Hec Forum最新文献

Organizational Ethics in Healthcare: A National Survey. 医疗保健领域的组织伦理：全国调查。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-01-17 DOI: 10.1007/s10730-023-09520-3

Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A Nelson

{"title":"Organizational Ethics in Healthcare: A National Survey.","authors":"Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A Nelson","doi":"10.1007/s10730-023-09520-3","DOIUrl":"10.1007/s10730-023-09520-3","url":null,"abstract":"Organizational ethics-defined as the alignment of an institution's practices with its mission, vision, and values-is a growing field in health care not well characterized in empirical literature. To capture the scope and context of organizational ethics work in United States healthcare institutions, we conducted a nationwide convenience survey of ethicists regarding the scope of organizational ethics work, common challenges faced, and the organizational context in which this work is done. In this article, we report substantial variability in the structure of organizational ethics programs and the settings in which it is conducted. Notable findings included disagreement about the activities that comprise organizational ethics and a lack of common metrics used to assess organizational ethics activities. A frequently cited barrier to full engagement in these activities was poor institution-wide understanding about the role and function of organizational ethics resources. These data suggest a tension in the trajectory of organizational ethics' professionalization: while some variability is appropriate to the field's relative youth, inadequate attention to definitions of organizational ethics practice and metrics for success can impede discussions about appropriate institutional support, leadership context, and training for practitioners.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"559-570"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical-Legal Partnerships and Prevention: Caring for Unrepresented Patients Through Early Identification and Intervention. 医疗-法律合作与预防：通过早期识别和干预照顾无代表病人。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2023-12-23 DOI: 10.1007/s10730-023-09518-x

Cathy L Purvis Lively

引用次数: 0

What is a High-Quality Moral Case Deliberation?-Facilitators' Perspectives in the Euro-MCD Project. 什么是高质量的道德案例审议？

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-02-05 DOI: 10.1007/s10730-023-09519-w

Lena M Jakobsen, Bert Molewijk, Janine de Snoo-Trimp, Mia Svantesson, Gøril Ursin

{"title":"What is a High-Quality Moral Case Deliberation?-Facilitators' Perspectives in the Euro-MCD Project.","authors":"Lena M Jakobsen, Bert Molewijk, Janine de Snoo-Trimp, Mia Svantesson, Gøril Ursin","doi":"10.1007/s10730-023-09519-w","DOIUrl":"10.1007/s10730-023-09519-w","url":null,"abstract":"The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators'. We aim to describe facilitators' perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. Facilitators' perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"541-557"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-Psychiatric Treatment Refusal in Patients with Depression: How Should Surrogate Decision-Makers Represent the Patient's Authentic Wishes? 抑郁症患者拒绝非精神治疗：代理决策者应如何代表患者的真实意愿？

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-01-27 DOI: 10.1007/s10730-024-09522-9

Esther Berkowitz, Stephen Trevick

{"title":"Non-Psychiatric Treatment Refusal in Patients with Depression: How Should Surrogate Decision-Makers Represent the Patient's Authentic Wishes?","authors":"Esther Berkowitz, Stephen Trevick","doi":"10.1007/s10730-024-09522-9","DOIUrl":"10.1007/s10730-024-09522-9","url":null,"abstract":"Patients with mental illness, and depression in particular, present clinicians and surrogate decision-makers with complex ethical dilemmas when they refuse life-sustaining non-psychiatric treatment. When treatment rejection is at variance with the beliefs and preferences that could be expected based on their premorbid or \"authentic\" self, their capacity to make these decisions may be called into question. If capacity cannot be demonstrated, medical decisions fall to surrogates who are usually advised to decide based on a substituted judgment standard or, when that is not possible, best interest. We propose that in cases where the patient meets the widely accepted cognitive criteria for capacity but is making decisions that appear inauthentic, the surrogate may best uphold patient autonomy by following a \"restorative representation\" model. We see restorative representation as a subset of substituted judgement in which the decision-maker retains responsibility for deciding as the patient would have, but discerns the decision their \"truest self\" would make, rather than inferring their current wishes, which are directly influenced by illness. Here we present a case in which the patient's treatment refusal and previously undiagnosed depression led to difficulty determining the patient's authentic wishes and placed a distressing burden on the surrogate decision-maker. We use this case to examine how clinicians and ethicists might better advise surrogates who find themselves making these clinically and emotionally challenging decisions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"591-603"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

