• Some Considerations about Decisions and Decision-Makers in Hospital Ethics Committees

      Peirce, Anne Griswold (The Aquila Digital Community, 2004-01-01)
      This paper presents a brief history of the development of hospital ethics committees. Following the introduction, areas of decision vulnerability are considered. Areas of potential concern include committee composition, including the influence of experts upon the decisions and decision makers. Also considered are bounded rationality, herd behavior and informational cascades. The paper ends with some suggestions about decisions and decision-makers for hospital ethics committees.
    • Universal Healthcare in America

      Hayes, Sandra Carr (The Aquila Digital Community, 2004-01-01)
      Lack of health care insurance, once thought to be a problem of the poor, and has now begun to affect a new population- the middle class. The major factors contributing to this are increased deductibles and co-payments, cost shifting and the introduction of managed care networks. The idea of a universal health plan has been introduced several times over the last few decades. With the introduction of Medicare and Medicaid came the promise of a more inclusive health care plan for all Americans. However, Medicare and Medicaid remain largely unchanged from what they were when they were first introduced in 1965. The U. S. was built on the foundation of ‘unalienable rights’. Why then is the number of uninsured and uninsured rising and projected to continue rising? This article seeks to explore these questions.
    • Ethics and Genetic Privacy

      Robinson, Jennifer C. (The Aquila Digital Community, 2004-01-01)
      With the mapping of the Human Genome and increasing interest in genetic testing and therapies, the potential for ethical problems has increased. Nursing and medicine have the ethical responsibility to “do no harm” and to protect the privacy of clients. However, our clients may also be family members and descendants of those we care for. The purpose of this article is to discuss issues related to genetic privacy using a deontological approach and to outline methods to protect clients and research participants.
    • Remedies for the Obesity Epidemic: Can We Afford Them? Do We Want Them?

      Davis, Sheila P. (The Aquila Digital Community, 2004-01-01)
      This paper challenges readers to consider the ethical principle of beneficence, the moral obligation to act for the benefit of others, in addressing the obesity epidemic. One thought provoking question asked is: are we ready to trade jobs for lives if obesity reduction resulted in a significant revenue loss? Currently, the obesity epidemic is estimated to cost $117 billion annually. Stated differently, this epidemic possibly generates $117 billion annually. Readers are warned that unless drastic, wide sweeping efforts are instigated on a societal scale, the obesity epidemic will win out. This is especially pertinent for children. Epidemiologists have determined that at least one out of every three Caucasian child and one out of every two ethnic minority child born in 2000 and beyond will become diabetic unless as a society we do the right thing in terms of aggressively implementing solutions which we know to be effective in curbing the epidemic. Lastly, 14 governments, policy-oriented remedies are presented and 13 family-related, obesity reduction/prevention remedies are shared. Readers are left with the challenge of deciding if we as a society can afford the remedies and if we really want the remedies. Davis concludes with the reminder that we have a moral obligation to help those, especially children, who suffer for this life threatening epidemic.
    • "Forward" Commentary

      Davis, Sheila P., Ph.D., RN (The Aquila Digital Community, 2004-01-01)
    • Nancy O’Neal Tatum Dedication

      Turner, Helen R., M.D., Ph.D. (The Aquila Digital Community, 2004-01-01)
    • Lucy 1845

      Gunn, Jennie A. (The Aquila Digital Community, 2004-01-01)
      Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. In the communications process, the physician providing or performing the treatment and/or procedure should disclose and discuss: The patient's diagnosis, if known; The nature and purpose of a proposed treatment or procedure; The risks and benefits of a proposed treatment or procedure; Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance); The risks and benefits of the alternative treatment or procedure; and The risks and benefits of not receiving or undergoing a treatment or procedure.
    • Elders Impressions of Ethicolegal Issues in Healthcare

      Cooper, Gabriella H., BSN, RN; Buckner, Ellen B., DSN, RN (The Aquila Digital Community, 2005-01-01)
      Ethicolegal issues are those that involve ethical and legal considerations when one is deciding on a course of action. They include topics in advance directives, basic human needs, general nursing care, and health care decision-making. The purpose of this study was to investigate the perspectives of elders regarding geriatric care. Seniors ages 65 and older were interviewed using the Seniors Perspectives Regarding Elder Care Issues (SPRECI) questionnaire to obtain qualitative responses. Eight open-ended questions developed by the investigator comprised the SPRECI. The questionnaire was reviewed for content validity by a CNS with cardiovascular and administrative experience, a faculty member with experience in geriatric nursing, a faculty member with experience in ethicolegal issues, and another with experience in research methods. Emergent themes: (a) general nursing care, (b) basic needs, (c) advance directives, (d) decision making, and 5) understanding, intimate that elders commend hospitals for effectively providing for the geriatric patient, yet they identify deficits in trust, communication, and frustration with that care. The implication is that nurses should become more active in eliciting information from elders which accurately document their experiences in health care settings. This information is needed in order to address elders ethicolegal needs.
    • Elective Cesarean Section: How Informed is Informed?

