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PubMed2002

Teaching ethics in nursing.

Being a professional nurse requires ethical decision making and this in turn necessitates an effective learning process. The active participation of students in the teaching of ethics will contribute to this process. This study was conducted at Hacettepe University School of Nursing, Ankara, Turkey, to determine the views of students about the nursing ethics content in the curriculum, the examination system, and some educational characteristics of the teachers responsible for the course. The sample comprised 113 students who participated voluntarily. In general, the students expressed a positive view relating to the course content and the teachers. The majority stated that the discussions on case study analysis by using ethical principles, rights, legal aspects and the use of the International Council of Nurses Code of Ethics were very useful in developing ethical decision-making skills. We believe that the results of this study will enhance our efforts in amending this course and improving the ethical decision-making skills of our students.

Education, Nursing↗
PubMed1997

Teaching ethics: effect on moral development.

The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest's Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students' development of moral judgement.

Clinical Competence↗
PubMed2005

Ethical challenges in surgery as narrated by practicing surgeons.

BACKGROUND: The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. METHODS: Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. CONCLUSION: The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.

Attitude of Health Personnel↗
PubMed2003

Ethical issues after the disclosure of a terminal illness: Danish and Norwegian hospice nurses' reflections.

This research explored the ethical issues that nurses reported in the process of elaboration and further disclosure after an initial diagnosis of a terminal illness had been given. One hundred and six hospice nurses in Norway and Denmark completed a questionnaire containing 45 items of forced-choice and open-ended questions. This questionnaire was tested and used in three countries prior to this study; for this research it was tested on Danish and Norwegian nurses. All respondents supported the ethics of ongoing disclosure to terminally ill patients based on ethical principles embedded in their country's Patients' Rights Acts. Truth, as an intrinsic value, proved foundational to patient autonomy, the most frequent ethical principle these nurses reported to justify their ethical position on information disclosure to terminally ill people. Telling the truth about a diagnosis was not the end of ethics in hospice care, but rather the beginning because what occurs ethically in dealing with prognosis issues became central to these hospice nurses, the patients and their families. Coupled with truth-telling, compassionate interaction and care become extensions of patients' rights.

Adult↗
PubMed2004

Ethical moments in practice: the nursing 'how are you?' revisited.

In seeking for an understanding of ethical practices in health care situations, our challenge is always both to recognize and respond to the call of individuals in need. In attuning ourselves to the call of the vulnerable other an ethical moment arises. Asking 'how are you?' in health care practice is our very first possibility to learn how a particular person finds herself or himself in this particular situation. Here, 'how are you?' shows itself as an ethical question that opens up a relational space that calls forth a response. It is a way to understand the situated moments in which we are already that enables us to act respectfully. Our ethical frameworks assist us in trying to decide what is the right thing to do given a set of circumstances. Yet there is a prior step that already calls us to ethical attention; this is when we ask 'how are you?', which transforms a seemingly small interaction into an ethical moment. 'How are you?' is a question that turns us back to who we are as health care professionals and calls us to be more deeply attentive to the moment. When we sincerely ask 'how are you?' we enact our ethical commitments to one another.

Attitude to Death↗
PubMed1999

Ethics in Christianity and health care: can "character" be defined in this interdisciplinary course?

OBJECTIVE: To describe a unique interdisciplinary ethics course that incorporates elements of character into a decision-making model. METHODS: The Ethics in Christianity and Health Care course is divided into two sections: ethics in Christianity and ethics in health care. The first section comprises the initial 30% of the course, and the second portion spans the latter 70%. Character traits of ethical persons are described in the second section of the course and are then used in an adapted decision-making model. A scenario from a nontraditional Doctor of Pharmacy student is included to illustrate this decision-making process. Texts, assignments, and assessments are also discussed briefly. SUMMARY: This course provides a framework within which ethical relationships are described and discussed. The character traits delineated in the article offer a logical approach when solving ethical dilemmas.

Character↗
PubMed2006

Knowledge, attitudes and practice of medical students at the Cave Hill Campus in relation to ethics and law in healthcare.

