The Ethics of Resuscitation: How Do Paramedics Experience Ethical Dilemmas when Faced with Cancer Patients with Cardiac Arrest?

2012 ◽  
Vol 27 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Halvor Nordby ◽  
Øyvind Nøhr
Keyword(s):  
Cardiac Arrest ◽  
Cancer Patients ◽  
Exploratory Study ◽  
Ethical Dilemmas ◽  
Human Life ◽  
Structured Interviews ◽  
Emergency Personnel ◽  
Medical Issues ◽  
Illness Experiences ◽  
Ethical Choices

AbstractIntroduction: Research on prehospital emergency work traditionally has focused on medical issues, but paramedics often have to make ethical choices. The goal of this exploratory study was to understand how paramedics experience difficult ethical dilemmas regarding resuscitation of cancer patients.Methods: Paramedics from ambulance services in Norway were interviewed about resuscitation of cancer patients with cardiac arrest. The qualitative study included naturalistic, semi-structured interviews and a cognitive-emotional, interpretive approach.Results: All study participants believed that it ethically can be correct not to resuscitate if the patient is expected to survive for only a short time with a very low quality of life and severe negative illness experiences. However, this belief sometimes failed to match formal or informal guidelines and contextual factors such as expectations of relatives. When confronting these challenges, the majority of the paramedics relied heavily on the advice of medical experts, but some had to make more autonomous decisions.Discussion: The concept of a double pressure situation can be used to analyze the ethical dilemmas regarding resuscitation of cancer patients. The pressure from “below” is grounded in individual caring frameworks, and in the belief that it can be wrong to resuscitate. The pressure from “above” is objective and system-related, related to uncertainty, and grounded in the fundamental and irreducible value of human life.Conclusions: The findings of this qualitative, exploratory study suggest that ethical concepts and analyses of double pressure situations should have an important role in education and training designed to prepare emergency personnel for difficult life and death choices. More research is needed to shed light on how ethical dilemmas arise in prehospital work.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

2021 ◽  
Author(s):  
Kyle Wilhelm ◽  
Lindsey Wilhelm
Keyword(s):  
Music Therapy ◽  
Private Practice ◽  
Phenomenological Study ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
The United States ◽  
Business Owners ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Music Therapists

Abstract As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs’ lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

scholarly journals Linking Conservation, Community Knowledge, and Adaptation to Extreme Climatic Events: A Case Study in Gorongosa National Park, Mozambique

2021 ◽  
Vol 13 (11) ◽  
pp. 6478
Author(s):  
Amemarlita Matos ◽  
Laura Barraza ◽  
Isabel Ruiz-Mallén
Keyword(s):  
National Park ◽  
Animal Species ◽  
Human Life ◽  
Management Strategies ◽  
Forest Products ◽  
Buffer Zone ◽  
Structured Interviews ◽  
Extreme Climatic Events ◽  
Water Provision

This study is based on ethnographic research that analyzes how traditional knowledge and local beliefs on biodiversity conservation relates to the local ability to adapt and be resilient to climatic changes in two communities around Gorongosa National Park, Mozambique: Nhanfisse in the buffer zone and Muanandimae in the core area. A total of 78 semi-structured interviews with heads of households were conducted. We found that both communities carried out practices and held beliefs associated with conservation, such as protecting trees and animal species considered sacred or perceived as beneficial for human life in terms of water provision and agricultural production. In addition to traditional ceremonies that respond to extreme climatic events such as drought and flood, other adaptation strategies used by the communities include moving to neighboring areas in search of better living conditions and using forest products in times of scarcity. We discuss that the management of the park should be agreed on, in a shared way, between local communities and conservation agents to ensure that these areas continue to perform the ecological, subsistence, and spiritual functions required. Our research results contribute to a better understanding of local adaptation dynamics towards extreme climatic events and improvement of management strategies.

scholarly journals Ethical Issues around Death and Withdrawal of Life Support in Neonatal Intensive Care

2021 ◽  
Author(s):  
Stuti Pant
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Human Life ◽  
Traumatic Experiences ◽  
National Guidelines ◽  
Brain Injured ◽  
Discharge Against Medical Advice

AbstractAmongst all the traumatic experiences in a human life, death of child is considered the most painful, and has profound and lasting impact on the life of parents. The experience is even more complex when the death occurs within a neonatal intensive care unit, particularly in situations where there have been conflicts associated with decisions regarding the redirection of life-sustaining treatments. In the absence of national guidelines and legal backing, clinicians are faced with a dilemma of whether to prolong life-sustaining therapy even in the most brain-injured infants or allow a discharge against medical advice. Societal customs, vagaries, and lack of bereavement support further complicate the experience for parents belonging to lower socio-economic classes. The present review explores the ethical dilemmas around neonatal death faced by professionals in India, and suggests some ways forward.

