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Disaster Medicine and Public Health... Aug 2019Disaster ethics is a developing field of inquiry recognizing the wide variety of ethical issues confronting various professionals involved in planning for and responding...
Disaster ethics is a developing field of inquiry recognizing the wide variety of ethical issues confronting various professionals involved in planning for and responding to different types of disasters. This article explores how ethical issues related to floods are addressed in academic literature. The review involved analysis of publications on ethics and floods identified in a systematic literature search of electronic databases that included sociological, biomedical, and geophysical sources. The review methods were guided by the PRISMA Statement on systematic reviews, adapted to this topic area, and followed by a qualitative analysis of the included publications. All articles were analyzed using NVivo software version 11. The qualitative analysis showed that further research is needed on the ethical issues involved in flood disasters. Ethical guidelines are needed for flood planners and responders that are based on the consistent application of well-established ethical principles, values, and virtues to the specific circumstances arising with each flood. Flexibility is required in applying such approaches. The results suggest that interdisciplinary collaboration (sociological, biomedical, geophysical, engineering, and ethical) could contribute significantly to the development of ethics in floods. (Disaster Med Public Health Preparedness. 2019;13:817-828).
Topics: Ethics, Medical; Floods; Humans
PubMed: 30626460
DOI: 10.1017/dmp.2018.154 -
BMC Medical Education Jan 2021Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks... (Review)
Review
BACKGROUND
Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks (hereafter "tools") provide useful foundations for integrating new knowledge and skills into existing professional practice and education. We conducted this scoping review to identify tools used for teaching cybercivility in health professions education.
METHODS
Using Arksey and O'Malley's scoping review framework, we searched six biomedical and educational databases and three grey literature databases for articles available in English published between January 1, 2000 and March 31, 2020. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we screened and extracted relevant data, and reported the results of the search.
RESULTS
The search resulted in 2272 articles, with 8 articles included in this review after inclusion criteria were applied. Four articles (50%) were peer-reviewed journal papers while the other 4 (50%) were dissertations. Eleven unique tools were identified by this review: (1) Transpersonal Caring Theory, (2) Theory of Workplace Incivility, (3) Conceptualization of Incivility, (4) Media Ecology Theory, (5) Principlism, (6) Salmon's Five Stage Model of Online Learning, (7) Learner-Centered Educational Theory, (8) Gallant and Drinan's 4-Stage Model of Institutionalization of Academic Integrity, (9) Theory of Planned Behavior, (10) Communication Privacy Management Theory, and (11) Moral Development Theory. Based on the tools analyzed in our scoping review, we determined three features of cybercivility pedagogy to which the tools provided a guide: (1) behavioral manifestations, (2) academic integrity, and (3) digital professionalism.
CONCLUSIONS
The reviewed tools provide a pedagogical foundation and guidance for teaching various properties of cybercivility. Future studies should be expanded to include a broader literature body and non-English literature to provide the global perspective and global skills needed by a diverse population of learners.
Topics: Communication; Delivery of Health Care; Health Occupations; Professionalism; Thinking
PubMed: 33516204
DOI: 10.1186/s12909-021-02507-z -
Nursing Ethics May 2020In the last two decades, nursing authors have published ethical analyses of palliative sedation-an end-of-life care practice that also receives significant attention in...
BACKGROUND
In the last two decades, nursing authors have published ethical analyses of palliative sedation-an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care.
RESEARCH AIM
The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses' moral identities are portrayed within this literature.
RESEARCH DESIGN
We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher's Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven), of the values, responsibilities, and relationships reflected in authors' portrayal of the nursing role.
FINDINGS
Two different tones are apparent in the extant nursing ethics literature. One is educational, while the other is critically reflective. Irrespective of tone, all authors agree on the alleviation of suffering as a fundamental nursing responsibility. However, they differ in their analysis of this responsibility in relation to other values in end-of-life care, including those that depend on consciousness. Finally, authors emphasize the importance of subjective and experience-based understandings of palliative sedation, which they argue as depending on nurses' proximity to patients and families in end-of-life care.
