scholarly journals ELEMENTS OF MORAL SENSITIVITY IN THE PRACTICE OF CLINICAL HOSPITAL NURSES

2020 ◽  
Vol 29 ◽  
Author(s):  
Janaína Cassana Mello Yasin ◽  
Edison Luiz Devos Barlem ◽  
Jamila Geri Tomaschewski Barlem ◽  
Gustavo Baade de Andrade ◽  
Rosemary Silva da Silveira ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Ethical Issues ◽  
Clinical Decision ◽  
Moral Dilemmas ◽  
Health Condition ◽  
University Hospital ◽  
Hospital Nurses ◽  
Medical Clinic ◽  
Moral Sensitivity ◽  
Structured Interviews

ABSTRACT Objective: to identify the elements of moral sensitivity held by nurses working in a medical clinic unit. Method: this exploratory-descriptive study with a qualitative approach addressed 18 nurses from a medical clinic of a university hospital located in southern Brazil using semi-structured interviews, which were analyzed using discursive textual analysis. Results: data were structured into six categories: relational orientation; experiencing moral dilemmas; following rules; benevolent motivation; structuring moral meaning; and autonomy. These categories enabled the identification of important elements of moral sensitivity, such as acknowledging the ethical dimension of one’s attitudes, acknowledging the uniqueness of each patient, dealing with conflict between workers and patients and/or their companions, adapting to the workplace, empathy, dialogue, clinical decision-making, meeting the needs of patients, understanding patients’ health condition, respect, welcoming patients’ desires and providing guidance that concerns patients’ requests and refusals. Conclusion: the elements of moral sensitivity identified in this study contribute to support nurses when making clinical decisions, especially when facing ethical issues arising in a medical clinic setting.

Exploring hospital nurses’ transitional medication management for older patients with multi-morbidity: An ethnographic study

2021 ◽  
pp. 205715852110617
Author(s):  
Mette Geil Kollerup ◽  
Birgitte Schantz Laursen
Keyword(s):  
Older Patients ◽  
Communication Systems ◽  
Clinical Decision Making ◽  
Medication Management ◽  
Clinical Decision ◽  
Ethnographic Study ◽  
University Hospital ◽  
Hospital Nurses ◽  
Assessment Skills ◽  
Field Notes

Transitional medication management, in which individual needs are balanced against organizational priorities, is crucial for safe discharge processes. The aim of this study was to explore hospital nurses’ transitional medication management in the discharge of older patients with multi-morbidity. Using an ethnographic approach the data were collected through participant observations at a mixed medical ward at a Danish university hospital for two weeks. The participants were five registered nurses, responsible for nursing care of 23 patients with multi-morbidity and planned for discharge. The data comprised field notes that were analysed using iterative processes of domain, taxonomic and component analysis. The reporting adhered to the COREQ checklist. Hospital nurses’ transitional medication management was characterized by unpredictability and inconsistency in patient situations, fragmentation and discontinuity in working processes and complexity in communication systems. Special attention to nurses’ needs assessment skills and clinical decision making in caring for patients with multi-morbidity in a single focused healthcare system is required.

scholarly journals The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study

2020 ◽  
Vol 17 (9) ◽  
pp. 3059 ◽  
Author(s):  
Nikolina Farčić ◽  
Ivana Barać ◽  
Robert Lovrić ◽  
Stana Pačarić ◽  
Zvjezdana Gvozdanović ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Students ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Self Concept ◽  
Hospital Nurses ◽  
Sectional Study ◽  
Cross Sectional

The aim of this study is to examine the influence of nurses’ self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses’ self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses’ CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

scholarly journals Shared clinical decision-making experiences in nursing: A qualitative study

2021 ◽  
Author(s):  
Fen-Fang Chung ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Pao-Yu Wang ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Cultural Sensitivity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Information Communication ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Basic Ability

Abstract Background Shared decision making (SDM) is a patient-centred nursing concept that emphasises the autonomy of the patient. It is a co-operative process of exchanging information, communication and response, and treatment decisions made between medical staff and patients. In this study, we explored the experience of clinical nursing staff participating in SDM. Methods We adopted a qualitative research method. Semi-structured interviews were conducted with 21 nurses at a medical centre in northern Taiwan. The data obtained from interview recordings were transferred to verbatim manuscripts. Content analysis was used to analyse and summarise the data. Results Clinical nursing staff should have basic professional skills, communication and response skills, respect and cultural sensitivity, the ability to form a co-operative team, the ability to search for and integrate empirical data, and the basic ability to edit media to participate in SDM. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM, which can be used as a reference for nursing education and nursing administrative supervisors to plan and enhance professional nursing SDM in nursing education.

scholarly journals Qualitative exploration of the medical learner’s journey into correctional health care at an academic medical center and its implications for medical education