"Follow the Science" in COVID-19 Policy: A Scoping Review. COVID-19 政策中的 "遵循科学"：范围审查。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-03-12 DOI: 10.1007/s10730-024-09521-w

Jacob R Greenmyer

{"title":"\"Follow the Science\" in COVID-19 Policy: A Scoping Review.","authors":"Jacob R Greenmyer","doi":"10.1007/s10730-024-09521-w","DOIUrl":"10.1007/s10730-024-09521-w","url":null,"abstract":"\"Follow the science\" was commonly repeated during debates on COVID-19-related policy. The phrase \"follow the science\" raises questions that are central to our theories of knowledge and the application of scientific knowledge to maximize the wellbeing of our society. The purpose of this study was to (1) perform a scoping review of literature discussing \"follow the science\" and COVID-19, and (2) consider \"follow the science\" in the context of pediatric health. A comprehensive search of 14 databases was performed on May 23, 2023. Articles were included if they used terms such as \"follow the science\", \"follow the scientists\", \"listen to science\" or \"listen to scientists\", and discussed COVID-19. There were 24 articles included in the final review. Existing literature on \"follow the science\" (1) differentiates between scientific knowledge and policy decisions; (2) emphasizes the importance of social sciences in policy making; (3) calls for more transparency in the knowledge synthesis and policy generating process; and (4) finds that scientific advisors see their role as advising on science rather than policy decision making. There was no definitional, epistemological, or philosophical intellectual defense of \"follow the science\" in the peer reviewed literature. Policy requires (1) reliable data and (2) agreement on what to do considering those empirical facts by appealing to values, ethics, morality, and law. A review of school shutdowns is used as an example of the inadequacy of \"follow the science\" as a guiding principle for public policy.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"571-589"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care. 在优先考虑直接患者护理时定位伦理：在儿童癌症护理中实施伦理案例反思查房的经验。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-11-02 DOI: 10.1007/s10730-024-09541-6

Pernilla Pergert, Bert Molewijk, Cecilia Bartholdson

{"title":"Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.","authors":"Pernilla Pergert, Bert Molewijk, Cecilia Bartholdson","doi":"10.1007/s10730-024-09541-6","DOIUrl":"https://doi.org/10.1007/s10730-024-09541-6","url":null,"abstract":"Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Ethics Consult Documentation Simplification Project: Summation of Participatory Processes, User Perceptions, and Subsequent Use Patterns. 伦理咨询文件简化项目：对参与过程、用户感知和后续使用模式的总结。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-10-10 DOI: 10.1007/s10730-024-09537-2

Meaghann S Weaver, Anita J Tarzian, Hannah N Hester, Karinne R Davidson, Rodney P Dismukes, Mary Beth Foglia

