scholarly journals Possible advantages of the clinical policy ethics assessment tool: institutional support or unnecessary bureaucracy?

2020 ◽  
pp. 147775092094668
Author(s):  
Alfonso Rubio-Navarro ◽  
Diego Jose Garcia-Capilla ◽  
Maria Jose Torralba-Madrid ◽  
Jane Rutty
Keyword(s):  
Clinical Practice ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Institutional Support ◽  
Ethical Practice ◽  
Ethical Assessment ◽  
Simple Tool ◽  
Ethics Assessment

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue.

scholarly journals The development of a clinical policy ethics assessment tool

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2259-2277
Author(s):  
Diego José Garcia-Capilla ◽  
Alfonso Rubio-Navarro ◽  
Maria José Torralba-Madrid ◽  
Jane Rutty
Keyword(s):  
Clinical Practice ◽  
Nursing Practice ◽  
Assessment Tool ◽  
Ethical Issues ◽  
Reliability And Validity ◽  
Individual Treatment ◽  
Research Protocol ◽  
Developed Country ◽  
Ethical Assessment ◽  
Ethics Assessment

Introduction: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. Aim: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and guidelines. Methodology: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. Ethical consideration: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Results: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. Discussion: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care. Conclusion: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice.

scholarly journals Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice

2020 ◽  
pp. 026921632097427
Author(s):  
Guy Schofield ◽  
Mariana Dittborn ◽  
Richard Huxtable ◽  
Emer Brangan ◽  
Lucy Ellen Selman
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Clinical Practice ◽  
Ethical Issues ◽  
Clinical Care ◽  
Ethical Principles ◽  
Original Research ◽  
Specialist Palliative Care ◽  
Ethical Challenges ◽  
Ethical Practice

Background: Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff. Aim: To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice. Design: Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative. Data sources: Seven databases (MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges. Results: A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy). Conclusion: Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.

scholarly journals Ethical issues in optometric practice

2010 ◽  
Vol 69 (2) ◽  
Author(s):  
H. L. Sithole
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Unethical Behavior ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Health Care Practitioner ◽  
Ethical Practice ◽  
Ethical Concerns ◽  
Legal Constraints

Ethics as a discipline is the study and analysis of values and standards related to duty, responsibility, and right and wrong behavior. The ethical obligations of optometry toward patients are similar to those of other health professionals. These obligations generally require optometrists to recognize, respect, and protect the rights of their patients. This approach encourages patients to participate actively in their care and allows them to develop arelationship with their optometrist based on trust. The ethical codes which contain guiding principles serve to help practitioners in their decisions and in practicing in accordance with a set of standards that are expected of a health care practitioner. There are four major ethical principles in health care, namely; beneficence, non-maleficence, and respect for autonomy and justice. Because these principles are easily recognized as being among the primary ethical goals of health care, using them as the basis for ethical analysis may help to explain the moral justification for certain professional actions as well as to identify unethical behavior. However, in clinical practice, the specific demands and rationales of these broad principles may be difficult to apply. This illustrates the paradox that whilst these principles are essential tools for ethical practice, if applied too rigidly, they can be problematic. How-ever, the goal of ethical decision making in optometry should be to identify one or more courses of action that will honor the profession’s essential values while minimizing conflict with other values and professional standards. Every profession, every practice and every practitioner is governed by not only legal constraints, but also by the ethical concerns of ensuring that the patient is properly served. Considering our practices from a patient’s perspective can help optometrists understand the multiple responsibilities of clinical practice. (S Afr Optom 2010 69(2) 93-99)

Ethical Issues Encountered by Military Nurses During Wartime

2016 ◽  
Vol 34 (1) ◽  
pp. 227-246 ◽  
Author(s):  
Janice Agazio ◽  
Petra Goodman ◽  
Oluwakemi Opanubi ◽  
Patricia McMullen
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Code Of Ethics ◽  
Ethical Dilemmas ◽  
Daily Practice ◽  
Professional Behavior ◽  
Future Research ◽  
Ethical Practice ◽  
Military Nurses ◽  
The Military

Military nurses encounter similar issues as civilian nurses in daily practice situations; however, wartime and humanitarian missions may bring unique and difficult ethical dilemmas. While nursing has the American Nurses Association code of ethics to provide a framework to guide ethical practice decisions, conflicts may arise from the unique aspects of nursing within a wartime environment. Understanding those conflicts occuring within the military wartime scenario can provide nurses with experiential examples from which to derive strategies for personal coping and professional behavior and decision making. This chapter describes the research that has focused upon the identification of these issues, the effects from uresolved issues, and those directions for future research to better prepare miltiary nurses before and during deployment.

scholarly journals Effectiveness of personal letters to healthcare professionals in changing clinical practice behaviours: A Systematic Review protocol

2020 ◽  
Author(s):  
Aikaterini Grimani ◽  
Louis Goffe ◽  
Mei Yee Tang ◽  
Fiona Beyer ◽  
Falko F. Sniehotta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Cochrane Library ◽  
Behaviour Change Techniques ◽  
Hand Search