2020 ◽  
Author(s):  
Ahmar H. Hashmi ◽  
Alina M. Bennett ◽  
Nadeem N. Tajuddin ◽  
Rebecca J. Hester ◽  
Jason E. Glenn
Keyword(s):  
Learning Environment ◽  
Clinical Decision Making ◽  
Ethical Issues ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Diagnostic Laboratory ◽  
Lower Priority ◽  
Academic Medical ◽  
Qualitative Exploration

Abstract Correctional systems in several U.S. states have entered into partnerships with academic medical centers (AMCs) to provide healthcare for persons who are incarcerated. One AMC specializing in the care of incarcerated patients is the University of Texas Medical Branch at Galveston (UTMB), which hosts the only dedicated prison hospital in the U.S. and supplies 80% of the medical care for the entire Texas Department of Criminal Justice (TDCJ). Nearly all medical students and residents at UTMB take part in the care of the incarcerated. This research, through qualitative exploration using focus group discussions, sets out to characterize the correctional care learning environment medical trainees enter. Participants outlined an institutional culture of low prioritization and neglect that dominated the learning environment in the prison hospital, resulting in treatment of the incarcerated as second-class patients. Medical learners pointed to delays in care, both within the prison hospital and within the TDCJ system, where diagnostic, laboratory, and medical procedures were delivered to incarcerated patients at a lower priority compared to free-world patients. Medical learners elaborated further on ethical issues that included the moral judgment of those who are incarcerated, bias in clinical decision making, and concerns for patient autonomy. Medical learners were left to grapple with complex challenges like the problem of dual loyalties without opportunities to critically reflect upon what they experienced. This study finds that, without specific vulnerable populations training for both trainees and correctional care faculty to address these institutional dynamics, AMCs risk replicating a system of exploitation and neglect of incarcerated patients and thereby exacerbating health inequities.

scholarly journals Eccentric Exercise for Achilles Tendinopathy: A Narrative Review and Clinical Decision-Making Considerations

2019 ◽  
Vol 4 (2) ◽  
pp. 34 ◽  
Author(s):  
Dhinu J. Jayaseelan ◽  
John J. Mischke ◽  
Raymond L. Strazzulla
Keyword(s):  
Decision Making ◽  
Eccentric Exercise ◽  
Sports Medicine ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Condition ◽  
Achilles Tendinopathy ◽  
Narrative Review ◽  
Control Group

Background: Achilles tendinopathy is a common health condition encountered in the orthopedic and sports medicine settings. Eccentric exercise is a common intervention in the management of pain and limited function for this patient population, although contemporary evidence suggests additional exercise methods may be effective as well. Study design: Narrative review: Methods: A literature review was performed using the electronic databases Pubmed and PEDRO for articles through February 2019. Randomized clinical trials integrating eccentric exercise, with or without co-interventions, were evaluated. Outcomes related to pain and/or function were considered. A patient case is provided to highlight decision making processes related to clinical prescription of eccentrics for Achilles tendinopathy. Results: After screening titles and abstracts, seven studies were included for full review. Two articles compared eccentric exercise to a control group, four compared eccentrics to the use of modalities, while one used eccentric exercise as part of a multimodal intervention. In each case, eccentric exercise was effective in reducing pain and improving function. In comparison to other forms of exercise or additional interventions, eccentric exercise was frequently not more effective than other options. Discussion: Eccentric exercise has been associated with clinical benefit in improving pain and function for patients with Achilles tendinopathy. Despite the available evidence reporting effectiveness of eccentrics, other options may be equally useful. Appropriate load modification and exercise prescription for patients with Achilles tendinopathy requires systematic clinical reasoning and incorporation of patient values to optimize outcomes.

scholarly journals Moral Ecology in Nursing: A Pluralistic Approach

2019 ◽  
Vol 5 ◽  
pp. 237796081983389
Author(s):  
Darcy Copeland
Keyword(s):  
Moral Judgment ◽  
Ethical Issues ◽  
Ecological Model ◽  
Social Systems ◽  
Moral Dilemmas ◽  
Moral Action ◽  
Moral Sensitivity ◽  
Ethical Frameworks ◽  
Moral Ecology ◽  
Ethical Systems

Moral dilemmas are present in all settings in which nurses work. Nurses are moral agents who must make moral decisions and take moral action in very complex social systems. Nurses are accountable for their actions, and it is therefore imperative that they have a solid foundation in ethics. There are multiple ethical frameworks nurses can utilize to justify their actions. A theory of moral ecology is presented here as a way to conceptualize the relationships between these frameworks. The first two steps of moral action, moral sensitivity and moral judgment, are explored in a pluralistic context. Specifically, multiple ethical frameworks that inform the practice of nursing are presented using an ecological model. Nurses work in a variety of practice environments, with different populations, across a spectrum of situations. An ecological model acknowledges that nurses are influenced by the complex social, and ethical, systems in which they find themselves taking moral action. When faced with ethical issues in practice, a nurse's moral sensitivity and moral judgment may be guided by ethical systems most proximal to the situation. Nurses bring individual moral beliefs to work and are influenced by the ethical directives of employers, the discipline's code of ethics, principles of bioethics, and various approaches to normative ethics (virtue, consequential, deontological, and care). Any of the frameworks presented may justifiably be applied in various nursing circumstances. I propose that the multiple ethical frameworks nurses utilize exist in a relationally nested manner and a model of moral ecology in nursing is provided.