OBJECTIVES: The purpose of this study is to assess the knowledge, attitudes and practices among medical students in relation to medical ethics and law. The results of the study will be a useful guide to tutors of medical students and curricula designers. METHODS: A thirty-item self-administered questionnaire about knowledge of law and ethics, and the role of an ethics committee in the healthcare system was devised, tested and distributed to all levels of students and staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) in 2003. The data from the completed questionnaires were entered into an SPSS database and analyzed using frequency and multiple cross-tabulation tables. RESULTS: Completed responses were obtained from 55 (96%) of the medical students. Medical students generally attested to the importance of ethical knowledge but felt that they knew little of the law. Students varied widely as regards the frequency with which they saw ethical or legal problems, with a quarter seeing them infrequently, but another quarter seeing them every day. They received their knowledge from multiple sources and particularly from lectures/seminars, and found case conferences the most helpful. Only a few students felt that text books had been helpful. Students were generally knowledgeable about most ethical issues, but many had uncertainties on how to deal with religious differences in treating patients, on the information to be given to relatives, and how violent patients should be treated. CONCLUSIONS: The results of the study highlight that medical students felt an inadequacy of knowledge of law as it pertains to their chosen career Since most of their knowledge of law was obtained from lectures, these should be reviewed and other avenues of tuition explored. The study also highlights the need to identify the minority of students who have problems with their ethical knowledge and to devise means whereby any deficiencies can be discussed and modified.

Adult↗
PubMed1998

An assessment of orthopaedic surgeons' knowledge of medical ethics.

We developed a survey instrument to evaluate knowledge of ethical issues among orthopaedic surgeons and to assess their ability to handle ethical dilemmas. The twenty-six-item survey evaluates seven areas of medical practice: confidentiality, informed consent, truth-telling, the physician-patient relationship, economic aspects of care, end-of-life decision-making, and the approach to an incompetent colleague. It was administered to 117 attending orthopaedic surgeons and residents in two orthopaedic surgery training programs. One hundred and two orthopaedic surgeons (87 per cent) completed the survey. Overall, they correctly answered a mean of nineteen (73 per cent) of the twenty-six questions. The respondents appropriately handled questions involving economic aspects, truth-telling, confidentiality, and an incompetent colleague. However, there was poorer understanding of proper ethical conduct with regard to informed consent (58 per cent of the responses were correct), the physician-patient relationship (72 per cent of the responses were correct), and end-of-life decision-making (78 per cent of the responses were correct). No significant differences were found, with the numbers available, in overall performance according to site, attending compared with resident status, age, gender, or whether the physician had had training in ethics. Economic, social, and professional forces have increased the medical ethical issues facing orthopaedic surgeons. Medical ethics now must be taught in training programs in orthopaedic surgery. Our survey of two orthopaedic surgery training programs demonstrated that orthopaedic surgeons approach most medical ethical problems appropriately. However, improvement is needed in selected areas.

Adult↗
PubMed1998

Teaching medical ethics to orthopaedic surgery residents.

Orthopaedic surgery residents will be faced with a variety of ethical issues when they enter clinical practice. A previous survey suggested that they lack knowledge about how to approach several types of medical ethics dilemmas. We developed a medical ethics curriculum for orthopaedic surgery residents and presented it over a one-year period to the residents in one training program. The effect of the educational intervention on the residents' knowledge of medical ethics and their ability to handle hypothetical situations was measured by comparing their responses to a questionnaire, administered before and after the intervention, with those of residents in a training program in which the intervention was not provided. The twenty-five residents at the site of the educational intervention had a mean improvement of 0.10 in the overall score, from a mean score of 0.71 on the baseline survey to a mean score of 0.81 on the follow-up survey. This improvement was significantly greater than the mean improvement of 0.02 for the thirty residents at the control site, who had a mean score of 0.72 on the baseline survey and a mean score of 0.74 on the follow-up survey (p = 0.002). Six residents who participated in the medical ethics curriculum rated it as very useful; seventeen, as somewhat useful; one, as slightly useful; and one, as not at all useful. A medical ethics curriculum can increase orthopaedic residents' knowledge of medical ethics. Whether this curriculum also will lead to behavioral changes requires additional evaluation.

California↗
PubMed1999

Morality, ethics, and radiologists' responsibilities.

The goal of this discussion was to address the matter and methodology of ethics and critical thinking and to ask several questions about the relationship between ethics and radiology. Questions about the nature of the moral and how ethics inform decision making raise our awareness and may provide new understanding about moral thinking. Why is medicine a moral endeavor? Overridingness, universalizability, and other-regarding virtues were discussed. How do ethics inform medical decision making? Ethical theories, including parentalism, autonomy, and the engagement model, were discussed. What are radiologists' ethical responsibilities? Our ethical responsibilities as radiologists entail seven briefly described elements: assessing the appropriateness of the imaging examination, participating in the informed consent process, protecting patient interests, providing excellent image interpretation, communicating effectively with physicians and patients, seeking continued learning, and continuously improving quality. Of these responsibilities, competence, loyal concern for the patient's well-being, and respect for his or her person provide the basis for trust in the patient-physician relationship. If the central paradox in medicine is the tension between self-interest and altruism, then responsibility to the patient in this trust has the greatest force and overrides other obligations. Finally, our challenge is to critically examine our and each other's professional role and the extent to which we achieve excellence in our contribution to patient care; to break out of comfortable habits and reflect on new, alternative ways of knowing as caregivers; to think about what we are doing in medicine and the consequences for the human mind and spirit of our patients, our colleagues, and ourselves; and to provide a forum for this important dialogue in our practices, residency programs, and continuing education curricula.