DISCUSSION AND CONCLUSION
Based on our findings, we develop three recommendations for future writing by nurses about palliative sedation. These relate to the responsibility of recognizing how consciousness might matter in (some) peoples' moral experiences of death and dying, to the importance of moral reflectiveness in nursing practice, and to the value of a relational approach in conceptualizing the nursing ethics of palliative sedation.
Topics: Deep Sedation; Humans; Hypnotics and Sedatives; Palliative Care; Social Identification
PubMed: 31635514
DOI: 10.1177/0969733019876312 -
International Journal of Environmental... Apr 2022The aim of this study was to map and summarize the published research findings on hospital ethical climate and its relationship with nursing staff job satisfaction as... (Review)
Review
The aim of this study was to map and summarize the published research findings on hospital ethical climate and its relationship with nursing staff job satisfaction as well as strategies proposed in the literature for the improvement of hospital ethical climate and job satisfaction through the actions of nursing staff in leadership positions. A scoping review has been performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension scoping reviews statement (PRISMA-ScR). Three electronic bibliographic databases were searched: the SCOPUS, Medline, and CINHAL Complete using a combination of keywords with the range of years 1994-2021. A total of 15 papers out of 235 records identified were eligible for the analysis. The literature review confirmed a significant relationship between ethical climate and job satisfaction of nurses. Furthermore, the interdependence of ethical climate and job satisfaction of nursing staff affects many different aspects including patients, co-workers, an organization and research. Identifying factors that influence ethical climate and job satisfaction as well as the relationship between these variables may help to reduce the dropout concerning a change of profession among nursing staff.
Topics: Ethics, Nursing; Hospitals; Humans; Job Satisfaction; Leadership; Nurses; Nursing Staff, Hospital; Organizational Culture; Surveys and Questionnaires
PubMed: 35457422
DOI: 10.3390/ijerph19084554 -
Maternal & Child Nutrition Jul 2021Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and... (Review)
Review
Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.
Topics: Breast Feeding; Female; Guilt; Humans; Infant; Mothers; Postpartum Period; Shame
PubMed: 33491303
DOI: 10.1111/mcn.13141 -
Health Psychology Review Jun 2022Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date... (Meta-Analysis)
Meta-Analysis
Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.
Topics: Breast Feeding; Emotions; Female; Humans; Intention; Social Behavior; Social Norms
PubMed: 33618626
DOI: 10.1080/17437199.2021.1893783 -
Conservation Biology : the Journal of... Feb 2022Management of mangrove ecosystems is complex, given that mangroves are both terrestrial and marine, often cross regional or national boundaries, and are valued by local... (Review)
Review
Management of mangrove ecosystems is complex, given that mangroves are both terrestrial and marine, often cross regional or national boundaries, and are valued by local stakeholders in different ways than they are valued on national and international scales. Thus, mangrove governance has had varying levels of success, analyzed through concepts such as principles of good governance and procedural justice in decision-making. Although there is substantial research on case studies of mangrove management, global comparisons of mangrove governance are lacking. This research aims to fill this gap by comparing relationships among qualities of governance across mangrove social-ecological systems worldwide. Through a systematic literature search and screening process, we identified 65 articles that discussed mangrove governance and conservation. Case studies in these articles, drawn from 39 countries, were categorized as top-down, bottom-up, or comanaged and thematically coded to assess the influence of eight principles of good governance in mangrove conservation success. Across all three governance systems, the principles of legitimacy, fairness, and integration were most important in determining conservation success or failure. These principles are closely related to the concept of procedural justice, highlighting the importance of stakeholder inclusion throughout all stages of mangrove management. Thus, we recommend clearly defined roles for all governance actors, transparent communication of policy development to stakeholders, fairness in both process and outcome, and careful consideration of sustainable access to conservation resources.
