scholarly journals Scope of Practice and Principles of Care of Naturopathic Medicine in North America: A Commentary

Children ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 8
Author(s):  
Leslie Solomonian
Keyword(s):  
North America ◽  
Ethical Issues ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Illness Management ◽  
Integrative Care ◽  
Children And Families ◽  
Naturopathic Medicine ◽  
Integrative Healthcare ◽  
Complementary And Alternative

Naturopathic medicine is a growing profession in North America that provides expertise in complementary and alternative, or integrative care to pediatric patients. It is imperative that healthcare providers have an understanding of the training and scope of other health professionals in order to effectively make decisions regarding research, collaborative clinical care, and policy. Given the prevalence of use of complementary and alternative medicine by children and families in North America, and the growing interest in “integrative” medicine, we aim to offer an overview of naturopathic care for children. This document describes the principles, training, and scope of naturopathic medicine, including health promotion, disease prevention, and illness management. It describes the process by which naturopathic doctors create an integrative healthcare plan for children, evaluate and apply evidence, and integrate ethical issues in practice management, and speaks to the role naturopathic doctors have regarding advocacy for community and planetary health as it relates to pediatrics.

scholarly journals Knowledge regarding law and ethics among nurses at a tertiary care hospital in rural India

2018 ◽  
Vol 5 (9) ◽  
pp. 3882
Author(s):  
Thirunavukarasu M. R. ◽  
Velmurugan A.
Keyword(s):  
Ethical Issues ◽  
Clinical Skills ◽  
Clinical Care ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Healthcare Team ◽  
Care Hospital ◽  
Ethical Practices ◽  
Law And Ethics ◽  
Study Results

Background: Excellence in clinical skills along with a sound knowledge of standard practices related to bioethics and its application in the clinical settings is essential for healthcare providers. Nurses play a pivotal role in the healthcare team, being involved in various aspects like clinical care, research and medical education. It is essential for nurses to be aware of the ethical practices for effective patient care.Methods: It was a hospital-based descriptive study. A pre-tested questionnaire covering socio-demographic information and questions regarding law and ethics was used to collect the information. Nurses with more than one year experience and those who offered voluntary informed consent were included in the study. The study covered 50 staff nurses from both gender.Results: The study showed that majority of the participants (78%) had inadequate knowledge, nearly 7% of them are having moderate knowledge and only 4% are having adequate knowledge regarding law and ethics in Nursing.Conclusions: The study shows the need for increase in awareness regarding ethical issues associated with clinical practice and research among nurses. The study results were used to prepare a booklet on ethics and law for nurses and given to all the participants. Similar studies can be conducted among other members of the health care team (doctors, interns, researchers and trainee nurses) to generalize the results. Group discussions and workshops can be conducted for nurses and other members to promote the need for ethical practices.

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

Test genetici e consenso informato

2012 ◽  
pp. 68-95
Author(s):  
Marco Seri ◽  
Claudio Graziano ◽  
Daniela Turchetti ◽  
Juri Monducci
Keyword(s):  
Dna Sequencing ◽  
Human Genetics ◽  
Ethical Issues ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Genome Project ◽  
Ethical Challenges ◽  
Sequencing Technologies ◽  
The Human Genome Project

The pace of discovery in the field of human genetics has increased exponentially in the last 30 years. We have witnessed the completion of the Human Genome Project, the identification of hundreds of disease-causing genes, and the dawn of genomic medicine (clinical care based on genomic information). Reduction of DNA sequencing costs, thanks to the so-called "next generation sequencing" technologies, is driving a shift towards the era of "personal genomes", but scientific as well as ethical challenges ahead are countless. We provide an overview on the classification of genetic tests, on informed consent procedures in the context of genetic counseling, and on specific ethical issues raised by the implementation of new DNA sequencing technologies.

scholarly journals Pain Assessment: Subjectivity, Objectivity, and the Use of Neurotechnology Part One: Practical and Ethical Issues

