in nature. Universal morality is common to all humanity and is innate and autonomous. We can identify the two kinds of morality in psychological theory, representing stages of development. Psychoanalysis may facilitate a movement from authoritarian (relativistic) to autonomous (universal) morality. I shall argue that universal morality is relevant in psychotherapy. On the other hand, the therapist might help patients to question and reconsider their adherence to conventional codes.

Humans↗
PubMed2002

Persons and their bodies: how we should think about human embryos.

The status of human embryos is discussed particularly in the light of the claim by Fox, in Health Care Analysis 8 that it would be useful to think of them in terms of cyborg metaphors. It is argued that we should consider human embryos for what they are--partially formed human bodies--rather than for what they are like in some respects (and unlike in others)--cyborgs. However to settle the issue of the status of the embryo is not to answer the moral questions which arise concerning how embryos should be treated. Since persons rather than bodies have rights, embryos do not have rights. However, whether or not embryos have rights, people can have duties concerning them. Furthermore, the persons whose fully developed bodies embryos will, might (or might have) become can have rights. Contrary to what is often assumed, it is not merely persons who have (or have had) living, developed human bodies who have moral rights: so it is argued in this paper.

Embryo, Mammalian↗
PubMed1991

Ethics and embryos.

In this paper we argue that the human form should be seen to exist, in a longitudinal way, throughout the continuum of human growth and development. This entails that the moral value of that form, which we link analytically to the adult, interacting, social and rational being, attaches to all phases of human life to some extent. Having established this we discuss the consequences it has for the moral status of the human embryo. We then apply this argument, and the resulting moral status, to the area of reproductive technology. In doing this we show that there are certain regulations and controls which ought to apply to the use of these infertility treatments.

Abortion, Induced↗
PubMed1989

New developments in international nursing ethics.

This article has described numerous activities in nursing ethics at international levels. It acknowledges the larger context within which nurses practice by focusing on selected issues involved in resource allocation and death and dying, cross-culturally. The questions raised about universally shared moral principles reflects the larger questions of cultural and ethical relativism. The discussions of new developments in international nursing ethics focuses on international conferences, the teaching of nursing ethics, national nursing associations, and other professional groups that are actively involved in health care or nursing ethics. Finally, the development of international nursing ethics research studies is providing new knowledge about the scope of ethics within nursing and the nature of nursing care worldwide. Nurses are involved in some aspects of these new developments in nursing ethics in all countries. As they examine and reflect on ethical principles, virtues, and on an ethics of caring, they bring a new dimension to their work as nurses. This new dimension stands as one of the oldest and most central foundations in professional nursing.

Advisory Committees↗
PubMed2005

Expression of Discoidin Domain Receptor 2 (DDR2) in the developing heart.

Interactions between cells and the surrounding extracellular matrix are important for a number of developmental events. In the heart, cardiac fibroblasts produce the majority of extracellular matrix proteins, particularly collagen types I and III. Cells originating from the proepicardial organ migrate over the surface of the heart, invade the underlying myocardium and ultimately give rise to smooth muscle cells, fibroblasts, and coronary endothelium. Although integrin expression in the developing heart has been well characterized, the expression of Discoidin Domain Receptor 2 (DDR2) remains to be defined. Using confocal microscopy, the expression of DDR2 was examined at several points during cardiac development. Initially, DDR2 expression was detected on the epicardial surface of the heart and on endothelial and mesenchymal cells within the cardiac cushions. As development progressed, DDR2 expression increased at localized regions in the apex and atrioventricular sulcus, although this expression decreased from epicardial to endocardial surface. Eventually, DDR2 expression spanned the myocardial free wall and was detected within the septum. Not until postnatal development was DDR2 expression detected uniformly throughout the myocardium and this distribution was maintained in the adult heart. In summary, the data presented demonstrate that the distribution of DDR2-positive cells changes within the heart during development.

Animals↗
PubMedDate not supplied

Inability to noninvasively diagnose gastric intestinal metaplasia in Hispanics or reverse the lesion with Helicobacter pylori eradication.

BACKGROUND: Helicobacter pylori infection has been linked with the development of gastric adenocarcinoma and its precursor lesion, intestinal metaplasia (IM). The presence of gastric IM is not associated with symptoms, which makes identification of individuals with this lesion difficult. It is not clear whether eradication of H. pylori infection leads to reversal of gastric IM or the potential decrease in the risk of cancer in these patients. GOALS: The purpose of this pilot study was to define the prevalence of gastric IM in a population at high risk for gastric cancer (Southwestern Hispanics), examine the ability of noninvasive testing to identify individuals with the lesion, and determine whether eradication of H. pylori infection reverses gastric IM in this population. STUDY: Subjects from the Tucson metropolitan area were recruited, and baseline data, including the presence of upper gastrointestinal (UGI) symptoms, urinary sodium, and serum pepsinogen levels, were obtained. Upper endoscopy was performed and six gastric biopsies from specific anatomic sites were obtained, followed by methylene blue staining with targeted biopsies from blue-stained mucosa. Biopsies were evaluated for the presence of H. pylori infection and gastric IM. A subset of patients with gastric IM were treated to eradicate H. pylori infection. Follow-up exams with methylene blue staining, including biopsies for histology and rapid urease testing, were performed for up to 48 months. RESULTS: There were 84 subjects with a mean age of 53.0 years; 24 (29%) had gastric IM and 65 (77%) had H. pylori. There was no significant association between gastric IM and age, gender, UGI symptoms, H. pylori, or urine sodium. There was an association identified between gastric IM and a decreased pepsinogen I:II ratio (p = 0.03). Of the 11 individuals with gastric IM treated for H. pylori infection, 9 had successful therapy and underwent at least 2 follow-up examinations. The mean length of follow-up was 3.3 years. Eight of the nine (89%) had gastric IM identified histologically at the final endoscopic exam. CONCLUSIONS: H. pylori infection and gastric IM are frequent findings in Southwestern Hispanics, a high-risk population for gastric cancer. Noninvasive testing is not clinically useful in distinguishing individuals within this group who harbor gastric IM. Although eradication of H. pylori infection may lead to a decrease in the amount of gastric IM in some individuals, the lesion may be detected in the majority of individuals after more than 3 years of follow-up. These data suggest that therapy for H. pylori may not eliminate the risk of gastric cancer once IM has developed.

Adult↗
PubMed1986

Sex differences in moral reasoning: response to Walker's (1984) conclusion that there are none.

Data from the Family Socialization and Developmental Competence Project are used to probe Walker's conclusion that there are no sex differences in moral reasoning. Ordinal and nominal nonparametric statistics result in a complex but theoretically meaningful network of relationships among sex, educational level, and Kohlberg stage score level, with the presence and direction of sex differences in stage score level dependent on educational level. The effects on stage score level of educational level and working status are also shown to differ for men and women. Reasons are considered for not accepting Walker's dismissal of studies that use (a) a pre-1983 scoring manual, or (b) fail to control for education. The problems presented to Kohlberg's theory by the significant relationship between educational and stage score levels in the general population are discussed, particularly as these apply to the postconventional level of moral reasoning.

Adult↗