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Results for “Moral Development”

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PubMed2002

Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis.

OBJECTIVE: To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. DESIGN: Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. SETTING: Nine trusts (cross sectional study) and four trusts (case study) in London. PARTICIPANTS: 96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. MAIN OUTCOME MEASURES: Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. RESULTS: Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving pound 500 000 a year in management costs. CONCLUSIONS: Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring, such as primary care groups developing into primary care trusts and health authorities merging into strategic health authorities, should take these findings into account.

Attitude of Health Personnel↗
PubMed1997

'To be or not to be'--an ethical debate on the not-for-resuscitation (NFR) status of a stroke patient.

Nursing has been described as a moral endeavour (Seedhouse, 1988; Berger et al., 1991), the art of dealing with ethical issues of right and wrong. Within the nursing literature, ethical issues are a major topic for discussion. Berger et al. (1991) explain that this reflects larger societal concerns about ethics in business, industry and government. The development of advanced technology and life-sustaining treatments such as cardiopulmonary resuscitation (CPR) has heightened the dilemmas of moral decision making. CPR was developed in the 1960s as an emergency life-saving procedure, although it is currently used on anyone who does not have a not-for-resuscitation status (Anon., 1980). In this paper, an ethical issue involving the decision of whether or not to resuscitate a stroke patient is discussed. An overview of the main ethical theories is presented because they provide a framework for an explication of ethical decision-making. The options available to those involved are then discussed in relation to relevant research. Finally, a conclusion is drawn from the ensuing situation.

Age Factors↗
PubMed1990

The diagnostic interview for narcissistic patients.

This report describes the content and development of a semistructured interview, the Diagnostic Interview for Narcissism. The interview evaluates 33 features of pathological narcissism covering five domains of function: grandiosity, interpersonal relations, reactiveness, affects and moods, and social and moral adaptation. Its utility is established by reliability studies and by developing a scoring system from a sample of 24 prototypic narcissistic patients who were compared with 58 others. Because narcissistic personality disorder is a widely used diagnosis whose inclusion in DSM-III-R was without reference to an empirical base, this instrument offers a method for doing much-needed research.

Ambulatory Care↗
PubMed1986

Cognitive behaviour therapy and its application with adolescents.

Cognitive Behaviour Therapy is traditionally seen as a treatment for emotional disorders in adults. The paper argues that the technique can also be used with emotionally disturbed adolescents and younger children provided there is an awareness of cognitive and moral developmental processes and that these are taken into consideration. The paper discusses some of the advantages and excitement of using this technique with adolescents.

Adolescent↗
PubMed1985

Critique of "The use of animals in nursing research".

The authors present a critique of an article by Cunningham and Mitchell that advocates the use of animals in nursing research. Moral, political, social, and scientific arguments are presented to develop a case in opposition to the use of animals for experimentation. In conclusion, the authors assert that nurse scientists can make a choice at this critical juncture to take another path leading to the maturity of nursing as a research-based profession.

Animal Experimentation↗
PubMed2002

Ethics; 'In consideration of the love he bears.' Apprenticeship in the nineteenth century, and the development of professional ethics in dentistry. Part 2. Hippocrates' long shadow.

This two part paper takes a look at the ancient institution of apprenticeship. As stated in the introduction to the first part,(1) it regards the conventions of the scheme as having had a positive influence on the morality, legal identity, and professional allegiance of dentists during the ethical development of their profession in the nineteenth century. The first paper looked at the particular application of apprenticeship through the evidence of indentures in the BDA museum. This second paper enlarges on the view that the wider social institution of apprenticeship was at least in part responsible for the development of the ethics of the dental profession.

Education, Dental↗
PubMedDate not supplied

Program accreditation and correctional treatment.

In the correctional field, treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majesty's Prison Service has, in 3.5 years, accelerated the effectiveness of correctional treatment programming, established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales.

Accreditation↗
PubMed1995

A prepayment scheme for hospital care in the Masisi district in Zaire: a critical evaluation.

In most developing countries, government funding allocated to the health services is not sufficient to allow these services to provide appropriate health care accessible to all. Consequently, community financing has received much more attention in recent years and innovative schemes are being explored throughout the developing world. Risk-sharing schemes, like prepayment, are interesting because of their potential redistributive effects. At the end of the eighties, a prepayment scheme for hospital care was experimented with in the Masisi health district in Eastern Zaire. In the present paper, the experiment is described in a chronological way and the results are analyzed and discussed in detail. Although this particular case-study was not successful, it yields important lessons concerning the design, implementation and evaluation of prepayment schemes for hospital health care in developing countries. More specifically, phenomena like adverse selection and moral hazard are discussed. Finally, conditions for success of similar experiments are discussed. These conditions relate mainly to the organization pattern of the district health services system. The Masisi experiment is a nice illustration of the fact that prepayment is not a 'magic bullet': the lessons drawn from it may be of relevancy to health planners intending to implement hospital prepayment schemes in similar settings.

Democratic Republic of the Congo↗
PubMed1980

Moral and ethical dilemmas: seven years into the debate about human ambiguity.

Developments in modern medical technology force many questions upon the health professions and the public. To what extent should technology be used to extend life when doing so seems futile, perhaps brutal? Who should decide such questions? What options should be available? Conditions in which such questions arise are often chaotic because of the nature of illness and treatment and because many extremely important issues in life have been poorly deliberated by the health professions and the public. This essay is an attempt to clarify some of the issues.

Decision Making↗
PubMed1999

Hospice and euthanasia in The Netherlands: an ethical point of view.

This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967.

Ethics, Medical↗