Fair prioritization of casualties in disaster triage: a qualitative study

Abstract Background Disasters may result in mass casualties and an imbalance between health care demands and supplies. This imbalance necessitates the prioritization of the victims based on the severity of their condition. Contributing factors and their effect on decision-making is a challenging issue in disaster triage. The present study seeks to address criteria for ethical decision-making in the prioritization of patients in disaster triage. Methods This conventional content analysis study was conducted in 2017. Subjects were selected from among Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. Results Efficient and effective triage and priority-oriented triage were the main categories. These categories summarized a number of medical and nonmedical factors that should be considered in the prioritization of the victims in disaster triage. Conclusion A combination of measures should be considered to maximize the benefits of the prioritization of causalities in disasters. None of these measures alone would suffice to explain all aspects of ethical decision-making in disaster triage. Further investigations are needed to elaborate on these criteria in decision-making.

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The Way of Implementing the New Accreditation Standards at Shahid Motahhari Educational Center in Marvdasht City: A Qualitative Study

Evidence Based Health Policy Management and Economics ◽

10.18502/jebhpme.v2i4.277 ◽

2019 ◽

Author(s):

Hasan Jafari ◽

Abbass YazdanPanah ◽

Abdolreza Akbari

Keyword(s):

Content Analysis ◽

Qualitative Study ◽

Human Resources ◽

Snowball Sampling ◽

Structured Interviews ◽

Effective Factors ◽

Accreditation Standards ◽

Conventional Content Analysis ◽

Lack Of Commitment ◽

The Way

Background: One of the ways through which the quality of the hospital services can be improved is the accreditation, and most of the countries have launched their own accreditation system as a strategy to improve services. The aim of this research was to investigate the way of implementing the accreditation programs at Shahid Motahhari educational center in Marvdasht city. Methods: The current study was qualitative with conventional content analysis which was conducted by using the semi-structured interviews with eight officials and employees of Marvdasht Shahid Motahhari Medical Education Center in 2017. Purposeful sampling was done in this study and the next stage; the snowball sampling method was used to select the desired samples. Data were gathered to reach the data saturation point, and conventional content analysis was done to analyze the research data. Results: Two main themes and nineteen sub-themes were obtained through the nine categories. Self-confidence in the team, sense of superiority and achievement, all units’ coordination, accurate and scientific coherent supervision and management, and considering the book of standards as a guiding factor are among the strengths of this research.Poor management of programs, lack of proper context while running the program, lack of proper training, lack of financial and human resources, lack of commitment and interest in implementing the program among different groups were main identified barriers of the program. Conclusion: The effective factors on the implementation of the accreditation standards in the healthcarecenters should be identified. Besides, planning effective education, continued monitoring and assessing, creating suitable contexts of financial and human resources,consolidating the strengths and using the available potentials can be effective factors in line with the implemetation of accreditation standards. Keywords: Accreditation, Hospital, Qualitative study, Evaluation

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Explaining Courage in Ethical Decision-making by Nursing Managers: A Qualitative Content Analysis

Journal of Holistic Nursing and Midwifery ◽

10.32598/jhnm.31.4.2141 ◽

2021 ◽

Vol 31 (4) ◽

pp. 254-262

Author(s):

Mostafa Roshanzadeh ◽

◽

Zohreh Vanaki ◽

Afsaneh Sadooghiasl ◽

Ali Tajabadi ◽

...

Keyword(s):

Decision Making ◽

Content Analysis ◽

Ethical Decision ◽

Nurse Managers ◽

Ethical Decision Making ◽

Ethical Issues ◽

Qualitative Content Analysis ◽

Role Playing ◽

Face To Face ◽

Nursing Managers

Introduction: Ethical decision-making by nursing managers is influenced by various essential factors, such as courage, without which it is impossible to act on them. Objective: This study aimed to explore the experiences of nursing managers about courage in ethical decision-making. Materials and Methods: The current study was conducted in Iran by a qualitative content analysis approach in 2018. Nineteen nurse managers were selected purposefully from hospitals in Tehran and Shahrekord cities. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method. Results: Based on data analysis, we extracted 2 categories (obligation, decisiveness) and 8 subcategories (clearness in expressing decisions, the ability of the manager to make decisions in critical and complex situations, authority/decision-making as a religious responsibility, follow the decision process, being responsible, making compensatory decisions, making preventive decisions). Conclusion: The findings showed that managers who are committed to ethical decision-making have enough assertiveness to make the decisions. Educating, empowering, and sensitizing managers and enhancing their insight into ethical issues through problem-solving and role-playing techniques can play an essential role in promoting their commitment and responsibility.