2010 ◽  
Vol 4;13 (4;7) ◽  
pp. 305-315 ◽  
Author(s):  
James Giordano
Keyword(s):  
Pain Assessment ◽  
Subjective Experience ◽  
Ethical Issues ◽  
Social Issues ◽  
Clinical Care ◽  
Pain Syndrome ◽  
Objective Evaluation ◽  
Pain Patient ◽  
Key Words Pain ◽  
The Right

The pain clinician is confronted with the formidable task of objectifying the subjective phenomenon of pain so as to determine the right treatments for both the pain syndrome and the patient in whom the pathology is expressed. However, the experience of pain — and its expression — remains enigmatic. Can currently available evaluative tools, questionnaires, and scales actually provide adequately objective information about the experiential dimensions of pain? Can, or will, current and future iterations of biotechnology — whether used singularly or in combination (with other technologies as well as observational-behavioral methods) — afford objective validation of pain? And what of the clinical, ethical, legal and social issues that arise in and from the use — and potential misuse — of these approaches? Subsequent trajectories of clinical care depend upon the findings gained through the use of these techniques and their inappropriate employment – or misinterpretation of the results they provide — can lead to misdiagnoses and incorrect treatment. This essay is the first of a two-part series that explicates how the intellectual tasks of knowing about pain and the assessment of its experience and expression in the pain patient are constituent to the moral responsibility of pain medicine. Herein, we discuss the problem of pain and its expression, and those methods, techniques, and technologies available to bridge the gap between subjective experience and objective evaluation. We address how these assessment approaches are fundamental to apprehend both pain as an objective, neurological event, and its impact upon the subjective experience, existence, and expectations of the person in pain. In this way, we argue that the right use of technology — together with inter-subjectivity, compassion, and insight — can sustain the good of pain care as both a therapeutic and moral enterprise. Key words: pain, assessment, neurotechnology, biotechnology, neuroethics, medicine

scholarly journals Evaluation of Knowledge, Attitudes and Experience of off-label Drug Prescribing Practice among Physicians in Baghdad City Hospitals

2019 ◽  
Vol 28 (2) ◽  
pp. 115-123
Author(s):  
Aysha M. Shanshal ◽  
Ahmed H. Ataimish
Keyword(s):  
Clinical Trials ◽  
Ethical Issues ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Pharmaceutical Companies ◽  
Cross Sectional ◽  
Off Label ◽  
Healthcare Settings ◽  
Prescribing Practice ◽  
Self Administered Questionnaire

Abstract The present study aims to assess the knowledge, attitude, and experience of off-label prescribing practice among physicians in Baghdad city hospitals. This cross-sectional study was performed through the period from November 1st 2018 to March 2019 at 17 hospitals, a self-administered questionnaire was utilized to collect data from the physicians, and the targeted hospitals were randomly selected at different regions in Baghdad City area. Out of the 400 distributed questionnaires to the physicians, 383 of them were returned completed, 57.2% indicated that they were reasonably familiar with the term “off label drug”, 57.7% mentioned that the most common medical reasons for the prescribing off-label drugs were unavailability of alternatives, 67.6%, 65.5% had concerns regarding its safety and efficacy respectively, 62.7% agreed that the (MOH) authority should provide an incentive to stimulate pharmaceutical companies to perform clinical trials in Iraqi patients, 49.1% believed that clinical trials that recruit volunteers involve ethical issues. Extensive efforts are required to implant programs, regulations and guidelines to control the off-label prescribing practice among the Iraqi healthcare providers who are authorized to prescribe medications at different healthcare settings.    

scholarly journals A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice

2016 ◽  
Vol 23 (3) ◽  
pp. 514-525 ◽  
Author(s):  
Patrick C Sanger ◽  
Andrea Hartzler ◽  
Ross J Lordon ◽  
Cheryl AL Armstrong ◽  
William B Lober ◽  
...  
Keyword(s):  
Design Process ◽  
Data Transfer ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Surgical Patients ◽  
Discharge Process ◽  
Post Discharge ◽  
Patient Centered ◽  
Semistructured Interviews ◽  
Present Design

Objective The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology – mobile Post-Operative Wound Evaluator (mPOWEr) – that uses PGHD for post-discharge surgical wound monitoring. Materials and Methods As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers. Results We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses. Discussion We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications. Conclusion We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.