Abstract Background: Letters are regularly sent by healthcare organisations to healthcare professionals to encourage them to take action, change practice or implement guidance. However, whether letters are an effective tool in delivering a change in clinical practice behaviour is currently uncertain. In addition, there are currently no evidence-based guidelines to support providers and health authorities with advice on how to formulate the communication, what information and behaviour change techniques to include in order to optimise the potential effect on the behaviour of the receivers. To address this research gap, we aim to inform such guidance through this systematic review.Methods/ Design: A systematic literature search of published and unpublished studies (the grey literature) in electronic databases will be conducted to identify studies that meet our inclusion criteria. The search will be conducted in five electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Library and CINAHL. We will also conduct supplementary searches in Google Scholar, hand search relevant journals, and conduct backward and forward citation searching for included studies and relevant reviews. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic reviews and Meta-Analysis. Titles, abstracts, full-texts for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using quality assessment tool for studies with diverse design and Cochrane risk of bias tool. Disagreements will be resolved by a consensus procedure.Discussion: This review aims to provide comprehensive evidence of the effectiveness of personal letters to healthcare professionals in changing clinical practice behaviours. Health policy makers across government will benefit from being able to increase compliance in clinical settings by applying theories of behaviour to design of policy communications. The synthesized findings will be disseminated through peer-reviewed publication.Systematic review registration: PROSPERO CRD42020167674

scholarly journals Enhancing ethics review of social and behavioral research: developing a review template in Ethiopia

2019 ◽  
Vol 15 (3-4) ◽  
pp. 1-23
Author(s):  
Liya Wassie ◽  
Senkenesh Gebre-Mariam ◽  
Geremew Tarekegne ◽  
Stuart Rennie
Keyword(s):  
Assessment Tool ◽  
Ethical Issues ◽  
Behavioral Research ◽  
Ethical Review ◽  
Middle Income ◽  
Ethical Assessment ◽  
Ethics Review ◽  
Behavioral Studies ◽  
Important Region ◽  
Heavy Burden

Background: Africa is increasingly becoming an important region for health research, mainly due to its heavy burden of disease, socioeconomic challenges, and inadequate health facilities. Regulatory capacities, in terms of ethical review processes, are also generally weak. The ethical assessment of social and behavioral research is relatively neglected compared to the review of biomedical and clinical studies, which led us to develop an ethics review assessment tool for use in the review of social and behavioral research in Ethiopia, which could potentially be of value in low- and middle-income settings. Methods: Initially, we did a comprehensive literature review on principles, guidelines, and practices of research ethics, on social and behavioral studies, from which we extracted query terms to explore the opinions of selected key informants and focus groups in Ethiopia. The discussants and informants were selected using a convenience sampling method to evaluate an ethics review template, which integrated issues that commonly arise in social and behavioral studies. Finally, we directly solicited opinions from the discussants about the desirability, feasibility, acceptability, and relevance of the ethics review assessment tool and used the resulting data to refine our initial draft. Results and conclusion: Although the same basic ethics principles govern all research studies, social and behavioral research have some disciplinary particularities that may require reviewers to exercise a different orientation of ethical attention in some cases. Using a qualitative approach, we developed a review assessment tool that could potentially be useful to raise awareness, focus attention, and strengthen the review of social and behavioral studies by ethics review committees, particularly in settings without a long-standing tradition of reviewing such research. This process also exposed some areas where further capacity building and discussion of ethical issues may be necessary among stakeholders in the review of social and behavioral research.

scholarly journals An Ethical Assessment Tool (ETHAS) to Evaluate the Application of Assisted Reproductive Technologies in Mammals’ Conservation: The Case of the Northern White Rhinoceros (Ceratotherium simum cottoni)

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 312
Author(s):  
Barbara de Mori ◽  
Maria Michela Spiriti ◽  
Ilaria Pollastri ◽  
Simona Normando ◽  
Pierfrancesco Biasetti ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Ethical Issues ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Consultation Process ◽  
Vitro Fertilization ◽  
Ethical Assessment ◽  
Ceratotherium Simum ◽  
White Rhinoceros

Assisted reproductive technologies (ARTs) can make a difference in biodiversity conservation. Their application, however, can create risks and raise ethical issues that need addressing. Unfortunately, there is a lack of attention to the topic in the scientific literature and, to our knowledge, there is no tool for the ethical assessment of ARTs in the context of conservation that has been described. This paper reports the first applications of the Ethical Assessment Tool (ETHAS) to trans-rectal ovum pick-up (OPU) and in vitro fertilization (IVF) procedures used in a northern white rhinoceros (Ceratotherium simum cottoni) conservation project. The ETHAS consists of two checklists, the Ethical Evaluation Sheet and the Ethical Risk Assessment, and is specifically customized for each ART procedure. It provides an integrated, multilevel and standardized self-assessment of the procedure under scrutiny, generating an ethical acceptability ranking (totally, partially, not acceptable) and a risk rank (low, medium, high), and, hence, allows for implementing measures to address or manage issues beforehand. The application of the ETHAS to the procedures performed on the northern white rhinoceros was effective in ensuring a high standard of procedures, contributing to the acceptability and improved communication among the project’s partners. In turn, the tool itself was also refined through an iterative consultation process between experts and stakeholders.