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Nurses’ contributions to the resolution of ethical dilemmas in practice

Nursing Ethics ◽

10.1177/0969733017703700 ◽

2017 ◽

Vol 25 (2) ◽

pp. 230-242 ◽

Cited By ~ 11

Author(s):

Nichola Ann Barlow ◽

Janet Hargreaves ◽

Warren P Gillibrand

Keyword(s):

Decision Making ◽

Ethical Decision ◽

Moral Distress ◽

Ethical Decision Making ◽

Ethical Dilemmas ◽

Treatment Options ◽

District General Hospital ◽

Professional Relationships ◽

Structured Interviews ◽

Acute Care Nurses

Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. Findings: Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion: Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas.

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School Counselors’ Experiences With Ethical Decision Making

Professional School Counseling ◽

10.1177/2156759x211018640 ◽

2021 ◽

Vol 25 (1) ◽

pp. 2156759X2110186

Author(s):

Glenda S. Johnson ◽

Lucy L. Purgason

Keyword(s):

Decision Making ◽

School Counselors ◽

School Counselor ◽

Ethical Decision ◽

Ethical Decision Making ◽

Contributing Factors ◽

Ethical Guidelines ◽

Preparation Programs ◽

Counselor Preparation ◽

School Counselor Preparation

Using a purposeful, convenience sampling method, we explored six school counselors’ experiences of ethical decision making. We used a transcendental phenomenology research method and identified the themes of consulting, referring to ethical guidelines, documenting, contributing factors, and engaging in professional development. This article discusses implications for school counselor preparation programs and practicing school counselors.

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Ethical decision-making based on field assessment: The experiences of prehospital personnel

Nursing Ethics ◽

10.1177/0969733017736925 ◽

2017 ◽

Vol 26 (4) ◽

pp. 1075-1086 ◽

Cited By ~ 6

Author(s):

Mohammad Torabi ◽

Fariba Borhani ◽

Abbas Abbaszadeh ◽

Foroozan Atashzadeh-Shoorideh

Keyword(s):

Decision Making ◽

Ethical Decision ◽

Ethical Decision Making ◽

Structured Interviews ◽

Ethical Decisions ◽

Emergency Personnel ◽

Field Assessment ◽

Ethical Conflicts ◽

Prehospital Emergency ◽

Insufficient Time

Introduction: Due to the stressful nature of prehospital emergency providers’ duties, as well as difficulties such as distance to information resources and insufficient time to analyze situations, ethical decision-making in prehospital services is a daily challenge. Objectives: This study aimed to describe the experiences of Iranian prehospital emergency personnel in the field of ethical decision-making. Methods: The data were collected by semi-structured interviews (n = 15) in Iran and analyzed using the content analysis approach. Ethical considerations: This study was conducted in accordance with the principles of research ethics and national rules and regulations relating to informed consent and confidentiality. Results: The results obtained were categorized into three main categories that included “assessment of the scene atmosphere, assessment of patients’ condition and their family, and predicting outcomes of decision-making.” The central category was “field assessment,” which demonstrated the strategy of ethical decision-making by prehospital providers when facing ethical conflicts. Conclusion: Although findings showed that the majority of prehospital providers make ethical decisions based on the patients’ benefit, they also consider consequences of their decisions in dealing with personal and professional threats. This article identifies and describes a number of ethical values of prehospital providers and discusses how the values may be considered by paramedics when facing ethical conflicts.

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Personal moral values of directors and corporate governance

Corporate Governance ◽

10.1108/cg-03-2016-0046 ◽

2017 ◽

Vol 17 (1) ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Patricia Grant ◽

Peter McGhee

Keyword(s):

Decision Making ◽

Ethical Decision ◽

Ethical Decision Making ◽

Codes Of Ethics ◽

Moral Values ◽

Moral Code ◽

Moral Integrity ◽

Structured Interviews ◽

Content Type ◽

Ethical Experience

Purpose This paper aims to explore how directors understand the “how” and “why” of their personal moral values in their task of governing the organisation. Design/methodology/approach This paper is based on a qualitative study. Data were gathered through semi-structured interviews of 33 New Zealand directors. Findings Three major themes emerged: Directors’ personal moral values are a powerful driver in ethical decision-making of directors; codes of ethics are seen to be effective to the extent that individuals have a strong moral compass; great value is placed on their personal moral code as being consistent with it, defines who they are. Research limitations/implications This study reveals how and why directors’ personal ethics are important in their task of governance and demonstrates that they are extremely influential in their ethical decision-making. Practical implications Appraisal processes could also make sure this factor is given equal importance along with other skills and competencies. In the area of director selection, proven moral integrity could become a point to investigate prior to the appointment of a director. Originality/value There have been very few studies investigating the subjective ethical experience in ethical decision-making. Investigating the antecedents of ethical or unethical outcomes only provides a partial understanding of the ethical experience.

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