scholarly journals Awareness of predatory journals and open access among medical oncologists: results of an online survey

ESMO Open ◽  
2019 ◽  
Vol 4 (6) ◽  
pp. e000580 ◽  
Author(s):  
Georg Richtig ◽  
Erika Richtig ◽  
Alexandra Böhm ◽  
Christoph Oing ◽  
Farastuk Bozorgmehr ◽  
...  
Keyword(s):  
Open Access ◽  
Peer Review ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Scientific Practice ◽  
Peer Review Process ◽  
Clinical Decision ◽  
University Hospital ◽  
Predatory Journals ◽  
Number Of Publications

IntroductionPredatory journals harm the integrity of science as principles of ‘good scientific practice’ are bypassed by omitting a proper peer-review process. Therefore, we aimed to explore the awareness of predatory journals among oncologists.MethodsAn online survey among oncologists working in Germany or Austria of various professional surroundings was conducted between October 2018 and April 2019.ResultsOne hundred and eighty-eight participants (55 women (29.2%), 128 men (68.1%)) completed the questionnaire. 41 (21.8%) participants indicated to work in a hospital, 24 (12.8%) in private practice and 112 (59.6%) in a university hospital. 98.9% of participants indicated to actively read scientific articles and consider them in clinical decision-making (96.3%). 90.4% of participants indicated to have scientific experience by publishing papers in journals with peer-review system. The open-access system was known by 170 (90.4%), predatory journals by 131 (69.7%) and Beall’s list by 52 participants (27.7%). Predatory journals were more likely to be known by participants with a higher number of publications (p<0.001), with more high-impact publications (p=0.005) and with recent publications (p<0.001). Awareness of predatory journals did not correlate with gender (p=0.515) or translation of scientific literature into clinical practice (p=0.543).ConclusionsThe problematic topic of ‘predatory journals’ is still unknown by a considerable amount of oncologist, although the survey was taken in a cohort of oncologists with scientific experience. Dedicated educational initiatives are needed to raise awareness of this problem and to aid in the identification of predatory journals for the scientific oncology community.

scholarly journals Qualitative Study of Oncologists’ Views on the CancerLinQ Rapid Learning System

2017 ◽  
Vol 13 (3) ◽  
pp. e176-e184 ◽  
Author(s):  
Rachel M. Mayo ◽  
Julie F. Summey ◽  
Joel E. Williams ◽  
Rebecca A. Spence ◽  
Shally Kim ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Ethical Issues ◽  
Health Care Systems ◽  
Clinical Decision ◽  
Learning System ◽  
Patient Identification ◽  
Rapid Learning ◽  
Ethical Implications ◽  
Patient Consent ◽  
The Impact

Introduction: ASCO is actively developing CancerLinQ (CLQ), a rapid learning system for oncology care. The purpose of this study was to explore providers’ opinions and concerns related to implementation of CLQ, including ethical issues. Methods: Twenty key informant oncologists were recruited for individual in-depth interviews through ASCO contacts, purposively selected to represent a wide variety of cancer specialties as well as different levels of familiarity with CLQ (familiar v unfamiliar). Qualitative data analysis was completed by a three-member team using an inductive narrative approach. Themes were examined by participants familiar and unfamiliar with CLQ, and quotations exemplifying each theme are provided. Results: Participants’ opinions centered on three main themes: (1) general attitudes regarding learning health care systems, (2) optimal approach to patient consent, and (3) appropriateness of data use. There was clear support for the use of big data in clinical decision making for patients and in research. Unfamiliar participants expressed concerns regarding system protections against patient identification, and both familiar and unfamiliar participants discussed the dilemma of including genetic information. Respondents were in agreement with notifying patients early; however, there was debate over whether patients should opt in or opt out. Overall, there was great concern regarding sharing data with drug companies and insurers. Conclusion: Understanding oncologists’ perspectives regarding the ethical implications of CLQ implementation is critical to its success. More research is needed on the impact of rapid learning systems on providers, patients, health systems, and the ultimate effect on cancer care.

Ethical Issues for Neonatal Nurses

1998 ◽  
Vol 5 (3) ◽  
pp. 206-217 ◽  
Author(s):  
Kaye Spence
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Response Rate ◽  
Clinical Decision ◽  
Neonatal Nurses ◽  
Ethical Decisions

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.

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