Communication↗
PubMed2004

A Q-methodological study on nursing students' attitudes toward nursing ethics.

PURPOSE: Professional nursing ethics is a living, dynamic set of standards for nurses'professional moral behavior. Furthermore, in daily clinical nursing training, nursing students are constantly confronted with decision-making that is moral in nature. The aim of this study was to identify the perceived ethical attitudes in the clinical training process of senior nursing students using Q-methodology to offer basic strategies for nursing ethics education and thereby improve patients'care. METHODS: Q-methodology provides a scientific method for identifying perception structures that exist within certain individuals or groups. Thirty-seven participants in a university rated 38 selected Q-statements on a scale of 1-9. The collected data were analyzed using pc-QUNAL software. RESULTS: Principal component analysis identified 3 types of ethical attitudes in nursing students in Korea. The categories were labeled Sacred-life, Science-realistic and Humane-life. Sacred-life individuals think that a life belongs to an absolute power (God), not a man, and a human life is a high and noble thing. Science-realistic individuals disagreed that allowing an induced abortion or embryo (human) duplication is unethical behavior that provokes a trend, which takes the value of a life lightly; most of them took a utilitarian position with respect to ethical decisions. Humane-life individuals exhibit a tendency toward human-centered thought with respect to ethical attitudes. CONCLUSION: This study will be of interest to educators of students of nursing and hospital nursing administrators. Also, the findings may provide the basis for the development of more appropriate strategies to improve nursing ethics education programs.

Adaptation, Psychological↗
PubMed1990

Biomedical conflicts in the heartland. A systemwide ethics committee serves rural facilities.

Big-city medical research centers are not the only institutions facing ethical dilemmas. Bioethical conflicts occur regardless of community location or size. The Presentation Health Care System, Sioux Falls, SD, established a systemwide ethics committee. It owns, leases, or manages 15 rural institutions in four North Central states: South Dakota, North Dakota, Montana, and Minnesota. Of these facilities, 10 are hospitals and 5 are nursing homes. Most are located in small communities stretched along 1,100 interstate miles. The Presentation system began organizing its ethics committee in spring 1985. The ethics committee was to provide educational opportunities for its members, as well as for local facilities. These opportunities were to include subscriptions to appropriate publications, meetings with guest speakers, videos, and group "brainstorming" sessions. An annual ethics conference would provide community education and address the ethical issues confronting affiliates. Organizers scheduled a planning session at a systemwide leadership conference and invited anyone interested to attend. Eventually, 23 representatives of system affiliates were selected as members of the committee. The group meets twice a year. Since 1985, the committee has been holding ethics conferences on a regular basis.

Bioethics↗
PubMed1990

Business ethics: the materiel/manufacturing perspective.

The discussion of purchasing practices and product integrity, which have ethical implications for materiel/manufacturing management, serves to illustrate how routine decisions can have larger implications for the firm as a whole. Management needs to take a proactive role in confronting ethical issues by (1) demonstrating a corporate commitment to sound ethics in business practices, (2) providing written policies where appropriate to provide a basis for sound ethical conducts, (3) educating various functional areas to understand their responsibility in seeming unrelated ethical problems, (4) delegating authority in ethical issues where such issues are considered in decision making, and (5) fostering interfunctional communication as a means in establishing corporatewide responsibility. The basic philosophical principles of JIT serve as a blueprint for recognizing and managing ethical responsibility. The unexpected by-products of a JIT implementation may be vendor/customer good will and an excellent reputation for the firm.

Commerce↗
PubMed1990

The ethics of Cruzan. Families, not states, should make treatment termination decisions.

Although the U.S. Supreme Court justices frequently alluded to ethical concepts in delivering their opinions in the Cruzan decision, no clear or consistent ethical framework supported this jargon. The decision, in fact, resolves none of the ethical and professional questions that initially brought the case to the courts. The various arguments about whether and when it is ethical to terminate treatment are the first source of ethical confusion in questions about death and dying. Individuals arriving at the same conclusion can begin from significantly different ethical principles. An added complexity arises as a result of differences among medical professionals regarding what constitutes a fatal pathological condition. A resolution of these differences would clarify a number of ethical questions. The biggest problem with the Missouri Supreme Court's decision was that it gave absolute precedence to the state's interest in preserving life, excluding quality-of-life considerations and disregarding personal, familial, and professional values that should have affected the decision. In fact, since a medically well-informed family is in most cases in the best position to make a decision that would conform with a family member's wishes, applying the "clear and convincing" evidence standard in the Cruzan case shifts the burden of proof to the wrong party. Instead, the state should be obliged to give convincing evidence of why it has intervened in a decision for which the patient's family and physician should have authority.