Ethical concerns and dilemmas of Finnish and Dutch health professionals

2016 ◽  
Vol 23 (6) ◽  
pp. 659-673 ◽  
Author(s):  
Hanna Hopia ◽  
Ilsa Lottes ◽  
Mariël Kanne
Keyword(s):  
Health Professionals ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Quality Care ◽  
Healthcare Providers ◽  
Online Discussions ◽  
Master's Level ◽  
Dutch Health ◽  
Ethics Courses

Background: Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them. Research objective: To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master’s level. Research design: Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data. Method: Participants’ online discussions were analyzed using inductive content analysis. Participants: The sample consisted of 49 students at master’s level enrolled in professional ethics courses at universities in Finland and the Netherlands. Ethical considerations: Permission for conducting the study was granted from both universities of applied sciences. All students provided their informed consent for the use of their assignments as research data. Findings: Participants described 51 problematic work situations. Among these, 16 were found to be ethical dilemmas, and the remaining were work issues with an ethical concern and did not meet criteria of a dilemma. The most common problems resulted from concerns about quality care, safety of healthcare professionals, patients’ rights, and working with too few staff and inadequate resources. Discussion: The results indicated that participants were concerned about providing quality of care and raised numerous questions about how to provide it in challenging situations. The results show that it was difficult for students to differentiate ethical dilemmas from other ethical work concerns. Conclusion: Online discussions among healthcare providers give them an opportunity to relate ethical principles to real ethical dilemmas and problems in their work as well as to critically analyze ethical issues. We found that discussions with descriptions of ethical dilemmas and concerns by health professionals provide important information and recommendations not only for education and practice but also for health policy.

scholarly journals Ethical Decision-Making of Health Professionals Caring for HIV-Infected People in Hunan, China: A Qualitative Study

2020 ◽  
Author(s):  
Hangyu Huang ◽  
Deborah Koniak-Griffin ◽  
Honghong Wang ◽  
Min Yang
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Health Professionals ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Hunan Province ◽  
Negative Attitudes ◽  
Infected People

Abstract Background: Numerous ethical issues surged the moment AIDS was discovered. As advocates of HIV-infected people, health professionals encounter many ethical dilemmas in clinical practice. However, it remains unclear how health professionals solve these issues. To explore the ethical decision-making experiences of health professionals who care for HIV-infected people in Hunan Province, China, and to discuss the strategies for enhancing ethical decision-making competence in AIDS care. Methods: This descriptive qualitative research adopted semi-structured, in-depth interview and thematic analysis. Participants were recruited by purposive sampling. In total, twenty-two participants completed the interview. Results: Three themes emerged from data analyses of the interviews: (1) common ethical dilemma experienced by health professionals, (2) factors influencing ethical judgment, (3) ethical motivations. Conclusion: About two thirds of informants failed to recall ethical dilemmas experienced in their clinical practice. Emotions, gender, occupation, and difficulty balancing different roles may influence the ethical judgments of health professionals. In the ethical decision-making process, most informants took other people’s interests into consideration and conformed to law and professional codes of conduct. However, negative attitudes towards HIV-infected people still exist among a few professionals. Furthermore, some informants showed a misunderstanding of ethical principles. And the fear of medical disputes (conflicts with families and others) was experienced by many informants, influencing their ethical behaviors. Hence, more efforts are needed to eliminate negative attitudes towards HIV-infected patients. This study underscores the importance of continuing ethical education for HIV/AIDS-related professionals to enhance their ethical decision-making competence. Moreover, sound governmental laws may promote ethical behavior in AIDS care.

How Nurses and physicians face ethical dilemmas — the Croatian experience

2011 ◽  
Vol 18 (3) ◽  
pp. 341-355 ◽  
Author(s):  
Iva Sorta-Bilajac ◽  
Ksenija Baždarić ◽  
Morana Brkljačić Žagrović ◽  
Ervin Jančić ◽  
Boris Brozović ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ethical Issue ◽  
Clinical Ethics ◽  
Assisted Suicide ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Complete Information ◽  
Perceived Usefulness ◽  
Physician Assisted Suicide ◽  
Nurses And Physicians

The aim of this study was to assess nurses’ and physicians’ ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N = 364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life decisions for physicians (27%). The main ethical issue is limiting life-sustaining therapy (nurses 15%, physicians 24%) and euthanasia and physician-assisted suicide (nurses 16%, physicians 9%). The types of help available are similar for nurses and physicians: obtaining complete information about the patient (37% vs. 50%) and clarifying ethical issues (31% vs. 39%). Nurses and physicians experience similar ethical dilemmas in clinical practice. The usage of clinical ethics consultations is low. It is recommended that the individual and team consultations should be introduced in Croatian clinical ethics consultations services.

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