Topics: Conservation of Natural Resources; Data Accuracy; Ecosystem; Policy Making; Social Justice
PubMed: 34668608
DOI: 10.1111/cobi.13850 -
Disaster Medicine and Public Health... Apr 2022The main objective of this study was to summarize the Hybrid War's core characteristics and humanitarian and medical impacts. (Review)
Review
OBJECTIVE
The main objective of this study was to summarize the Hybrid War's core characteristics and humanitarian and medical impacts.
METHOD
A Systematic Literature Review according to PRISMA guidelines, using the following keywords, 'Hybrid War,' 'Humanitarian Law,' 'Human Rights,' 'Lawfare,' and search engines PubMed, Scopus, Web of Science, and Gothenburg University's database to collect literature from 2000 to 2022 in English was conducted. The eligibility of qualified articles was assessed, an inductive qualitative thematic analysis was applied, and the scientific evidence of each selected piece was evaluated.
RESULTS
The objectives of a Hybrid War are to achieve the tactical and strategic goals in a battle rather than to save civilian lives. It involves networks of state and non-state actors with various means of military and militia influences and strategies, creating difficulties in implementing, controlling, and evaluating the International Humanitarian Law's "A State responsibility" principle, to gain insight into an armed conflict. It targets populated civilian areas and raises ethical and moral concerns by using Lawfare.
CONCLUSIONS
Hybrid War's multi-domain action should be met with multi-dimensional approaches and a doctrine of 'acceptable losses.' Its characteristics and consequences should be learned and taught. Several measures need to be implemented to counteract its impacts, and a flexible surge capacity should be designed, planned, and executed.
Topics: Humans; Warfare; Crime Victims; Outcome Assessment, Health Care
PubMed: 35400358
DOI: 10.1017/dmp.2022.96 -
Orphanet Journal of Rare Diseases Jun 2021The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients... (Review)
Review
BACKGROUND
The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective.
RESULTS
With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status.
CONCLUSION
Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
Topics: Budgets; Humans; Morals; Orphan Drug Production; Rare Diseases; Technology Assessment, Biomedical
PubMed: 34193232
DOI: 10.1186/s13023-021-01925-y -
Journal of Pain and Symptom Management Feb 2023The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten... (Review)
Review
INTRODUCTION
The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten death (WTHD). Whilst shaped by local legal and sociocultural considerations, appreciation of how patients, healthcare professionals and lawmakers relate notions of dignity to self-concepts of personhood and the desire for assisted dying will better inform and direct support of patients.
METHODS
Guided by the Systematic Evidence Based Approach, a systematic scoping review (SSR in SEBA) on perspectives of dignity, WTHD and personhood featured in PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Scopus databases and four key Palliative Care journals was conducted. The review hinged on the following questions: "what is the relationship between dignity and the wish to hasten death (WTHD) in the assisted dying debate?", "how is dignity conceptualised by patients with WTHD?" and "what are prevailing perspectives on the role of assisted dying in maintaining a dying patient's dignity?"
RESULTS
6947 abstracts were identified, 663 full text articles reviewed, and 88 articles included. The four domains identified include 1) concepts of dignity through the lens of the Ring Theory of Personhood (RToP) including their various definitions and descriptions; 2) the relationship between dignity, WTHD and assisted dying with loss of dignity and autonomy foregrounded; 3) stakeholder perspectives for and against assisted dying including those of patient, healthcare provider and lawmaker; and 4) other dignity-conserving measures as alternatives to assisted dying.
CONCLUSION
Concepts of dignity constantly evolve throughout the patient's end of life journey. Understanding when and how these concepts of personhood change and trigger the fear of a loss of dignity or intractable suffering could direct timely, individualised and appropriate person-centred dignity conserving measures. We believe an RToP-based tool could fulfil this role and further study into the design of this tool is planned.
Topics: Humans; Euthanasia; Palliative Care; Personhood; Respect; Suicide, Assisted; Terminal Care
PubMed: 36244639
DOI: 10.1016/j.jpainsymman.2022.10.004