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PubMedDate not supplied

An educational consultative model for general practice training programs.

A behavioral science consultant has been retained by two hospital-based general practice residency (GPR) programs and one advanced program in general dentistry at the University of Rochester, and Eastman Dental Center, NY. This consultant is available throughout the year and serves as an external consultant who knows the programs well, and can be used as a source of information on various existing and potential issues and problems. The model used by the consultant has been inductive and is based on the expressed needs of faculty members, trainees, and directors. A number of issues or problems were identified, including faculty member morale, evaluation of residents' growth, resident and supporting staff relations, curriculum development, cooperation with other departments and institutions, and dealing with patients' anxiety to dental treatment. For each, a specific plan was developed. Various types of experiential techniques were used, including brainstorming, role playing, and taping and feedback. Didactic activities included minicourses and workshops in which standard teaching methods were used, such as lectures, seminar discussions, literature study, and demonstration. The model has evolved, and as each activity has succeeded, more faculty members have sought help from the consultant.

Consultants↗
PubMed1989

Genetic correction of hereditary disease.

Several hereditary disorders may be potentially correctable by the introduction and incorporation of the normal gene into human tissues using a variety of systems. Although technical issues surrounding integration, stable expression and potential insertional mutagenesis to the treated cells has not yet been fully resolved, enough scientific progress has already been made to consider somatic cell gene therapy acceptable from both the scientific and ethical viewpoints. Tissue-specific stem cell and embryonic stem cell transplantation will allow therapy earlier in the developing embryo. As technical problems are eliminated, these procedures will become morally permissible, as they will allow the correction of devastating hereditary disease.

Ethics, Medical↗
PubMed1984

The case for investor-owned hospitals.

The author presents the case for investor-owned hospitals based on his work experience in both nonprofit and for-profit hospitals. Viewing investor-owned hospitals as a natural development within a capitalistic democracy, he discusses the origins of the moral, ethical, and political arguments used against for-profit hospital care, as well as the increasing necessity for all hospitals to follow the laws of sound economic practice. Finally, having seen good and bad hospitals in every ownership category, the author believes that issues of cost and quality depend not on type of ownership, but on a complex set of variables including goals, management, personnel, and fiscal and physical resources.

Biomedical Research↗
PubMed1997

[The exercise of nursing in its bioethical dimension].

In the present study we approached Bioethics, an area that has been targeted for discussion and reflection within the scope of biological and health sciences, in order to rethink human conduct towards moral values in the current context of great technological and scientific development. We started a discussion about the exercise of nursing in its bioethical dimension, analyzing how such exercise has been occurring at the level of the ethics of principles, which is based on beneficence, autonomy and justice. In this respect, in their relations with patients, the members of the nursing team have adopted a posture based on beneficence linked to the subordination of their practice to the medical act. On the other hand, close contact with patients enables the nursing team to form ties that confer a certain power, which can be used to lead patients to exercise the ir autonomy.

Bioethics↗
PubMed1998

Cooperation: the foundation of improvement.

Cooperation--working together to produce mutual benefit or attain a common purpose--is almost inseparable from the quest for improvement. Although the case for cooperation can be made on ethical grounds, neither the motivation for nor the effects of cooperation need to be interpreted solely in terms of altruism. Cooperation can be a shrewd and pragmatic strategy for accomplishing personal goals in an interdependent system. Earlier papers in this series have explored the conceptual roots of modern approaches to improvement, which lie in systems theory. To improve systems, we must usually attend first and foremost to interactions. Among humans, "better interaction" is almost synonymous with "better cooperation." Physicians have ample opportunities and, indeed, an obligation to cooperate with other physicians in the same or different specialties, with nurses and other clinical workers, with administrators, and with patients and families. Many intellectual disciplines have made cooperation an object of study. These include anthropology; social psychology; genetics; biology; mathematics; game theory; linguistics; operations research; economics; and, of course, moral and rational philosophy. Scientifically grounded methods to enhance cooperation include developing a shared purpose; creating an open, safe environment; including all who share a common purpose and encouraging diverse viewpoints; negotiating agreement; and insisting on fairness and equity in the application of rules. These methods apply at the organizational level and at the level of the individual physician. This paper describes the application of these methods at the organizational level and focuses on one especially successful example of system-level cooperation in a care delivery site where interactions matter a great deal: the modern intensive care unit.

Cooperative Behavior↗
PubMed1990

Life, death, and liability: duties of health care providers regarding withdrawal of treatment.

