Ethical Challenges in Independent Living Donor Advocacy

2021 ◽  
pp. 152692482110246
Author(s):  
Sarah B. Vittone ◽  
Nancy A. Crowell
Keyword(s):  
Decision Making ◽  
Independent Living ◽  
Living Donor ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Research Questions

The Independent Living Donor Advocate, who is required on the transplant team, advocates, promotes, and protects the interests of the donor. Previously described ethical challenges perceived by these advocates and the variability of their responses prompted further inquiry. Research Questions: How are ethical obligations perceived by ILDAs? What ethical principles do ILDAs identify as the basis of their decision making? What are the ethical challenges for ILDAs? Study Design: A descriptive cross-sectional survey was designed and administered via REDCap. Participants were recruited from the National Kidney Foundation Living Donor Advocate email list. Quantitative and qualitative data on their role, ethical decision making, and perceived ethical issues, by seriousness and frequency, were collected. Results: Thirty-four participants responded. Nonmaleficence was ranked as the primary ethical principle used in decision making. Participants rated obligations to protect higher than advocacy. Participants reported experiencing internal ethical conflict to protect over advocate for the donor. The most serious ethical challenge participants perceived for donors was their decisional capacity, followed by their emotional or psychological distress, which was also described as a frequent donor challenge experienced in their role. Discussion: The results of this survey validate previous descriptions that the advocate role is largely perceived as protective. Their independent nature as well as the inherent vulnerabilities of the potential living donor compels the continued mitigation of ethical challenges, to enhance advocacy and protection for the living donor.

Building your self: a sensemaking approach to expatriates’ adjustment to ethical challenges

2014 ◽  
Vol 2 (1) ◽  
pp. 53-84 ◽  
Author(s):  
Nuno Guimarães-Costa ◽  
Miguel Pina e Cunha ◽  
Arménio Rego
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Relevant Information ◽  
Sub Saharan Africa ◽  
Ethical Challenge ◽  
The European Union ◽  
Ethical Challenges ◽  
Content Type ◽  
Sensemaking Process

Purpose – The purpose of this paper is to understand the behaviours described by expatriates (“what expatriates say they do”) when they are pressed for adjustment and, at the same time, they feel ethically challenged. Design/methodology/approach – The authors interviewed 52 expatriates from the European Union working in Sub-Saharan Africa who were immersed in what was considered by them to be an ethically challenging context or situation while they were in the process of adjusting to their international assignment. The authors conducted a reflexive qualitative analysis between the data and existing literature. Findings – The authors found that the feeling of moral discomfort that causes the perception of an ethical challenge is triggered by an event that contrasts with the expatriates’ notion of morals. After feeling ethically challenged, expatriates engage in a sensemaking process that is hinged in an “intended future identity”. Research limitations/implications – The authors contribute to the literature by stressing the ethical dimension of adjustment. The authors complement the normative approaches to ethical decision making in international contexts. The research identifies a set of events that are considered as ethical challenges by business expatriates. Practical implications – The research opens the possibility to anticipate and manage potential conflicts, thus minimizing the probability of expatriation failure. Early knowledge about an expatriate's intended future identity can provide relevant information concerning the probable type of adjustment problems s/he will face. Originality/value – The research combines two hitherto separate streams of literature – expatriate adjustment and ethical decision making in international contexts – to open the possibility of ethical adjustment. This is supported by a sensemaking process that is also grounded in future intentions, and not only in past experiences and present signals.

scholarly journals Context of Vignettes and Ethical Sensitivity in Decision-Making Among Undergraduate Business Studies Learners at University of Nairobi, Kenya

2020 ◽  
Vol 9 (4) ◽  
pp. 151
Author(s):  
Prisca Mary Oluoch ◽  
Paul Amollo Odundo ◽  
John Kamau Mwangi
Keyword(s):  
Decision Making ◽  
Business Ethics ◽  
Ethical Decision Making ◽  
Educational Communication ◽  
Primary Data ◽  
Ethical Sensitivity ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Business Studies ◽  
The University

