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PubMedDate not supplied

The process of ethical decision making in psychiatric nursing practice.

The process by which nurses make ethical decisions in clinical practice has significance for the practitioners, educators, and administrators concerned with professional standards and quality of care. Twenty nurses participated in semistructured interviews during which they discussed ethical problems of their choice that had occurred in their clinical practice. Content analysis of interview transcripts revealed a 10-stage process used in ethical decision making. The process begins with an emotional response on hearing of an event that affects clinical practice and ends in an aftermath that includes feelings, talking with others, reconsiderations, and change or vows to change. The study identifies both affective and cognitive components of the decision-making process. The importance of the emotional aspect of ethical decision making, absent from previous studies, is recognized and evaluated. Implications based on the study suggest that the problems of ethical decision making may be a significant part of the stress in nursing. In addition, there is evidence that the process of ethical decision making affects nurses' views of self and of the profession and may have direct bearing on their leaving nursing for another professional career.

Adult↗
PubMedDate not supplied

Evaluating a Web-based graduate level nursing ethics course: thumbs up or thumbs down?

BACKGROUND: This article discusses the course design, experiential findings, and evaluation of a Web-based course for graduate nurses examining professional health care practice and ethical issues. METHOD: Using course input and evaluative data, the article addresses student and teacher perceptions of use of a Web-based delivery mode for graduate level courses and the appropriateness of this ethics course for graduate level students. RESULTS: Evaluative data supported existing knowledge concerning pros and cons of Web-based education. New insights concerning the Web's ability to foster critical thinking skills and supports for continuing ethics education for nurses are reported. All students assessed this ethics course as being of considerable value to their professional practice. CONCLUSION: Students evaluated the pros of Web use for the course as far outweighing the cons. The students' substantial interest in and critical thinking about appropriate knowledge bases to underpin effective ethical decision-making strongly supports the need for continuing ethics education for practicing nurses.

Attitude of Health Personnel↗
PubMed1999

Relational narrative: the postmodern turn in nursing ethics.

A philosophy of nursing requires an ethical cornerstone. I describe three dialectical layers of an ethical cornerstone: subjective immersion, objective detachment, and relational narrative. Dialectically, the move from immersion to detachment is the turn from communitarian to rational ethics, replacing traditions with universal principles. The move from universalism to engagement is the turn from rational to relational ethics, replacing detached reason with engagement between particular selves. Conceptually, the three layers correspond to premodern, modern, and postmodern ethics. I propose that the layers be viewed not as stages, but as elements that coexist in an ethically vital profession, and I conclude with an illustration of their coexistence in a clinical situation.

Ethics, Nursing↗
PubMedDate not supplied

[Epidemiology between ethics and politics].

Over the last two decades ethics in epidemiology has been the subject of a substantial number of conferences, books, articles, guidelines as well as training courses. The relevance of ethics for epidemiology does not make the ethical approach sufficient to exhaust the analysis of the relationship between epidemiology and society: on one side the ethical assessment of an epidemiological investigation is not self-sufficient but depends on the evaluation of the scientific worth of the study (a planned study involving humans is automatically unethical if scientifically unsound) and, on the other side, to be of practical value it needs expanding as to its policy implications. A few remarks on two issues, ethics committees and human reproductive cloning, support the general contention that translating knowledge into effective public health actions may be grounded in ethical considerations but necessitates a substantial development at political level.

Cloning, Organism↗
PubMed2000

Teaching ethics to students in the University College of Nursing Studies in Maribor.

We wish to present our experiences of the educational process in the teaching of the philosophy of nursing ethics in healthcare to nursing students at the University of Maribor, College of Nursing Studies. Application of professional ethics in the study program: awareness of professional ethics theory and philosophy, and the application of these theories and philosophies in the nursing learning laboratory, the use of Slovenia's nursing code of ethics in clinical practice, the use of combined clinical practice and seminar presentations of situations which are of an ethical nature. Evaluation of the student's understanding and usage of theoretical/philosophical ethics in concrete examples.

Curriculum↗
PubMed2001

Healthcare ethics committees and managed care.

