Viewing the image? Ultrasound examination during abortion preparations, ethical challenges

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s (HCP) experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee (2014/1276). The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination.

Download Full-text

‘Ethics Between the Lines’ – Nurses’ Experiences of Ethical Challenges in Long-Term Care

Global Qualitative Nursing Research ◽

10.1177/23333936211060036 ◽

2021 ◽

Vol 8 ◽

pp. 233339362110600

Author(s):

Hilde Munkeby ◽

Aud Moe ◽

Grete Bratberg ◽

Siri A. Devik

Keyword(s):

Long Term Care ◽

Ethical Reflection ◽

Ethical Challenges ◽

Care Needs ◽

Term Care ◽

Organizational Conditions ◽

Cost Efficient ◽

Group Interviews ◽

The Individual

In long-term care, ethical challenges are becoming increasingly apparent as the number of older patients with complex care needs increases, in parallel with growing demands for more cost-efficient care. Scarce resources, cross-pressure and value conflicts are associated with missed care, moral stress and nurses wanting to leave the profession. Through five focus group interviews, this study aimed to explore how nurses working in nursing homes and homecare services perceive, experience and manage ethical challenges in everyday work. Content analysis revealed three main themes: striving to do good; failing and being let down and getting rid of frustrations and learning from experiences. The nurses’ morality was mainly expressed through emotions that arose in specific situations. Dedicated spaces for ethical reflection and leaders who recognize that organizational conditions affect the individual nurse-patient relationship are required. Facilitating ethical reflection is an important leadership responsibility, which may also require leaders to actually participate.

Download Full-text

Screening for Down syndrome using first-trimester combined screening followed by second-trimester ultrasound examination in an unselected population

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/s1090-798x(08)70046-8 ◽

2007 ◽

Vol 2007 ◽

pp. 59-61

Author(s):

L.P. Shulman

Keyword(s):

Down Syndrome ◽

Ultrasound Examination ◽

First Trimester ◽

Second Trimester ◽

Unselected Population

Download Full-text

Navigating the health care system: perceptions of patients with chronic pain

Chronic Diseases in Canada ◽

10.24095/hpcdp.29.4.03 ◽

2009 ◽

Vol 29 (4) ◽

pp. 162-168

Author(s):

AL Dewar ◽

K Gregg ◽

MI White ◽

J Lander

Keyword(s):

Health Care ◽

Chronic Pain ◽

Health Care System ◽

Health Care Professionals ◽

Primary Care Physicians ◽

Treatment Compliance ◽

Care Utilization ◽

Semistructured Interviews ◽

The Individual ◽

Care System

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual’s experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization.

Download Full-text

Optimization of the care model for elderly in Poland

Physiotherapy ◽

10.2478/physio-2013-0048 ◽

2013 ◽

Vol 21 (4) ◽

Author(s):

Felicja Lwow ◽

Małgorzata Korzeniowska ◽

Joanna Dadacz ◽

Ewa Hladik ◽

Agata Łukojko ◽

...

Keyword(s):

Health Care ◽

Chronic Conditions ◽

Institutional Care ◽

Developed Countries ◽

Social Aspect ◽

Age Group ◽

Care Needs ◽

Optimal Health ◽

Health Care Models ◽

The Individual

AbstractThe demographic situation of Poland as well as other developed countries shows a growing number of people at retirement age. According to the data from GUS (Central Statistical Office), their number reached 6.5 mln in Poland in 2011, and the prognosis for shows 8,3 mln by the year 2035. The consequence of this fact is a necessity of including the specificity of this age group in the functioning of Polish health care as well as in preventive medicine and health promotion. Unifying the health needs of this age group would be disadvantageous due to the diversification of physical efficiency level in the psychosomatic and social aspect. Nevertheless, the key problem is to distinguish the optimal health care models which include not only chronic conditions and dysfunctions but also the quality of life and socially independent life style that guarantee the lack of isolation and social exclusion. Distinguishing the four action models, namely people considered as healthy by the system, autonomously functioning people with chronic conditions, and people who need other people or institutional care to function in a society, seems to cover the individual needs of this group. Concluding, the National Health Care needs to work out some proceeding algorithms for these models. The optimal program adjustment for the needs of the target group would most certainly improve the effectiveness of the Health Care.

Download Full-text

Health Care Reform: Has the Supreme Court Already Embraced the Individual Mandate?