      Zeidenstein, Laura (The Aquila Digital Community, 2005-01-01)
      The national C-section rate has sky rocketed to nearly 25% of all births, although its widespread use has not improved birth outcomes. Elective cesarean surgery for non-medical reasons is now available to women. The ethical dilemma of elective cesarean involves confusion about what constitutes informed consent. Issues related to autonomy and informed consent requires examination within the context of women's actual health care experiences. The midwifery model of care should be utilized to foster health promotion and active family participation in prenatal care decision making.
    • Breastfeeding in the HIV Epidemic: A Midwife's Dilemma in International Work

      Dohrn, Jennifer Ellen (The Aquila Digital Community, 2005-01-01)
      As standards develop to reduce the maternal-to-child transmission of HIV, healthcare professionals need to evaluate recommendations in the context of culturally-accepted values for the populations to be served. Breastfeeding, a central value in South African families, carries the risk of transmission in mothers that are HIV+. A dilemma faced by international workers is the sharing of information that challenges culturally-accepted practices. A nurse-midwife working with HIV positive women during the childbearing cycle in the United States is expected to implement protocols to prevent transmission of the HIV virus to the newborn. These include administration of antiretroviral medications to the women during the pregnancy and labor, as well as the policy of no breastfeeding, since breast milk contains the HIV virus and can be a source of passing the infection to the baby. Ethical dilemmas develop when the nurse-midwife is an international worker in a country which is in the midst of the HIV epidemic such as South Africa. Current South African policy regarding mother-to-child transmission recommends either exclusive breastfeeding with rapid weaning at six months, or exclusive bottle feeding. Cultural practice favors breastfeeding with the addition of cereals, in effect, mixed feeding. These practices lead to a high risk of transmission and infection in the newborn.
    • Uninformed Consent

      Thomas, Edwidge Jourdain, ANP, Dr.NP (The Aquila Digital Community, 2005-01-01)
      Patients seek the advice of health care providers regarding treatment options and protocols. When there is a condition with several treatment alternatives, patients generally rely on their health care providers to explore all the options available and guide them on the evidence-based treatment that would ensure the best outcome. This simple premise is complicated by the fact that there are often not one, but a range of treatments with differing interpretations of the best outcome. In addition, failure to ensure that patients have adequate comprehension of treatment options and complications often result in negative treatment outcomes. Cases where the treatment causes more harm than the disease generally lead to debates of whether observation without intervention is the optimal course. This article discusses a patient’s total reliance on the advice of the attending physician, who apparently failed to ensure that the patient had adequate comprehension of the long-term implications and complications resulting from a recommended surgical procedure. The ethical dilemma that emerged is analyzed, with emphasis on the concept of informed consent, by reviewing the patient’s surgical outcome and roles of the surgeon and primary care provider. The paper concludes by providing recommendations to ensure that patients are sufficiently informed before consenting.
    • The Ethics of Assisted Reproduction Technologies and the HIV Infected Woman

      Hardwicke, Robin Lynn (The Aquila Digital Community, 2005-01-01)
      Currently HIV infected men and women are living longer quality lives. This phenomenon is raising more and more ethical questions concerning ability to reproduce offspring. HIV infected women frequently ask health care providers about the safety and risks of becoming pregnant. HIV infected women also face the challenges of fertility more frequently and seek assisted reproductive technologies. Each case raises many ethical questions. The case study discussed in this paper illustrates the ethical issues raised by knowingly risking the birth of a child, as well as the health of the woman infected with HIV. The paper also offers a more balanced approach to enable nurses to understand the issues.
    • Nursing Ethics: Across the Curriculum and Into Practice Book Review

      Butts, Janie B., D.S.N., RN; Rich, Karen L., Ph.D. (c), RN (The Aquila Digital Community, 2005-01-01)
      Spanning the nursing curriculum, Nursing Ethics: Across the Curriculum and Into Practice is derived from theoretical foundations, clinical evidence and case study. Based on the concept that compassionate relationships between nurses and patients form a vital element of humanistic nursing, this text provides foundational knowledge about ethics and decision-making strategies to prepare nurses for the moral issues they experience daily. Nursing Ethics includes decision-making approaches and models, rationale for decisions, and management of care for various topics.
    • Cultural Competence: Myth or Mandate