OBJECTIVES: Healthcare ethics committees (HECs) play an important role in medical decision making in US hospitals, but no study has determined whether HECs deal with managed care, in any form. This pilot study was performed to evaluate the activities and perceptions of HECs about managed care. STUDY DESIGN: Forty-five hospitals in the Philadelphia area were selected at random, and comprised 36.6% of area institutions and 47% of area inpatient beds. Surveys were administered to ethics committee representatives by the authors in 1998. PATIENTS AND METHODS: Survey responses were coded, and both tabulated responses and analyzed data are presented. Correlations were analyzed with the unpaired 2-tailed t test. RESULTS: HECs devoted 7.6% of committee time to managed care issues, and the remainder to education, policy development, and case consultation. Time spent on managed care issues depended on the size of the institution (small hospitals spent twice the time on managed care as did large institutions); composition of the committee (presence of clergy and retirees on HECs correlated with the likelihood that HECs would address managed care issues); and whether the HEC was requested to help with managed care issues. Of the HECs surveyed, 18% had formal but disparging discussions of ethical concerns in managed care. The impact of changing insurance programs on the hospital and HECs was a concern. CONCLUSIONS: HECs arbitrate ethical conflicts in managed care when asked. As the presence of managed care increases, ethics committees will increasingly be called on to resolve the resulting ethical dilemmas. To be effective in this role, HECs must become knowledgeable about managed care principles and policies.

Data Collection↗
PubMed2000

Understanding medical ethics.

Moral thinking is embedded within cultures, and we use ethics all the time in our dealings with one another. Many functioning communities tend to share some values that reflect a particular view of the importance of human life in quantity and quality. Rights and duties form an interconnected network of obligations that protect the security of individuals and groups. In health care, the motives and virtues of practitioners are important sources of the determination to provide care for the ill within the limits of resource constraints. Ethics and the law have similarities, but also significant differences that may cause tension between the two systems. Health care is morally grounded, and provides a bulwark against the widespread fear of disease and suffering. The way in which health care is delivered depends on both national wealth and community values. Ethical problems can be seen as dilemmas, in which there are conflicting values. Modern ethical thinking in health is complicated by the need to consider the values and interests of many stakeholders--patients, health care workers, families, politicians, administrators, health bureaucrats and many others. There are ways of ethical thinking that take account of these often countervailing interests. No universally 'right' answers can be specified. The mode and the thoroughness of ethical consideration, and the careful consideration of local community values, will help to assure that we make the best possible decisions for the time and place.

Culture↗
PubMed1989

Ethical dilemmas in perioperative nursing practice.

Ethical dilemmas in perioperative nursing practice occur during all phases and in every practice setting. Awareness of commonly experienced dilemmas and understanding of a model available to analyze and resolve these dilemmas can benefit patients and perioperative nurses. Patients will benefit from nurse advocates who recognize and act to resolve actual and potential ethical dilemmas. Nurses will benefit when they are empowered with the knowledge and ethical skills to enhance patient autonomy, to protect dignity and confidentiality, and human rights. Perioperative nurses should reflect on previous dilemmas and use them to assist with resolution of similar dilemmas. They should be knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas. The ANA code for Nurses and the AORN Statements of Competency in Perioperative Nursing are two resources available to perioperative nurses. In the increasingly complex, technologically laden surgical environment, patients who are sicker and living longer will require services of highly skilled and educated professionals. They are vulnerable in the surgical setting and need surgical teams to act on their behalf. Perioperative nurses with ethical skill are an asset to patients and other members of the surgical team when they seek to resolve ethical dilemmas in knowledgeable and systematic ways.

Acquired Immunodeficiency Syndrome↗
PubMed1982

The teaching of ethics in the dental hygiene curriculum.

This study describes the extent of formal instruction in ethics in dental hygiene programs. Responses from 159 programs indicated that all hygiene programs include ethics in the curriculum, but the method of teaching and the amount of time devoted to the subject varied considerably. The majority of programs included ethics as a component of a larger course such as dental hygiene practice or as a separate course in ethics and jurisprudence. Although most course instructors used the lecture format, most programs combined lecture with more active forms of learning, such as use of ethical dilemmas. In general, respondents felt satisfied with the current role of ethics in the dental hygiene curriculum, although there was some concern about their own competence in teaching the subject.

Curriculum↗
PubMed1995

Priority ethical issues in oncology nursing: current approaches and future directions.

PURPOSE/OBJECTIVES: To describe ethical issues determined to be highly important to oncology nurses and to discuss strategies by which the Oncology Nursing Society (ONS) can address these priority concerns. DATA SOURCES: Survey on oncology nurses regarding ethical issues; nursing literature. DATA SYNTHESIS: Nine priority ethical issues of oncology nurses are identified. Past, current, and future ONS activities that address these priority issues are discussed. IMPLICATIONS FOR NURSING PRACTICE: ONS must support activities to increase the knowledge, confidence, and involvement of oncology nurses in discussions and decision making related to the ethical issues. CONCLUSIONS: The top three priority ethical issues for oncology nurses are assisted suicide, end-of-life decisions, and pain management. Efforts should be made to increase ethics expertise among the ONS membership.

Bioethical Issues↗
PubMed1997

[Ethics code of the Chilean Biological Society].

