scholarly journals Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

2020 ◽  
Author(s):  
Mervyn Conroy ◽  
Aisha Y Malik ◽  
Catherine Hale ◽  
Catherine Weir ◽  
Alan Brockie ◽  
...  
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Practical Wisdom ◽  
Research Question ◽  
Ethnographic Study ◽  
Medical Decision ◽  
Final Decision ◽  
Theoretical Understanding ◽  
Medical Practitioners

Abstract BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, sometimes referred to as the ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis -based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n=131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian and MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.FindingsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ collective practical wisdom, including the phronesis virtue. This study advances the existing theory on phronesis as a decision-making approach because only now a theoretical ‘collective practical wisdom’ exists. ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, our contribution in the form of a moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

scholarly journals Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors.

2020 ◽  
Author(s):  
Mervyn Conroy ◽  
Aisha Y Malik ◽  
Catherine Hale ◽  
Catherine Weir ◽  
Alan Brockie ◽  
...  
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Practical Wisdom ◽  
Research Question ◽  
Ethnographic Study ◽  
Medical Decision ◽  
Final Decision ◽  
Theoretical Understanding ◽  
Medical Practitioners

Abstract Background: Medical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, sometimes referred to as the ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis -based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.Methods: The primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n=131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian and MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.Findings: We found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ collective practical wisdom, including the phronesis virtue. This study advances the existing theory on phronesis as a decision-making approach because only now a theoretical ‘collective practical wisdom’ exists. Conclusion: Given the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, our contribution in the form of a moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

scholarly journals Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mervyn Conroy ◽  
Aisha Y. Malik ◽  
Catherine Hale ◽  
Catherine Weir ◽  
Alan Brockie ◽  
...  
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Practical Wisdom ◽  
Research Question ◽  
Ethnographic Study ◽  
Theory And Practice ◽  
Medical Decision ◽  
Final Decision ◽  
Theoretical Understanding

Abstract Background Medical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians. Methods The primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process. Results We found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua. Conclusion Given the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

scholarly journals Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors.

2020 ◽  
Author(s):  
Mervyn Conroy ◽  
Aisha Y Malik ◽  
Catherine Hale ◽  
Catherine Weir ◽  
Alan Brockie ◽  
...  
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Practical Wisdom ◽  
Research Question ◽  
Ethnographic Study ◽  
Theory And Practice ◽  
Medical Decision ◽  
Final Decision ◽  
Theoretical Understanding

Abstract Background Medical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis -based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians. Methods The primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n=131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process. Results We found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua. Conclusion Given the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

scholarly journals Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors.

2021 ◽  
Author(s):  
Mervyn Conroy ◽  
Aisha Y Malik ◽  
Catherine Hale ◽  
Catherine Weir ◽  
Alan Brockie ◽  
...  
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Practical Wisdom ◽  
Research Question ◽  
Ethnographic Study ◽  
Theory And Practice ◽  
Medical Decision ◽  
Final Decision ◽  
Theoretical Understanding

Abstract Background Medical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis -based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians. Methods The primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n=131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process. Results We found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua. Conclusion Given the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

Hindrances to achieve professional confidence: The nurse’s participation in ethical decision-making

2017 ◽  
Vol 26 (3) ◽  
pp. 715-727 ◽  
Author(s):  
Anne Storaker ◽  
Dagfinn Nåden ◽  
Berit Sæteren
Keyword(s):  
Decision Making ◽  
Data Storage ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Research Question ◽  
Daily Practice ◽  
Clinical Work ◽  
Ethical Guidelines ◽  
Science Data ◽  
Written Information

Background: Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient’s dignity in their clinical work. Objectives: The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is “How do nurses participate in ethical decision-making for the patient?” Design and method: We use Gadamer’s philosophical hermeneutics as well as Kvale and Brinkmann’s three levels of understanding in interpreting the data material. Nine registered nurses were interviewed. Ethical considerations: The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki (1964). The participants were assured that privacy, and confidentiality would be duly protected. Results: Four key themes emerged: (1) confusion in relation to professional and operational expectations of role, (2) ideal somnolence, (3) inadequate argumentation skills, and (4) compound pressure. Conclusion: Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients.