SSRN Electronic Journal ◽

10.2139/ssrn.2070325 ◽

2012 ◽

Author(s):

Emily M. Bass

Keyword(s):

Health Care ◽

Supreme Court ◽

Health Care Reform ◽

The Supreme Court ◽

Individual Mandate ◽

The Individual

Download Full-text

The Globalization of Health Law: The Case of Permissibility of Placebo-based Research

American Journal of Law & Medicine ◽

10.1017/s0098858800011047 ◽

2000 ◽

Vol 26 (2-3) ◽

pp. 175-186

Author(s):

Timothy S. Jost

Keyword(s):

Health Care ◽

Medical Practice ◽

Health Care Professionals ◽

Global Markets ◽

Health Law ◽

Cross Border ◽

Internet Pharmacies ◽

The Individual ◽

Global Communications ◽

National Borders

If any trend can be confidently predicted for the next millennium (or, more modestly, for our lifetimes) it is the globalization of health law. We live in an age of global markets and global communications. While care of the individual patient has remained largely local, national borders are quite porous to health care professionals. The cross-border flow of patients is a significant factor in some regions, and the development of telemedicine and internet pharmacies is radically expanding the possibility of cross-border medical practice.

Download Full-text

The triple aim of clinical research

Clinical Trials ◽

10.1177/17407745211001522 ◽

2021 ◽

pp. 174077452110015

Author(s):

E Ray Dorsey ◽

Karl Kieburtz

Keyword(s):

Health Care ◽

Clinical Research ◽

Population Health ◽

Patient Experience ◽

Triple Aim ◽

Per Capita ◽

The Individual

The proposed triple aim of health care—enhanced patient experience, improved population health, and reduced per capita costs—can be applied to clinical research. A triple aim for clinical research would (1) improve the individual research participant’s experience; (2) promote the health of populations; and (3) reduce per capita costs of clinical research. Such an approach is possible by designing trials around the needs of participants rather than sites, embracing digital measures of health, and advancing decentralized studies. Recent studies, including those evaluating therapies for COVID-19, have demonstrated the value of such an approach. Accelerating the adoption of these methods can help fulfill this new triple aim of clinical research.

Download Full-text

First trimester tricuspid regurgitation and fetal abnormalities

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0058 ◽

2015 ◽

Vol 43 (5) ◽

Cited By ~ 2

Author(s):

Marcin Wiechec ◽

Agnieszka Nocun ◽

Ewa Wiercinska ◽

Jill Beithon ◽

Anna Knafel

Keyword(s):

Tricuspid Regurgitation ◽

Screening Tool ◽

Ultrasound Examination ◽

First Trimester ◽

Study Group ◽

Fetal Life ◽

Inclusion Criteria ◽

Positive Group ◽

Congenital Cardiac Defects ◽

Chromosomal Status

AbstractTricuspid regurgitation (TR) is a common sonographic finding during the fetal life. It has been reported in 7% of normal fetuses. It may be associated with aneuploidy and with both cardiac and extracardiac defects.In this study, we have looked at the characteristics of fetuses with and without TR at 11The study group included women, who underwent an ultrasound examination at 11–13Some 1075 patients met our inclusion criteria including 979 fetuses without TR and 96 with TR. There were 72 cases of aneuploidy diagnosed (6.7%). Isolated TR was found in 53 euploid fetuses (5.2%). All of the TR(+) aneuploid fetuses (n=40) had additional ultrasound markers present. Extracardiac anatomy showed a higher prevalence of abnormalities in the group of TR positives (12.5%) vs. TR negatives (1.6%). Abnormal cardiac findings were more frequent in the TR-positive group independently of chromosomal status and were found in 18.8% of fetuses with TR and in 1.9% with a normal tricuspid flow.TR in combination with other markers is the strongest predictor for aneuploidy. TR, as an isolated parameter, is a poor screening tool both for all and for each individual chromosomal abnormality and congenital cardiac defects.

Download Full-text

When Is Patient Education Unethical?

Nursing Ethics ◽

10.1177/0969733008095389 ◽

2008 ◽

Vol 15 (6) ◽

pp. 813-820 ◽

Cited By ~ 9

Author(s):

Barbara K Redman

Keyword(s):

Health Care ◽

Health Promotion ◽

Patient Education ◽

Capabilities Approach ◽

Ethical Practice ◽

Patient Beliefs ◽

Moral Framework ◽

Provider Group ◽

The Individual ◽

Group Limit

Although patient education is central to the ethical practice of nursing, it can be practiced in an ethically contested or unethical way. It is sometimes used to: forward a societal goal the individual might not have chosen; assume that patients should learn to accommodate unjust treatment; exclude the views of all except the dominant health care provider group; limit the knowledge a patient can receive; make invalid or unreliable judgments about what a patient can learn; or require a patient to change his or her identity to meet a medical ideal. Both health promotion education and manipulating patient beliefs in situations of uncertainty are ethically contested. Nussbaum's capabilities approach is used here as a moral framework through which to view the goals and practice of patient education. This provides better guidance than the current conception of patient education as an instrument to carry out the directives of medical practice.

Download Full-text