{"title":"An Ethics Consult Documentation Simplification Project: Summation of Participatory Processes, User Perceptions, and Subsequent Use Patterns.","authors":"Meaghann S Weaver, Anita J Tarzian, Hannah N Hester, Karinne R Davidson, Rodney P Dismukes, Mary Beth Foglia","doi":"10.1007/s10730-024-09537-2","DOIUrl":"https://doi.org/10.1007/s10730-024-09537-2","url":null,"abstract":"Healthcare ethics consultants in the Veterans Health Administration (VHA) document consults in an enterprise-wide web-based database entitled IEWeb, serving as a system of record for healthcare ethics documentation at 1300 VA facilities. The need arose to evolve the database from an ethics process training resource into a more streamlined documentation repository that captures essential consult elements. A VHA National Center for Ethics in Health Care (NCEHC) Improvement Team convened for three tasks: (1) Specify and prioritize IEWeb changes (occurred via six focus groups composed of \"new user\" and \"super user\" cohorts with analysis of existing documentation patterns); (2) Pilot the changes regionally (via regional communication, training, and reviews of pre-post use patterns); and (3) Measure the impact of national change implementation on user perspectives (via pre-and post-change implementation polls). Focus groups identified six implementable priority areas for ethics consult documentation improvement, including the development of a usable consult summary note for ready conversion from IEWeb fields into the electronic health record. Post-IEWeb updates showed an increased number of consults documented, a reduction in \"time to consult documentation closure\" by a mean of 4.5 days, and a clinically-meaningful improvement in the quality of documentation (78% of ethics questions scored \"above-bar\" on the validation tool pre- vs. 89% scored \"above-bar\" post-IEWeb changes, n = 140). According to national survey findings, the number of consultants documenting \"all\" consults in IEWeb increased, satisfaction increased, and perception of documentation difficulty decreased. IEWeb simplification enabled ethics consultants to re-focus their documentation completion efforts by decreasing perception of documentation burden while improving documentation frequency and quality in a clinically-meaningful way.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Survey of Moral Distress and Self-Awareness among Health Care Professionals. 医护人员道德压力和自我意识调查。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-27 DOI: 10.1007/s10730-024-09539-0

Sharoon Shahzad, Rehana Sajid, Joel Fakhar, Ayesha Saleem Khan, Nizar Ali, Ahtisham Younas

{"title":"Survey of Moral Distress and Self-Awareness among Health Care Professionals.","authors":"Sharoon Shahzad, Rehana Sajid, Joel Fakhar, Ayesha Saleem Khan, Nizar Ali, Ahtisham Younas","doi":"10.1007/s10730-024-09539-0","DOIUrl":"https://doi.org/10.1007/s10730-024-09539-0","url":null,"abstract":"Health care professionals experience moral distress due to challenging ethical decision-making during patient care. Self-awareness can be associated with moral distress. This study determined the levels of and relationship between moral distress and self-awareness of health care professionals. A convenience sample of physicians and nurses was recruited. Data were collected using the Moral Distress and Self-Awareness Scales. In total, 168 physicians and 201 nurses participated with a mean age of 30.54 ± 7.87 and clinical experience of 6.40 ± 6.22 years. Moderate levels of moral distress (127.07 ± 71.90) and high levels of self-awareness (70.20 ± 11.37) were found. A weak positive correlation was found between self-awareness and moral distress (r = 0.21, p < 0.001) and weak negative correlation between moral distress (r = - 0.115, p = 0.03) and age. Nurses were more self-aware, but no differences were observed in moral distress based on sex and clinical settings. A weak correlation between self-awareness and moral distress may suggest that self-awareness can increase intrapersonal tensions, contributing to distress. Further research is needed to support any conclusive relationship between moral distress and self-awareness.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Ethics of Human Embryo Editing via CRISPR-Cas9 Technology: A Systematic Review of Ethical Arguments, Reasons, and Concerns. 通过 CRISPR-Cas9 技术进行人类胚胎编辑的伦理问题：对伦理论点、原因和担忧的系统回顾》。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-20 DOI: 10.1007/s10730-024-09538-1

Lindsay Wiley, Mattison Cheek, Emily LaFar, Xiaolu Ma, Justin Sekowski, Nikki Tanguturi, Ana Iltis

引用次数: 0

Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations. 减轻精神压力：儿科重症监护护士的建议。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-05-04 DOI: 10.1007/s10730-023-09506-1

Sadie Deschenes, Shannon D Scott, Diane Kunyk

{"title":"Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations.","authors":"Sadie Deschenes, Shannon D Scott, Diane Kunyk","doi":"10.1007/s10730-023-09506-1","DOIUrl":"10.1007/s10730-023-09506-1","url":null,"abstract":"In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) \"I'm sorry, there's nothing else\": increasing supports for patients and families; (2) \"someone will commit suicide\": improving supports for nurses: (3) \"Everyone needs to be heard\": improving patient care communication; and (4) \"I didn't see it coming\": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"341-361"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10314416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0