scholarly journals What matters to patients? A mixed method study of the importance and consideration of oncology patient demands

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathias WAELLI ◽  
Etienne Minvielle ◽  
Maria Ximena Acero ◽  
Khouloud Ba ◽  
Benoit Lalloué
Keyword(s):  
Cancer Patients ◽  
Mixed Method ◽  
New Technologies ◽  
Care Pathway ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Delivery Systems ◽  
Breast Cancer Patients ◽  
Structured Interviews ◽  
Oncology Patient

Abstract Background A patient-centred approach is increasingly the mandate for healthcare delivery, especially with the growing emergence of chronic conditions. A relevant but often overlooked obstacle to delivering person-centred care is the identification and consideration of all demands based on individual experience, not only disease-based requirements. Mindful of this approach, there is a need to explore how patient demands are expressed and considered in healthcare delivery systems. This study aims to: (i) understand how different types of demands expressed by patients are taken into account in the current delivery systems operated by Health Care Organisations (HCOs); (ii) explore the often overlooked content of specific non-clinical demands (i.e. demands related to interactions between disease treatments and everyday life). Method We adopted a mixed method in two cancer centres, representing exemplary cases of organisational transformation: (i) circulation of a questionnaire to assess the importance that breast cancer patients attach to every clinical (C) and non-clinical (NC) demand identified in an exploratory inquiry, and the extent to which each demand has been taken into account based on individual experiences; (ii) a qualitative analysis based on semi-structured interviews exploring the content of specific NC demands. Results Further to the way in which the questionnaires were answered (573 answers/680 questionnaires printed) and the semi-structured interviews (36) with cancer patients, results show that NC demands are deemed by patients to be almost as important as C demands (C = 6.53/7 VS. NC = 6.13), but are perceived to be considered to a lesser extent in terms of pathway management (NC = 4.02 VS C = 5.65), with a significant variation depending on the type of non-clinical demands expressed. Five types of NC demands can be identified: demands relating to daily life, alternative medicine, structure of the treatment pathway, administrative and logistic assistance and demands relating to new technologies. Conclusions This study shows that HCOs should be able to consider non-clinical demands in addition to those referring to clinical needs. These demands require revision of the healthcare professionals’ mandate and transition from a supply-orientated system towards a demand-driven approach throughout the care pathway. Other sectors have developed hospitality management, mass customisation and personalisation to scale up approaches that could serve as inspiring examples.

Exploratory Study of Advance Care Discussions Among Chinese American and White Stage IV Cancer Patients at an American Tertiary Medical Center

2021 ◽  
pp. 104990912110126
Author(s):  
Avery Caz Glover ◽  
Courtney Schroeder ◽  
Emma Ernst ◽  
Tamara Vesel
Keyword(s):  
Cancer Patients ◽  
Exploratory Study ◽  
Stage Iv ◽  
Chinese American ◽  
Chinese Americans ◽  
Do Not Resuscitate ◽  
Essential Components ◽  
Advance Care ◽  
Stage Iv Cancer ◽  
White Patients

Purpose: Timely advance care discussions are essential components of quality care for diverse populations; however, little is known about these conversations among Chinese American cancer patients. This exploratory study describes differences in advance care discussions and planning between Chinese American and White advanced cancer patients. Methods: We collected data for 63 Chinese American and 63 White stage IV cancer patients who died between 2013 and 2018. We compared: frequency and timing of prognosis, goals of care (GOC), and end-of-life care (EOLC) discussions in the final year of life; family inclusion in discussions; healthcare proxy (HCP) identification; do not resuscitate (DNR) order, do not intubate (DNI) order, and other advance directive (AD) completion. We did not conduct statistical tests due to the study’s exploratory nature. Results: Among Chinese American and White patients, respectively, 76% and 71% had prognosis, 51% and 56% had GOC, and 89% and 84% had EOLC discussions. Prognosis, GOC, and EOLC discussions were held a median of 34.0, 15.5, and 34.0 days before death among Chinese American and 17.0, 13.0, and 24.0 days before death among White patients. Documentation rates among Chinese American and White patients were 79% and 76% for DNRs, 81% and 71% for DNIs, 79% and 81% for HCPs, and 52% and 40% for other ADs. Conclusions: Findings suggest that Chinese Americans had similar rates of advance care discussions, completed conversations earlier, and had similar to higher rates of AD documentation compared to White patients. Further studies are needed to confirm our preliminary findings.