Vignettes have been applied to train professionals in various fields, which has contributed to significant improvements in learning outcomes, ethical sensitivity and learners’ ethical decision-making. At the University of Nairobi’s Department of Educational Communication and Technology, most instructors have been slow to embrace experiential learning and inconsistent in applying vignettes to deliver business ethics lessons that emphasise ethical sensitivity in decision-making, with far reaching effects on the quality of graduates. This study responded to the information gap about the relationship between the use of vignettes and learners’ ethical sensitivity in decision-making at the University of Nairobi. Cross-sectional survey design guided the research process, and primary data were sourced in 2018 from 116 learners. Both quantitative and qualitative analysis techniques were applied. Key results show that learners who agreed strongly that the context of vignettes influences ethical sensitivity in decision-making were about 3.9 times as likely to make ethically sensitive decisions as colleagues who disagreed strongly. Those who agreed that the context of vignettes influences ethical sensitivity in decision-making had about 2.3 times the odds of making ethically sensitive decisions as colleagues who indicted strong disagreement. This means that the more the learners appreciated that the context of vignettes influences ethical sensitivity in decision-making, the higher the chances of them making ethically sensitive decisions, and vice-versa. This brings to the fore the need for instructors to consistently apply the context of vignettes to deliver business ethics lessons to improve learners’ ethical sensitivity and propensity to make ethical decisions. The study recommends that for practice, vignettes business contexts should be integrated in teacher training business studies ethics lessons.

Knowledge, Attitudes and associated factors to Use District Health Information System (DHIS2 data) for decision making among health professionals in a Resource limited settings: Cross-sectional Survey (Preprint)

2020 ◽  
Author(s):  
Shuma Gosha Kanfe ◽  
Nebyu Demeke Mengiste ◽  
Mohammedjud Hassen Ahmed ◽  
Gebiso Roba Debele ◽  
Berhanu Fikadie Endehabtu
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Associated Factors ◽  
Good Knowledge ◽  
Cross Sectional Survey ◽  
District Health ◽  
Cross Sectional ◽  
Determinant Factors ◽  
Knowledge And Attitudes ◽  
Health Need

BACKGROUND Evidence based practice is a key to increase effectiveness and efficiency of quality health services. To achieve this, utilization of health facility data (DHIS2 data) is required which is determined by knowledge and attitudes of health professionals. Thus, this study aimed to assess knowledge and attitudes of health professionals to use DHIS2 data for decision making. OBJECTIVE This study aimed to assess the knowledge, attitudes and its associated factors among health professionals to use DHIS2 data for decision making at South west of Ethiopia 2020 METHODS Cross sectional quantitative study methods was conducted to assess Knowledge and Attitudes of health professionals to use DHIS2 data. A total of 264 participants were approached. SPSS version 22 software was used for data entry and analysis. Descriptive and analytical statistics including Bivariable and Multivariable analyses was done RESULTS Overall 130(49.2%) of the respondents had good knowledge to use DHIS2 data (95% CI: [43, 55.3]), whereas over 149 (56.4%) of the respondents had favorable attitudes towards the use of DHIS2 data for decision making purpose (95% CI: [53.2, 59.8]). Skills [AOR=2.20,95% CI:(1.16, 4.19)], Age [AOR= 1.92, 95% CI: (1.03, 3.59)] ,Resources[AOR=2.56, 95% CI:(1.35,4.86)], Staffing[AOR= 2.85, 95% CI : (1.49, 5.48)] and Experiences[AOR= 4.66, 95% CI: (1.94, 5.78)] were variables associated with knowledge to use DHIS2 data whereas Training [AOR= 5.59, 95% CI: (2.48, 5.42)], Feedback [AOR= 4.08, 95% CI: (1.87, 8.91)], Motivation [AOR=2.87, 95% CI: (1.36, 6.06)] and Health need [AOR=2.32, 95% CI: (1.10-4.92)] were variables associated with attitudes of health professionals to use DHIS2 data CONCLUSIONS In general, about half of the study participants had good knowledge of DHIS2 data utilization whereas more than half of respondents had favorable attitudes. Skills, resources, ages, staffing and experiences were the most determinant factors for the knowledge to use DHIS2 data whereas health need, motivation, feedback and training were determinant factors for attitudes to use DHIS2 data

