• Underserved R Undeserved?

      Davis, Sheila P., Ph.D., RN (The Aquila Digital Community, 2005-01-01)
    • Fostering Self Efficacy as an Ethical Mandate in Health Promotion Practice and Research

      Hendricks, Constance S.; Hendricks, Denisha L.; Webb, Shelia J.; Davis, Janice Bonner; Spencer-Morgan, Barbara (The Aquila Digital Community, 2005-01-01)
      Self-efficacy, a social psychology concept, is defined as the likelihood of an individual engaging in health behaviors. Correctly understood, authors posit that health care providers and researchers have an ethical mandate to foster self-efficacy in patients. Further, self-efficacy promotes the commonly ascribed moral principles of respect for the person as a being of worth and fosters autonomy. This paper provides an overview of the concept of self-efficacy, provides a brief discussion on the difference between self-esteem and self-efficacy, and discusses its relationship to health promotion and selected moral principles. Health care providers and researchers are challenged to foster self-efficacy among patients and others as a means to facilitate health promotion. The continuous ethical challenge for health care providers, health promotion advocates and researchers is to remain mindful of the complexity of the opportunity to empower others, the privilege to improve the quality of life for others and the responsibility to remain true to the ethical principles at all times. Consideration of self-efficacy as an ethical mandate remains a vital element within health promotion practice and research.
    • Antepartal Bed rest: Conflicts, Costs, Controversies and Ethical Considerations

      Dunn, Linda L., DSN, RN; Handley, Marilyn C., PhD, RN; Carter, Melondie R., DSN, RN (The Aquila Digital Community, 2006-01-01)
      Currently, more than 90% of obstetricians prescribe bed rest for antepartal women who are experiencing complications in pregnancy. Even though researchers have found that bed rest is not effective in reducing preterm births, 20 percent of pregnant women will spend at least one week during pregnancy on bed rest. Preterm premature rupture of membranes (PPROM) accounts for 33% of all preterm births and is significantly associated with maternal, fetal, and neonatal morbidity and mortality risks. Antenatal bed rest creates physical, emotional and financial costs for the patient, families, and third-party payers. National health care dollars spent in 2001 for short gestation was $1,887, 716,535. Treatment decisions are often made on an emotional basis or medical litigation issues rather than ethical outcomes surrounding the threshold of fetal/neonatal viability.
    • Informed Consent in a Clinical Trial: Participants Satisfaction of the Consent Process and Voluntariness of Participation

      Manafa, Ogenna Uzoma, MD; Lindegger, Graham; Ijsselmuiden, Carel (The Aquila Digital Community, 2006-01-01)
      A study was conducted among participants in an antiretroviral therapy (ART) clinical trial to determine how voluntary their participation was and their satisfaction to the consent process. A semi structured questionnaire was administered to 88 of the 180 people enrolled in the study at the time of interview and who were willing to participate. Participation in the study was driven mainly by unmet health needs and participant reported benefits (free drug and tests) as the primary motive to participate in the research. The absence of alternatives to access medical services creates challenges to voluntary participation. Most of the participants saw the consent process as satisfactory, the satisfaction might be based on the hope the treatment is giving them and on the trust they have on investigators and the institution. It is then of importance that research participants be given enough time to reflect on the information provided during the consent process before obtaining consent from them.
    • African Americans’ Trust and the Medical Research Community

      Mokwunye, Nneka O., MA (The Aquila Digital Community, 2006-01-01)
      African Americans have been victims in many of the medical atrocities involving human subject research. It is well established that African Americans are less likely to enroll in research protocols and have more distrust of the medical field than any other ethnic group due to the Tuskegee Syphilis Study. Researchers must be responsible for creating a trustworthy environment. The creation of a cultural competency curriculum designed specifically for training researchers is warranted and will help open the communication barrier between researcher and participant. Trust must be created before the distrust of the medical research community will be resolved. This paper describes successful recruitment strategies that help foster a trusting environment and increase enrollment. Enrollment increase will help lead to understanding disparities and creating solutions.
    • Reimbursements Sway Oncologists' Drug Choices ‘Letter to Editor’

      Pawelski, Gregory D. (The Aquila Digital Community, 2006-01-01)
    • Should The US Media Have A Duty To Cover All International Tragedies Even If Such Reporting Cannot Be Measured In Their Ratings and, Thereby, Their Respective Financial Status?