The Chilean Biological Society has approved an ethics code for researchers, elaborated by its Ethic Committee. The text, with 16 articles, undertakes the main ethical problems that researchers must solve, such as institutional, professional or societal ethics, scientific fraud, breaches in collaborative work, relationships between researchers, participation in juries and committees, ethical breaches in scientific publications, scientific responsibility and punishments. This code declares its respect and valorization of all life forms and adheres to international biomedical ethical codes. It declares that all knowledge, created or obtained by researchers is mankind's heritage.

Biology↗
PubMed1998

Ethical issues and critical thinking: students' stories.

Through the stories told by these students it is evident that beginning students do think critically and act ethically during their first clinical nursing course. Ethical dilemmas involving students and staff, patients, faculty, and peers depict beginning students' development of values as they evolve into professionals. The conscientiousness and caring displayed by beginning students is apparent from students' shared perspectives. It is particularly encouraging that they seemed to focus more on values and cognitive aspects of patient care than on primarily technical psychomotor skills such as taking blood pressures and giving injections. Teaching beginning students is a challenge because the educator's role is twofold: Help students build a foundation for developing ongoing critical thinking abilities and help students develop an ethical view of patient care. Further exploration of critical thinking and ethical decision making should emphasize the mutual student-educator roles in facilitating self-awareness, through conscious awareness of their beliefs, values, feelings, and multiple perspectives. Because nursing emphasizes the human element and student nurses deal with human lives, educators play a vital role in facilitating the development of beginning students as critical thinkers and as ethical nurses. The most knowledgeable and most psychologically mature faculty are needed to teach beginning nursing students. Through ongoing reflection and critical thinking, nurse educators can help beginning students to identify and develop multiple perspectives on the ethics of nursing practice.

Clinical Competence↗
PubMed1996

Phronesis in clinical ethics.

This essay argues that while we have examined clinical ethics quite extensively in the literature, too little attention has been paid to the complex question of how clinical ethics is learned. Competing approaches to ethics pedagogy have relied on outmoded understandings of the way moral learning takes place in ethics. It is argued that the better approach, framed in the work of Aristotle, is the idea of phronesis, which depends on a long-term mentorship in clinical medicine for either medical students or clinical ethics students. Such an approach is articulated and defended.

Casuistry↗
PubMed1992

What is nursing ethics?

This article tries to bring some clarity into the current confusion about the nature of nursing ethics. It distinguishes between the empirical, prescriptive and analytic dimensions of ethics. It then describes six contemporary understandings of the parameters and aims of ethics via six different approaches: moral education, management, professional conduct, bioethics, clinical ethics and political ethics.

Education, Nursing↗
PubMed1987

The philosophical basis of medical ethics.

After a short introduction on the status of medical ethics as a special branch of a more general ethical theory, I try to identify its particular principles. According to my analysis there are two opposite basic principles which individuate two conflicting perspectives, i.e. the principle of sanctity of (human) life, and the principle of disposability of mere biological (human) life. Current troubles in medical ethics are mostly dependent on the fact that we are assisting a change from an ethics of the sanctity of life to an ethics of the disposability of life, and I argue for the latter.

Ethical Analysis↗
PubMed1990

Clinical ethics: a role theoretic look.

The new phenomenon of clinical ethics is analyzed from a role theoretic perspective that differentiates consulting, teaching, watching, and witnessing. Teaching and consulting are seen as main role alternatives in clinical ethics practice, with watching and witnessing defining transitional states that reveal the complexity of clinical ethics. The problem of the legitimation of clinical ethics is discussed in terms of legal, professional, and social accountability and authorization. It is argued that the problem of legitimation is tied up with the related issue of expertise that, in turn, reflects the complex role alternatives of consulting, teaching, watching, and witnessing. Finally, the question of methodology and practice of clinical ethics is explored in connection with the four role alternatives delineated.

Bioethical Issues↗
PubMed1998

Clinical ethics: theory or practice?

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information.

Cultural Diversity↗
PubMed1994

Will the new code help researchers to be more ethical?

A code of ethics has 2 largely incompatible objectives: to set forth enforceable minimal standards of conduct and to teach about or invoke ethical conduct. The section of the new American Psychological Association code dealing with research ethics achieves the former to some degree. However, it neither provides needed education in the ethics of research nor states where the reader might turn for such information. The code is particularly deficient in the following areas: privacy and confidentiality; institutional review boards; deception; debriefing; data sharing; and research on marginal populations, on children and adolescents, and in organizational contexts. Suggestions are offered for providing a bibliographic resource, in hard copy and on-line, that would stimulate independent interest, scholarship, education, and research on research ethics.

Behavioral Research↗