Ethical Issues in Dissemination and Implementation Research

2017 ◽  
Author(s):  
James M. DuBois ◽  
Beth Prusaczyk
Keyword(s):  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Dissemination And Implementation ◽  
Ethical Challenges ◽  
Specific Complex ◽  
Dissemination And Implementation Research ◽  
Research Regulations ◽  
Human Participants ◽  
Context Specific

This chapter focuses primarily on the protection of human participants in D&I studies. It begins by reviewing the Belmont principles that undergird US research regulations and considering the ethical case for D&I research. It then proceeds to examine some ethical issues that might arise during the course of a public health, D&I research agenda in middle schools. It covers the ethical case for D&I research and common ethical challenges. The chapter also discusses strategies for ethical decision-making. While these strategies may be beneficial to all researchers, the authors believe they are of particular value to dissemination and implementation researchers because the nature of their work—context specific, complex, and unfamiliar to many peers, collaborators, and reviewers—means they will deal with uncertainty and conflict on a regular basis, and solutions to the problems they face will rarely be found through simple reference principles, rules, or regulations.

scholarly journals Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

2021 ◽  
pp. bmjspcare-2020-002619
Author(s):  
Marcus Sellars ◽  
Julien Tran ◽  
Linda Nolte ◽  
Ben White ◽  
Craig Sinclair ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Public Knowledge ◽  
Cross Sectional Survey ◽  
Medical Decisions ◽  
Cross Sectional ◽  
Minimal Support ◽  
Substitute Decision Maker ◽  
Final Sample ◽  
Advance Care

ObjectiveTo describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.MethodsThis is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.ResultsOf 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, p<0.001), documented their ACP preferences (3.0 vs 2.0, U=71 984, z=4.087, p<0.001) or acted in the SDM role (3.0 vs 2.0, U=56 353, z=−3.694, p<0.001) were significantly higher compared with those who had not.ConclusionsThe Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.

Neonatal nurse practitioner ethics knowledge and attitudes

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2247-2258
Author(s):  
Mobolaji Famuyide ◽  
Caroline Compretta ◽  
Melanie Ellis
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Neonatal Nurse Practitioners

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

scholarly journals US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022730 ◽  
Author(s):  
Rachel C Forcino ◽  
Renata West Yen ◽  
Maya Aboumrad ◽  
Paul J Barr ◽  
Danielle Schubbe ◽  
...  
Keyword(s):  
Decision Making ◽  
Family Medicine ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Shared Decision ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Knowledge And Attitudes ◽  
Positive Attitudes

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.Participants272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.ResultsWe found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.ConclusionsRecent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

Data-based ethical decision making, lateral relations, and organizational commitment

2018 ◽  
Vol 40 (6) ◽  
pp. 946-963 ◽  
Author(s):  
Sean Robert Valentine ◽  
David Hollingworth ◽  
Patrick Schultz
Keyword(s):  
Decision Making ◽  
Organizational Commitment ◽  
Information Flow ◽  
Structural Equation ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Self Report ◽  
Equation Modeling ◽  
Content Type

Purpose Focusing on ethical issues when making organizational decisions should encourage a variety of positive outcomes for companies and their employees. The purpose of this paper is to determine the degree to which data-based ethical decision making, lateral relations and organizational commitment are interrelated in organizations. Design/methodology/approach Data were collected from business professionals employed at multiple locations of a financial services firm operating in the USA. Mediation analysis (based on structural equation modeling) was used to test the proposed relationships. Findings Results indicated that employees’ perceptions of data-based ethical decision making were positively related to perceived lateral relations, and that perceived lateral relations were positively related to organizational commitment. Research limitations/implications Given that information was collected using only a self-report questionnaire, common method bias could be an issue. In addition, the study’s cross-sectional design limits conclusions about causality. Another limitation involves the study’s homogenous sample, which decreases the generalizability of the findings. Finally, variable responses could have been impacted by individual frames of reference and other perceptual differences. Practical implications Results suggest that information flow enhancements should support or be consistent with horizontal information flow enhancements, and that together these factors should increase employee commitment. Originality/value Given the dearth of existing research, this interdisciplinary investigation is important because it fills gaps in the management literature. This study is also important because the results could inform decisions regarding the use of data analysis in ethical decisions and lateral forms of organizational structuring to improve work attitudes.

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