      Hertelendy, Attila J., MS, MHSM, NREMT-P, CCEMT-P, ACP; Vanderslice, George, MS, RT (R) (M); Dillon, Danett A., BS; Jefferson-Nash, Brenda, BS; Treolar, RN, MSN, CFNP, Debbie (The Aquila Digital Community, 2006-01-01)
      Hurricane Katrina was one of the most devastating natural disasters to occur in United States history. Within months, both the domestic and international news media has moved on to more lucrative stories that inspire higher ratings. The international media, has been criticized for failing to provide balanced and ethical coverage of international disasters, and has focused only on reporting those news items that can be measured in their ratings and has a positive impact on the financial bottom line.
    • The Last Chapter in the Story: A Place for Aristotle's Eudaemonia in the Lives of the Terminally Ill

      Cowley, Christopher, MD (The Aquila Digital Community, 2006-01-01)
      The 'deficiency model' of aging has often been criticized for its lack of attention to the individual patient's narrative understanding of his own life. However, such narrative conceptions tend to focus on a generic adult person, situated in specific on-going projects and relationships, moving toward a more or less clear conception of the future. What interest me, on the other hand, are those individuals who have become aware of their own death as imminent, and who therefore strive to compose the 'last chapter' of their life story. Imminence is not to be taken in chronological or clinical terms, but as revealing an attitude to oneself and one's own life. The composition of the last chapter requires recollecting and reappraising the events of one's life in an effort to make sense of the life as a whole. I propose revising the ancient Greek word eudaemonia to capture this sense of achieving an integrated meaning to one's life.
    • Disaster Ethics and Healthcare Personnel: A Model Case Study to Facilitate the Decision Making Process

      Powell-Young,, Yolanda M., PhD, MSN, RN, BC, CPN, CNS; Baker, Janelle R., PhD, MSN, APRN, BC; Hogan, Jacqueline G., MSN, APRN, CNS (The Aquila Digital Community, 2006-01-01)
      The impact of Hurricane Katrina on the Gulf Coast signified the arrival of the most catastrophic natural disaster in United States history. Despite years of dire warnings, the absence of hurricane evacuation policies and disaster contingency plans highlighted not only staggering ineptitudes at all levels of government but at all levels of healthcare organization as well. Thousands of healthcare personnel and, in some instances, their families were stranded in New Orleans hospitals awaiting evacuation in rapidly deteriorating conditions. Many of these healthcare workers are not expected to return to New Orleans. Some of these decisions are infrastructure driven however, many are due to the psychological traumas experienced as a result of the ethically perpetuated conflicts they were, in some instances, forced to contend with. Familiarity with and utilization of a framework for ethical decision-making may facilitate healthcare professionals in maneuvering through disaster-instigated ethical dilemmas.
    • New Perspectives in Healthcare Ethics: An Interdisciplinary and Cross-cultural Approach by Rosemarie Tong Book Review

      Gillis, Marin M., LPh, PhD (The Aquila Digital Community, 2006-01-01)
      Tong, a well-known biomedical ethicist, combines medical ethics, bioethics, and her own unique insights to provide a comprehensive survey of contemporary health care ethics issues. The following is a book review of Rosemarie Tong, New Perspectives in Healthcare Ethics: An Interdisciplinary and Cross-cultural Approach.
    • Charles Dickens’ Hard Times and the Academic Health Center: A Tale of the Urban Working Poor and the Violation of a Covert Covenant, an American Perspective

      Papadimos, Thomas J., M.D., M.P.H. (The Aquila Digital Community, 2006-01-01)
      Charles Dickens’ novel “Hard Times” focuses on the struggles of urban workers in 19th century England. The situations of workers in 21st century America are not dissimilar thus making Dickens’ commentary and characters applicable to the contemporary socioeconomic scene. The number of uninsured or underinsured poor in America is rising. AHCs must go beyond their traditional mission of patient care, education and research and embrace the local neighborhoods they serve. The urban location, technical expertise, and educational mission of many AHCs make them ideally suited to assist urban populations that are at great health risk. Many Academic Health Centers (AHCs) in America found their origins in working class neighborhoods, such as those described by Dickens, and today are surrounded by the urban poor. An argument is made that AHCs have a moral obligation to these neighborhoods; it is an implied, or covert, covenant that they are obliged to honor.
    • Ethical Considerations: Growth Hormone Treatment in Children with Idiopathic Short Stature

      Bucher, Dawn R. (The Aquila Digital Community, 2007-01-01)
      Being short is a natural diversity of the human race. In 2003, the Food and Drug Administration (FDA) approved the use of growth hormone (GH) for the treatment of idiopathic short stature (ISS) in children. Research has shown that GH therapy in children with ISS has a variable effect on increasing height. However, the literature has not shown the efficacy in improving psychosocial function to justify the costs and potential adverse effects. GH use in children with ISS is a subject of great ethical debate. Ethical implications including beneficence, nonmaleficence, autonomy, and justice are discussed. ISS requires thoughtful consideration by the patient, parents, and healthcare professionals. Well-designed long-term studies are needed to determine the benefits of such treatment.
    • Public Health Principlism

      Klugman, Craig M., Ph.D. (The Aquila Digital Community, 2007-01-01)
      Public health ethics has grown out of the medical ethics movement and has remained in individualistic biomedical models. However, as public health is a different enterprise than medicine dealing with communities rather than individuals. The author develops public health principlism based on the idea of common citizenship in the community. When the four principles of public health ethics—solidarity, efficacy, integrity, and dignity—are in balance, a state of justice exists. The goal is to have programs that are the least destructive to communities and the least restrictive to people. These principles provide guidance in ethical reasoning when analyzing programs and interventions such as mandatory helmet laws, water fluoridation, and smallpox vaccination to improve the aggregate health of a community.
    • Doing the Right Thing – Helping Families Decide Whether to Withhold Artificial Nutrition & Hydration in Alzheimer Disease