Many of the issues surrounding refusal and withdrawal of medical treatment are so new and complex that the U.S. society has not resolved the ethical or legal questions involved. Questions such as where life ends and death begins, how to determine the circumstances when withdrawal of treatment is appropriate, and who should make such decisions will have to be resolved before the law in this area can become settled. Naturally, society is a long way from resolving these issues, since they involve such fundamental social, moral, medical, and legal considerations. Nevertheless, a body of law has developed that increasingly recognizes the right of an individual to direct his or her own medical care. To that end, an individual's clearly expressed intention to discontinue medical treatment will generally be honored, even if death results from the withdrawal of that treatment. Legislatures and courts have also encouraged health care providers to abide by the wishes of their patients by giving immunity to health care providers who comply in good faith with the provisions of a living will. Courts have also been reluctant to impose liability on health care providers for withdrawal of treatment absent a living will if it were done in good faith (with the consent of family or guardian) and was in accordance with accepted medical practice. It would appear that as the law gives individuals increased control over the private matter of their own medical treatment, health care providers may face more civil suits for maintaining life support systems against the patient's (or family's) wishes. In any event, while society is in the process of catching up with medical technology, individuals can best protect their right to medical self-determination by expressing their wishes clearly in the form of a living will and durable power of attorney. Health care providers can best protect themselves by keeping abreast of medical and legal developments in connection with these issues and by communicating effectively with their patients as to their wishes regarding life-prolonging medical treatment.

Crime↗
PubMed2000

Uncertain genesis. The academic institutionalization of American psychology in 1900.

The new discipline of psychology had been established at a number of American colleges and universities by 1900, but it usually existed in a more rudimentary form, as compared with the familiar autonomous department of psychology found today. The current form took quite a number of years to evolve: A century ago, a survey of these schools would have shown psychology programs to have existed mostly at early stages of development. Many of the schools were still teaching some form of moral or mental philosophy or only one or two courses in psychology. A few of the schools had established psychology laboratories. Fewer still were offering the doctor of philosophy degree in psychology, while a mere handful had independent psychology departments.

Curriculum↗
PubMed2003

The head and neck radiation oncology patient.

Radiotherapy may be either an effective alternative to surgery or a valuable adjunct to surgery and/or chemotherapy in the locoregional treatment of malignant head and neck tumors. The care of patients with head and neck cancer undergoing radiotherapy or who have completed treatment is a multidisciplinary effort. Oral health care providers can expect to be called upon to care for patients with head and neck cancer undergoing radiotherapy. Early, active participation in developing preventive and therapeutic strategies, in implementing the plan, and in the education and rehabilitation of the patients is paramount in addressing quality of life issues. To provide timely and competent care, oral health care providers must understand the disease, its treatment, and the impact the disease and/or its treatment may have on these patients. Oral health care providers should develop and implement preventive and therapeutic strategies with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.

Candidiasis, Oral↗
PubMed2004

Immortality.

In December, the President's Council on Bioethics released Beyond Therapy: Biotechnology and the Pursuit of Happiness. Here, Lustig discusses the six-part report that provides a balanced but critical assessment of actual and prospective developments in biotechnology and seeks to anchor its discussion in shared moral and metaphysical concerns--the nature of human nature, and the social and political implications of unfettered choices in altering the human prospect through biotechnology.

Advisory Committees↗
PubMed2005

The medical oncology patient.

Chemotherapy may be either an effective alternative to surgery or a valuable adjunct to surgery and/or radiotherapy in the treatment of cancer. The care of medical oncology patients is a multidisciplinary effort. Oral health care providers can expect to be called on to care for patients with cancer undergoing chemotherapy. Early, active participation in developing preventive and therapeutic strategies, in implementing the plan, and in the education and rehabilitation of patients is paramount in addressing quality of life issues. To provide timely and competent care, oral health care providers must understand the disease, its treatment, and the impact the disease and/or its treatment may have on these patients. Oral health care providers should develop and implement preventive and therapeutic strategies with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.

Antineoplastic Agents↗
PubMedDate not supplied

Evaluation of a sister--charge nurse development course.

In this study the problems of implementing a sister/charge nurse development course are identified, and the impact of the course on its members and their practice is examined. The sample consisted of 22 newly promoted sisters and the data were collected through individual interviews and questionnaires. It was found that many of the problems of implementation related to lack of resources and management support and a working climate which was not conducive to motivating them to take an interest in their professional development. As a result, the course members' initial apathy, disillusionment, low morale and general dissatisfaction with their job and the profession were not altered as a result of the course. There were also strong criticisms of the health authority as uncaring and an exploiter of staff goodwill. The implications of these findings are discussed and an alternative approach to continuing nurse education is suggested.