Information behaviour and decision-making in patients during their cancer journey

2017 ◽  
Vol 35 (3) ◽  
pp. 494-506 ◽  
Author(s):  
Shih-Chuan Chen
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Information Source ◽  
Alternative Therapy ◽  
Treatment Decision ◽  
Treatment Method ◽  
Structured Interviews ◽  
Content Type ◽  
Information Behaviour ◽  
Treatment Decision Making

Purpose This paper aims to investigate the effect of cancer patients’ information behaviour on their decision-making at the diagnosis and treatment stages of their cancer journey. Patients’ information sources and their decision-making approaches were analyzed. Design/methodology/approach Semi-structured interviews were conducted with 15 participants. Findings The cancer patients sought information from various sources in choosing a hospital, physician, treatment method, diet and alternative therapy. Physicians were the primary information source. The patients’ approaches to treatment decision-making were diverse. An informed approach was adopted by nine patients, a paternalistic approach by four and a shared decision-making approach by only two. Practical implications In practice, the findings may assist hospitals and medical professionals in fostering pertinent interactions with patients. Originality/value The findings can enhance researcher understanding regarding the effect of cancer patients’ information behaviour on their decision-making.

Building a digital marketing internship program for technology-based start-ups: an exploratory study of student experiences

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
G. Russell Merz ◽  
Jamie Ward ◽  
Sufian Qrunfleh ◽  
Bud Gibson
Keyword(s):  
Factor Analysis ◽  
Language Processing ◽  
Exploratory Study ◽  
Study Data ◽  
Student Experiences ◽  
Structured Interviews ◽  
Content Type ◽  
Student Interns ◽  
Internship Programs ◽  
Blog Posts

PurposeThe purpose of this paper is to describe the role and characteristics of the summer internship program (Digital Summer Clinic) delivered by Eastern Michigan University. The authors report the results of an exploratory study of interns participating in the Digital Summer Clinic over a five-year time period. The study captures and analyzes the experiences of interns as expressed in structured interviews and blog posts.Design/methodology/approachThe study data were text from structured interviews and blog posts capturing the “voice” of the interns. A natural language processing (NLP) analysis of the text corpus, consisting of 43 interviews and blog posts, resulted in the identification of 242 unique stem-terms used by interns in describing the internship experiences. The authors used the JMP Pro 15.2 Text Explorer algorithm (It is defined as a suite of computer programs for statistical analysis developed by the JMP business unit of SAS Institute) to extract the terms that were subsequently transformed and analyzed with factor analysis and regression to address the research questions.FindingsThe factor analysis results found six dimensions or themes, defined by the stem-terms used by student interns, best described the internship experience. The authors then explored the relationship between the six themes and the umbrella term “internship” with multiple regression analysis. The regression findings suggest a hierarchy of effects with the theme “Introducing Professional Opportunities” being the theme most predictive of the umbrella term.Originality/valueThe methodology used within the paper is unique in several ways when compared to other research investigating internship programs. First, it uses NLP analysis for the qualitative analysis of text-based descriptions of student experiences over a five-year time horizon. Second, the data analysis uses transformed text to quantitatively determine the major dimensions or themes expressed by the interns about their experiences in the Summer Clinic program. Finally, the relative importance of the themes identified provided direction for future program development.

scholarly journals From teaching literacy to teaching numeracy: How numeracy teacher’s previous experiences shape their teaching beliefs

1970 ◽  
Vol 23 (1) ◽  
pp. 20-49 ◽  
Author(s):  
Sonja Beeli-Zimmermann
Keyword(s):  
Adult Education ◽  
Exploratory Study ◽  
Teaching And Learning ◽  
Teaching Beliefs ◽  
Structured Interviews ◽  
Mathematical Beliefs ◽  
Mathematical Belief

Beliefs guide teachers’ actions in the classroom and thereby influence what students learn. While this insight has led to numerous studies, particularly in the area of mathematical beliefs, it has been neglected in the growing field of numeracy teaching and learning within adult education. This exploratory study presents five illustrative cases of Swiss adult education teachers and traces their experiences, both as students and teachers. Based on data mainly collected in semi-structured interviews, the author argues that this study supports existing evidence from mathematical belief research in other sectors of education, pointing to the relevance of practice-based experiences for the change of beliefs.

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