Development of a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint)

2021 ◽  
Author(s):  
Rochelle K Rosen ◽  
Stephanie C Garbern ◽  
Monique Gainey ◽  
Ryan Lantini ◽  
Sabiha Nasrin ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Group ◽  
Acute Diarrhea ◽  
Clinical Utility ◽  
Qualitative Data ◽  
Care Delivery ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Final Analysis ◽  
Support Tool

BACKGROUND The availability of mobile clinical decision-support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and applications (apps). Though healthcare providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns raised include perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective of the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle- income countries. OBJECTIVE The aim of this study is to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. METHODS From November to December 2020, qualitative data were gathered through eight virtual focus group discussions with physicians and nurses from three Bangladeshi hospitals. Each discussion was conducted in the local language, Bangla, and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo12 and applied thematic analysis was used to identify themes that explore the clinical utility of a mHealth app to assess dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data, and thematic memos were written and used for the final analysis. RESULTS Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked at a diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. The participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 years. Key themes from the qualitative data analysis, including: current experience with CDS, overall perception of the app utility and its potential role in clinical care, barriers and facilitators to app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. CONCLUSIONS Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to further the design and programming. Participants felt that the tool would initially take time to use, but once learned could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. Additionally, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.

Ethical Issues in Qualitative Data Collection Among Vulnerable Populations in Healthcare Setting

2018 ◽  
pp. 80-97
Author(s):  
Seng Fah Tong ◽  
Wen Ting Tong ◽  
Wah Yun Low
Keyword(s):  
Data Collection ◽  
Therapeutic Relationship ◽  
Vulnerable Populations ◽  
Qualitative Data ◽  
Ethical Issues ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Future Patient ◽  
Qualitative Data Collection

The chapter aims to highlight the ethical issues in qualitative data collection among vulnerable populations. Among the ethical issues are the conflict role of interviewers, adverse impact on future patient-therapist relationship, and emotional trauma both during and after data collection. The interviewers, usually healthcare providers, may subconsciously assume the role as a therapist during the interviews. Furthermore, the interviewers may encounter the participants (patients) in future clinical consultations; hence, information exchanges during the interviews could influence the therapeutic relationship. Recollection of experiences with an illness during the interviews can be a painful experience for patients. These ethical dilemmas can be addressed with appropriate sampling of participants and constant awareness of the researcher roles and relationships with the participants. Debriefing the participants with support is important to handle emotional upheavals.

Ethics of Electronic Health Record Systems

2020 ◽  
pp. 1467-1484
Author(s):  
Brian J. Galli
Keyword(s):  
Electronic Health Record ◽  
Ethical Issues ◽  
Healthcare Providers ◽  
Meaningful Use ◽  
Health Record ◽  
Ethical Implications ◽  
Incentive Programs ◽  
Time Period ◽  
Electronic Health ◽  
The Government

This article describes how healthcare and IT are combatting the ethical implications of electronic health records (EHRs) in order to make them adopted by over 90% of small practices. There is a lack of trust in EHRs and uneasiness about what they will accomplish. Furthermore, security concerns have become more prevalent as a result of increased hacker activity. The objective of this article is to analyze these ethical issues in an effort to eliminate them as a hinderance to EHR implementation. As of now, 98% of all hospitals use EHRs. Between 2009 and 2015, the government allocated money and resources for incentive programs to get EHRs into every healthcare providers' office. During this time period, over $800 million dollars facilitated EHR implementation. Using this as a tool EHRs negative perception can be revitalized and combated with the meaningful use program. This article will highlight the ethical implications of EHRs and suggest ways in which to avoid them to make EHRs available in every healthcare provider.

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