Adult↗
PubMedDate not supplied

Ethics in health care, Part II: The product of shared deliberation. Working within a pluralistic culture.

In a pluralistic society, ethics must be understood as "what we ought to do and become, as civilized persons, in light of who we say we are." This understanding of ethics can help hospital ethics committees produce policies and consultations that are the result of shared deliberation and respect. The ethical principles of respect for autonomy, non-maleficence, beneficence, and justice are considered, and it is shown how these principles reveal values that are central to the practice of contemporary health care. Finally, the issue of refusing medical interventions--and some of the religious, ethical, and legal values that affect this issue--are explored. Part I of this article (1) described the process and activities of typical ethical committees functioning in health-care facilities today. This article will consider some of the more substantive issues these committees must deal with and some of the ethical conclusions and insights that have arisen as a result of the shared deliberations of these groups.

Advance Directives↗
PubMed2000

Ethical voices of pediatric mental health nurses.

Ethical issues in pediatric mental health care have undergone little theoretical consideration and empirical study. In this exploratory ethnographic study, 20 Pediatric Mental Health Registered Nurses (PMHRNs) describe the ethical issues they believe arise from the care they deliver to children in school-age and adolescent age groups. Three major themes emerge from the interviews. These themes, the PMHRNs' relational roles, their role as advocate facilitator, and their view of the milieu as an extension of the family, are analyzed for ethical content using several ethical theories. These ethical theories are evaluated for adequacy, and an argument for the use of relational ethical theories in examining pediatric mental health ethical issues, as well as general pediatric nursing practice, is presented.

Adolescent↗
PubMed2000

Medical ethics surveillance in the Armed Forces.

Modern defense services depend on a policy of the vigorous promotion of research to ensure that they retain an advantage in any future operational context. Research involving personnel within the armed forces, however, has certain constraints with respect to contemporary, best-practice medical ethics. Service members are one example of a class of "captive subjects" who require special protection in the context of medical research. (Prisoners, students, children, and the intellectually disabled are other such examples.) The majority of national defense forces now have ethical watchdog groups--institutional ethics committees--that oversee research involving service members. Such groups monitor the special considerations and constraints under which subjects in uniform can volunteer for biological research. These committees audit particularly the ethical themes of confidentiality, equality, and justice. Themes inherent in medical research in the military include the standard Beauchamp-Childress paradigm of autonomy, beneficence, nonmaleficence, and justice, to which are added the traditional military values of loyalty, respect, courtesy, and chivalry. Contemporary thinking is that the general principle of affording service members the opportunity to volunteer for research should be maintained within the constraints of compromised training time, national security, and operational necessity. Most biological research (and its outcome) does not in practice compromise confidentiality or military security. This paper presents an audit of the functioning of one national military medical ethics committee, the Australian Defence Medical Ethics Committee, and presents a discussion of its philosophies and influence within the broader military context. The Australian Defence Medical Ethics Committee believes that most research should, as an a priori condition of approval, be intended for open publication in peer-reviewed journals.

Australia↗
PubMed2000

The narrative approach in teaching medical ethics: the Turkish experience.

The Deontology and Medical History Departments in Turkey teach Medical Ethics Education. These departments were first established by medical historians and for the time being the staff is primarily interested in deontology. The Department of Deontology in the Faculty of Medicine at Ankara University is the first department in Turkey to teach medical ethics. In 1974, issues including medical ethics were included in the current curriculum for the Medical Deontology and Medical History Course, but without changing the title of the course. Since then, different scholars have used different teaching methods. In this paper, a very new teaching strategy and technique used by the author will be discussed. In Turkey, the main resources being used as teaching materials in medical ethics are books and periodicals of mainly Western European and North American origin. Cultural, religious, and traditional characteristics of Turkey differ a great deal, so these texts need to be modified. This modification is hard to accomplish, because discourse on authentic values and value systems is inadequate. Also, this way of thinking about values is alien to most medical students. A narrative approach in teaching medical ethics aims to introduce local values that affect medical practice to first year medical students of the Faculty of Medicine at Ankara University, by searching for those values in literary texts and case histories. Besides introducing local values, some of our main goals are to encourage students to develop a sensitivity towards ethical issues and to teach them the methodology of ethical thinking. This is still a pilot study that covers only four hours of a thirty-hour program (two-hour sessions, twice in one semester), but some conclusions can be drawn. In this presentation, some information about the content and the structure of the course will be given, and the positive and negative results about the narrative approach will be discussed, arising from our limited local experience.

Attitude to Health↗