      Spruill, Ida; Davis, Bertha L. (The Aquila Digital Community, 2005-01-01)
      The ability to provide effective, quality health care to clients from different cultures is becoming increasingly important to health care providers from all disciplines (Davidhizar, Bechtal, & Gregory, 1998). The United States census reported that by the year 2000, one third of Americans would be members of an ethnically diverse cultural group. The developmental process of the cultural competency continuum is often misunderstood and/or left out of many cultural competency and sensitivity training programs, resulting in the inadequate preparation of trained health professionals. When organizational systems and/or professionals strive to become culturally competent, they must first perform an assessment of self. A case study approach of the Project Sugar research study will be used to examine cultural competency and identify its placement on the Cultural Competency Continuum. Tools to retain cultural prurience will also be offered.
    • Death of Terri Schiavo

      Davis, Sheila P. (The Aquila Digital Community, 2005-01-01)
      Few cases in modern history have incited as much national debate and emotion as has the Theresa (Terri) Marie Schiavo case. Mrs. Schiavo had been in a persistent vegetative state (PVS) for the past 15 years, resultant from a chemical imbalance, and kept alive by a feeding tube until March 18, 2005. In compliance with a court order by Pinellas County, Florida Circuit Judge, George Greer, the feeding tube was removed and Terri died 12 days later.
    • Pulmonary Retransplant for a Patient with Bronchiolitis Obliterans Syndrome and Hepatitis C Viremia: An Ethical Case Analysis

      Maani, Patricia Ann, F.N. P., DrNP (c) (The Aquila Digital Community, 2005-01-01)
      The purpose of this paper is to discuss and analyze the ethical appropriateness of pulmonary retransplantation as a viable treatment option for end-stage bronchiolitis obliterans syndrome, commonly referred to as chronic rejection. Lung transplantation has become a life-saving treatment for patients with advanced lung disease, yet retransplantation not, for reasons not clearly elucidated. Though statistics show comparable survival of retransplant to primary transplant recipients, this is not an option often considered. Through the course of clinical practice, it became evident that retransplantation had many ethical components that were not fully investigated as part of the retransplantation process. This paper is to identify the relevant ethical considerations regarding pulmonary retransplantation.
    • Ethical Considerations for Conducting Cancer Medical Studies: The Tuskegee Study Aftermath

      Hughes, Gail D.; Knight, Bernadette; Fraser, Lionel, Jr.; Teague, Robert (The Aquila Digital Community, 2005-01-01)
      Recruitment of African-Americans, particularly men in clinical and prevention studies, has not been successful and retention is a major challenge. The paper examines the impact of the Tuskegee Study on research in the 21st century and its effect on recruitment of African-Americans into medical studies. A total of 6 focus groups were conducted among male participants diagnosed with prostate cancer to elicit responses regarding factors influencing participation into prospective studies and trials. Sessions were transcribed and analyzed using content analysis. Echoes of the Tuskegee Public Health Study legacy was a major concern voiced by participants throughout the focus group process. Participants recognize the importance and benefit of research, however the potential for unethical practices continue to linger in the minds of participants. Attitudes and beliefs toward research and the stigma associated with the Tuskegee Public Health Study must also be addressed to increase enrollment of African-Americans in medical studies.
    • Surgeon and Anesthesiologist Responsibilities for Operating Room Law: The Dilemma of Ethics

      Mousavi, Seyed Reza, MD, Ph.D. (The Aquila Digital Community, 2005-01-01)
      Law, ethics and concern for patient safety in the operating room are important considerations of the operating team, i.e., nurses, surgeons, and anesthesiologists. Meaningless rituals observed in the operating room (OR) must be replaced by practices and procedures based on sound principles of medical ethics. Modern technology and medical advances relieve the surgeon and anesthesiologist of many of the manual tasks, but have not completely solved the problems of ethics in the operating suite. Apathy, carelessness and indifference may be a more formidable dilemma unless curbed by moral, ethical and legal constraints. Operating room policies and procedures need constant review and reexamination. To maintain good medical ethics, enforcement of these policies and rules requires the cooperation of all who enter the OR suite. Recommendations are suggested to guide ethical behavior as it relates to the disclosure of the patient’s information in the operating room.
    • Welcome and Kudos

      Davis, Sheila P., Ph.D., RN (The Aquila Digital Community, 2005-01-01)
    • Red Cars and Tractors on an Ethical Country Road

      Gunn, Jennie (The Aquila Digital Community, 2005-01-01)
      This allegory depicts the mismatch between the organizing framework of a research proposal and research outcomes. The implication is that unethical practices obscures aprioriwork done in the conceptual and theoretical frameworks.