      Pensiero, Cheryl, RN, MS, NP-C (The Aquila Digital Community, 2007-01-01)
      Alzheimer disease causes cognitive and functional impairments manifested in memory impairment, personality changes, behavioral difficulties, bladder and bowel incontinence, difficulty with eating and swallowing, and recurrent respiratory or urinary infections. At the end of life, family members and clinicians face many decisions about medical care for patients with dementia, none more unsettling than that regarding artificial nutrition and hydration. Discussions with families should center on medical outcomes and weighing the benefits and burdens of this treatment.
    • Online Journal of Health Ethics Sponsors

      Davis, Sheila P., Ph.D., RN (The Aquila Digital Community, 2007-01-01)
    • Withholding and Withdrawing Life Support: Moral Dilemmas, Moral Distress, and Moral Residue

      Stewart, Robert Scott, Ph.D. (The Aquila Digital Community, 2007-01-01)
      This paper argues for the following points. (1) Despite the recent public controversy surrounding the Terri Schiavo case, withholding and withdrawal of life support rarely presents any moral dilemmas. (2) Given this, we ought to turn our attention to how end of life care is done rather than whether it ought to be done. (3) A ‘caring perspective’ is an essential ingredient in end of life care. Unfortunately, as nurses undergo their ‘professionalisation process’, they often lose this caring perspective. Hence, ways must be found to avoid this loss. (4) Assuming success in this enterprise, it is necessary that nurses be integrally engaged in both end of life care and decision making.
    • Ethical Dimensions within Qualitative Research

      Gunn, Jennie, FNP, PhD (The Aquila Digital Community, 2007-01-01)
      Throughout history people have relied on their culture for healing practices and ways of caring. Healing began in Africa thousands of years ago with herbs and plants that were used for healing and rituals. As African people came to America they brought with them cultural ways which were practiced throughout slavery. Thereafter, elders passed down the healing remedies until today. The purpose of this study was to discover beliefs, meanings, and practices of healing with botanicals (plant, root, or bark parts) recalled by African American women 80 years of age or older that were born and resided in the Mississippi Delta. The goal of the study was to provide insight into the cultural beliefs and ways of the people by identifying generic practices of the elders; thereby, providing additional knowledge needed to design and implement culturally congruent care. The knowledge obtained is posited to assist other nurses in the care of African Americans and highlight the importance of generic care awareness. This study discovered that the elders in the Mississippi Delta depend now on professional care and less on the remembered botanical healing ways of the past. Many botanical healing methods were remembered but few used today. However, women remain the healers in the family units and are considered important in care. African American elders view God as the center of life and healing. Health was defined by the elders and younger informants as the ability to get up and do normal things and is maintained by taking care of oneself. Illness is viewed as the inability to do normal activities. This finding may shed light on the late presentation of symptoms in health care within this culture. As population demographics shift, people and nurses are more mobile now than ever before. Because of this mobility, cultural care research is important to ensure provision of culturally competent care. This research provides additional resources toward understanding the elder African American culture in the Delta as it relates to provision of culturally congruent care. Ultimately, through culturally competent care, the client will receive care that is respectful, safe and not offensive.
    • Managing Peanut Allergies In Schools: Ethical And Policy Issues

      Resnik, David B (The Aquila Digital Community, 2007-01-01)
      Protecting children with peanut allergies from harm poses difficult ethical dilemmas for school administrators. Some schools have responded to the peanut allergy problem by implementing bans on peanuts and peanut products, thereby sparking outrage and protests from some parents. School administrators should carefully consider how best to protect allergic children while taking into consideration the interests of non-allergic children, their parents and practical considerations. While it is not realistic to expect that a school setting can be risk-free, every reasonable effort should be made to protect allergic children from harm in order to promote their health and educational attainment.
    • The Ethical Management of a Psychiatric Patient Disposition in the Emergency Department

      Lovrin, Mellen, MSN, APRN, BC, Dr.NP.c; Reinisch, Courtney, MSN, APN-C, Dr. NP.c (The Aquila Digital Community, 2007-01-01)
      This case examines the ethical issue of the disposition of a patient who presents in the emergency room with a psychotic disorder when a nurse practitioner is given the autonomy to determine disposition of a patient and the attending physician disagrees. Therein lies the dilemma of an NP lacking emergency psychiatric admitting privileges. The NP ethically needs to continue to act as a patient advocate to ensure patient safety and best outcomes.
    • State of Knowledge: Post-abortion Outcomes

      Wilson, Kaye, DNS; Haynie, Lisa, Ph.D. (The Aquila Digital Community, 2007-01-01)
      A critical analysis of research regarding post-abortion outcomes is presented. The studies reviewed include those following the U.S. legalization of abortion in 1973 and other countries where abortion is legal. Research is examined from the view point of only minimal negative outcomes are experienced and that significant negative outcomes are experienced by women following and elective abortion an elective abortion are discussed.