Historic Leadership: One Courageous School Nurse’s Heroic Journey—Part 3

2017 ◽  
Vol 32 (3) ◽  
pp. 165-171
Author(s):  
Ellen F. Johnsen ◽  
Katherine J. Pohlman
Keyword(s):  
Decision Making ◽  
Public Schools ◽  
Ethical Decision ◽  
Nursing Practice ◽  
Ethical Decision Making ◽  
School Nurse ◽  
Medication Administration ◽  
School Nursing ◽  
Final Decision ◽  
Professional Collaboration

School nursing practice establishes itself in the midst of both education and nursing philosophies, ethics, standards, laws, and regulations. Treading these two worlds is difficult at times and requires that a school nurse possess a strong foundational knowledge base, seek professional collaboration, and navigate conflicting professional demands in order to promote student and public safety. This article is Part 3 of a four-part series that recounts the inspiring story of a school nurse, Ellen Johnsen, who did just that back in the 1980s in Broken Arrow, Oklahoma. Part 3 describes the publication of the Attorney General’s opinion validating the illegality of the school district’s medication administration policy, the lawsuit Ellen brought against the Broken Arrow Public Schools, and the appeal of the final decision in that lawsuit. The purpose of this series is to enhance understanding of the legal parameters governing school nurse practice, provide examples of ethical decision making, and review the challenges associated with serving as a leader.

How Do People Make Moral Medical Decisions?

2020 ◽  
Author(s):  
Eleanor Gilmore-Szott ◽  
Thomas V. Cunningham
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Medical Decision ◽  
Moral Decision Making ◽  
Moral Choice ◽  
Medical Decisions ◽  
Ethical Decisions ◽  
Healthcare Decision Making ◽  
Empirical Approaches

This chapter describes moral decision making in clinical relationships that occur in psychotherapy. This chapter is broken into four sections. Following an introduction, the second section covers the contributions made by bioethics to healthcare decision making, specifically, the historical, legal, policy making, and scholarly background underlying moral choice, which culminate in the concept of informed consent. The next section then canvases the contemporary landscape of ethical decision making by focusing on the important concept of decisional capacity and empirical approaches for evaluating and supporting the capacity to make ethical decisions through improvements in health literacy, values clarification, and shared decision making. The fourth section provides a detailed case analysis to demonstrate the numerous challenges that come with applying frameworks of moral medical decision making to actual psychotherapeutic practice and means for resolving those challenges using concepts defined throughout the chapter.

Developing a moral compass: Themes from the Clinical Ethics Residency for Nurses’ final essays

2019 ◽  
Vol 27 (1) ◽  
pp. 28-39
Author(s):  
Susan Lee ◽  
Ellen M Robinson ◽  
Pamela J Grace ◽  
Angelika Zollfrank ◽  
Martha Jurchak
Keyword(s):  
Decision Making ◽  
Clinical Ethics ◽  
Moral Agency ◽  
Ethics Education ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Research Question ◽  
Educational Approach ◽  
Knowledge And Skills ◽  
Moral Compass

Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making.

scholarly journals Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions

2020 ◽  
Vol 2 (2) ◽  
pp. 29-53
Author(s):  
Michelle Danda
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Policy Development ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Research Question ◽  
Mental Health Nurses ◽  
Chemical Restraint ◽  
Inpatient Mental Health ◽  
Research Findings

While there is a growing body of research available on general restraint intervention in acute adult psychiatric settings, relatively little is known about nurses’ experiences of administering chemical restraint. The research question explored in this study was: what are mental health nurses’ experiences of using chemical restraint interventions in times of behavioural emergency on adult inpatient acute mental health units? Through this Canadian study understanding of direct care nurses’ first-hand experiences of the use of chemical restraint interventions was sought. Eight adult acute inpatient mental health nurses were interviewed using hermeneutic phenomenological method. Two major themes that emerged from data analysis are explored to illuminate the existing tension between therapeutic, person-centred care and coercive control to maintain safety: taking control to maintain safety and working within constraints. Integral ways that nurses make meaning from administering chemical restraint were found, as well as some of the complex clinical and ethical decision-making aspects involved in psychiatric nursing care. Implications for practice, education, and policy are discussed. Research findings indicated a need for further focus on medication best practice, policy development and nurse education. These exploratory research findings can be used to both inform and challenge dominant inpatient mental health practice to guide nurses, health care leaders, and policy makers by increased understanding of the complex ethical decision making required for use of chemical restraint interventions.

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