Education, Nursing, Continuing↗
PubMed1994

Continuing education--a choice between affluence and deprivation.

The study sought to identify reasons why initial enthusiasm for in-service training was not reflected in actual attendance. An interview and questionnaire survey of 61 midwives in a London health authority assessed their perceptions of, motivation for and participation in continuing professional education (CPE). The midwives surveyed appreciated the need for CPE, kept up with professional reading and took part in a wide range of educational activities. Managers and staff midwives were the poorest attenders at study days and training sessions, which may have adverse consequences for their development. It is suggested that CPE improves clinical standards and raises morale (a cycle of affluence) and that it may also prevent stress and 'burnout'.

Attitude of Health Personnel↗
PubMed2004

Understanding the importance of values and moral attitudes in nursing care in preserving human dignity.

The purpose of this investigation was to explore when nursing becomes an art, and to develop a theory/model of nursing as art. The overall design of the investigation was qualitative, and phenomenological-hermeneutic. The five substantial categories in the theory/model are: Invitation and confirmation, encounter, values, moral attitude and demeanor, the act of good will, and aesthetic communication. One main finding of this nursing investigation based on the caring perspective was that values and a thoroughly moral attitude and demeanor are central when nursing becomes an art.

Art↗
PubMed1993

Depression and moral masochism.

Depression and moral masochism are inseparable, and originate in a particular climate of lived experience in which one or both parents suffer from a masochistic-depressive disposition. Developmentally, there has been a deficit in the child's experience of shared pleasure, and of being a source of enjoyment to the parent. Instead, the child experiences himself or herself as a source of pain and feels responsible for the parent's dysphoric, anhedonic state. This is not simply a fantasy construction of the child, as parental reproachfulness is characteristically encountered. The child makes reparative efforts, but they generally do not succeed. Central psychological capacities are compromised under these conditions, particularly a sense of personal efficacy and of natural entitlement. The evolution of initiative, autonomy, and individuation are also significantly affected. The aggression, both conscious and unconscious, which is generated by these early conditions creates intrapsychic conflict which further inhibits the development of these essential psychological functions. Some therapeutic recommendations are proposed based on these considerations.

Aggression↗
PubMed2001

Dutch law and ethics concerning the experimental treatment of early psychosis.

Moral and social attitudes towards medical treatment and research rapidly changed during the last four decades of the Twentieth Century. In the Netherlands these changes are reflected in three laws adopted in the 1990s. The Law on Medical Treatment Agreement (Wet Geneeskundige BehandelOvereenkomst, WGBO, 1992) reflects the respect for autonomy and the protection of patient's rights. The Law on Special Admission to Psychiatric Hospitals (Bijzondere Opneming Psychiatrische Ziekenhuizen, BOPZ, 1994) reflects the idea that psychiatric subjects should be entitled to execute their civil rights as long as no danger exists to themselves or others, while the Law on Medical Research (Wet Medisch Onderzoek, WMO 1999), reflects the present moral opinions on bio-medical research. From these laws objections can be derived against the development of treatment and experiments on early psychosis. It will be argued here that these laws can also be taken to stimulate this kind of research. The difference between the two options is related to preconceived moral opinions towards psychosis and schizophrenia.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

Moral dilemmas in neonatology as experienced by health care practitioners: a qualitative approach.

During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported - terminating an already initiated treatment - we propose the concept of 'evidence shift' to clarify the ambiguous position of uncertainty in decision making.

Attitude of Health Personnel↗
PubMedDate not supplied

Mother-child discourse, attachment security, shared positive affect, and early conscience development.

The separate literatures on parental discipline, maternal discourse about emotion, and autobiographical memory support the idea that parent-child discourse in the context of a supportive relationship plays a role in a child's early conscience development, and this study was designed to examine this issue. Forty-two preschool children and their mothers took part in a 45-min structured laboratory session, and at their homes, mothers completed the Attachment Q-Set. As part of the laboratory session, each mother was asked to discuss with her child one incident that occurred within the last week in which her child behaved well and one in which her child misbehaved. These conversations were transcribed verbatim and coded for maternal references to feelings, rules, consequences of the child's actions, and moral evaluatives. Each child also took part in a behavioral measure of internalization and several compliance tasks, and mothers completed a maternal report of the child's early conscience development. Consistent with attachment theory, attachment security predicted maternal and child references to feelings and moral evaluatives. Attachment security, shared positive affect between the mother and child, and maternal references to feelings and moral evaluatives also predicted specific aspects of early conscience development.

Adult↗