Journal articles on the topic 'Decision making – Moral and ethical aspects'
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Parvari, Soraya, Hoorvash Farajidana, Zohreh Mahmoodi, Farima Mohamadi, Kourosh Kabir, Mehrad Boostanchi, and Nami Mohammadian Khonsari. "Components related to ethical decision making in medical science students: A structural equation model." PLOS ONE 19, no. 4 (April 17, 2024): e0297494. http://dx.doi.org/10.1371/journal.pone.0297494.
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Background Evaluating moral principles in the Society of Medical Sciences and health care workers (HCWs) is imperative due to their direct contact with the community and the significant impact of their attitudes and decisions on people’s lives. This study aimed to determine the components related to ethical decisions in medical sciences students. Methods One thousand two hundred thirty-five eligible students in the Alborz University of Medical Sciences participated in this descriptive study. We gathered their socio-demographic information, assessed their moral reasoning, and used the ethical decisions questionnaire, Lutsen moral sensitivity questionnaire, and general health questionnaire (GHQ) for data gathering. The data were analyzed with SPSS software version 25 and LISREL version 8.8. Results According to the path analysis test findings, ethical reasoning significantly correlated with ethical decision-making (B = 0.40). The number of clinical courses passed, moral sensation (moral sensitivity), and the total number of passed academic semesters had the greatest positive and negative association with ethical decision-making, respectively. (B = 0.54), (B = 0.524) and (B = -0.11). Conclusion Based on the findings of the moral reasoning test, the moral sensation was associated with ethical decision-making, which indicates the necessity of attending to ethical aspects, promoting moral reasoning, sensitivity, and students’ accuracy.
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Torabi, Mohammad, Fariba Borhani, Abbas Abbaszadeh, and Foroozan Atashzadeh-Shoorideh. "Barriers to ethical decision-making for pre-hospital care professionals." Nursing Ethics 27, no. 2 (June 11, 2019): 407–18. http://dx.doi.org/10.1177/0969733019848044.
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Background: Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision. Objectives: The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel. Methods: In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were collected by deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach. Ethical considerations: Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality. Findings: The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes. Conclusion: Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients’ moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them.
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Evans, Katherine, Nelson de Moura, Stéphane Chauvier, Raja Chatila, and Ebru Dogan. "Ethical Decision Making in Autonomous Vehicles: The AV Ethics Project." Science and Engineering Ethics 26, no. 6 (October 13, 2020): 3285–312. http://dx.doi.org/10.1007/s11948-020-00272-8.
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AbstractThe ethics of autonomous vehicles (AV) has received a great amount of attention in recent years, specifically in regard to their decisional policies in accident situations in which human harm is a likely consequence. Starting from the assumption that human harm is unavoidable, many authors have developed differing accounts of what morality requires in these situations. In this article, a strategy for AV decision-making is proposed, the Ethical Valence Theory, which paints AV decision-making as a type of claim mitigation: different road users hold different moral claims on the vehicle’s behavior, and the vehicle must mitigate these claims as it makes decisions about its environment. Using the context of autonomous vehicles, the harm produced by an action and the uncertainties connected to it are quantified and accounted for through deliberation, resulting in an ethical implementation coherent with reality. The goal of this approach is not to define how moral theory requires vehicles to behave, but rather to provide a computational approach that is flexible enough to accommodate a number of ‘moral positions’ concerning what morality demands and what road users may expect, offering an evaluation tool for the social acceptability of an autonomous vehicle’s ethical decision making.
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Bingham, Sarah-Louise. "Refusal of treatment and decision-making capacity." Nursing Ethics 19, no. 1 (January 2012): 167–72. http://dx.doi.org/10.1177/0969733011431925.
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This article explores refusal of medical treatment by adult patients from ethical and legal perspectives. Initially, consequentialist and deontological ethical theory are outlined. The concepts of autonomy, paternalism and competence are described and an overview of Beauchamp and Childress’s principle-based approach to moral reasoning is given. Relevant common law is discussed and the provisions of the Mental Capacity Act 2005 in assessing competence is evaluated. In order to demonstrate the consideration of moral issues in clinical practice, ethical theory is applied to two well-known incidents: the case of Re MB, where doubt over decision-making capacity led to a paternalistic act to override a patient’s choice; and the death of Emma Gough, a situation where respect for autonomy prevailed when healthcare staff acted lawfully in following a patient’s refusal of life-saving treatment. Finally, guidance from regulatory bodies on the roles and responsibilities of health professionals in relation to this topic are considered.
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Fragouli, Evangelia. "The interaction of employee trust & ethical decision making." Business and Management Review 11, no. 02 (December 15, 2020): 161–68. http://dx.doi.org/10.24052/bmr/v11nu02/art-19.
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Trust is seen to include both emotional and cognitive dimensions and to function as a deep assumption underwriting social order. In the past three decades, the importance of trust in the workplace & its influence on organizational performance has been recognized by research scholars, and practitioners. This research paper aims to examine the impact of employee trust on leaders' ethical decision-making. This study applies literature review method to address the above subject showing that the impact of employee trust on leaders’ ethical decision-making relates to organizational aspects, as well as personal characteristics of leaders. Consideration of organizational aspects include performance, effective communication, and organizational culture. The personal aspects relate to leadership self-certification, guilt, rational attitude, leader learning, and moral model. Further, this study suggests that employee trust enhances e& & motivates leaders to make ethical decisions. However, organizational culture and leadership personal characteristics may have a negative impact on ethical decision-making. This study suggests that organizations could make collective decisions on major issues to reduce the impact of these negative factors on ethical decision-making.
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Abou Hashish, Ebtsam Aly, and Nadia Hassan Ali Awad. "Relationship between ethical ideology and moral judgment: Academic nurse educators’ perception." Nursing Ethics 26, no. 3 (September 11, 2017): 845–58. http://dx.doi.org/10.1177/0969733017722825.
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Background: Ascertaining the relationship between ethical ideology, moral judgment, and ethical decision among academic nurse educators at work appears to be a challenge particularly in situations when they are faced with a need to solve an ethical problem and make a moral decision. Purpose: This study aims to investigate the relationship between ethical ideology, moral judgment, and ethical decision as perceived by academic nurse educators. Methods: A descriptive correlational research design was conducted at Faculty of Nursing, Alexandria University. All academic nurse educators were included in the study (N = 220). Ethical Position Questionnaire and Questionnaire of Moral Judgment and Ethical Decisions were proved reliable to measure study variables. Ethical considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent. Findings: This study reveals a significant positive moderate correlation between idealism construct of ethical ideology and moral judgment in terms of recognition of the behavior as an ethical issue and the magnitude of emotional consequences of the ethical situation (p < 0.001; p = 0.031) respectively. Also, there is a positive significant moderate correlation between relativism construct of ethical ideology and overall moral judgment (p = 0.010). Approximately 3.5% of the explained variance of overall moral judgment is predicted by idealism together with relativism. Discussion: The findings suggest that variations in ethical position and ideology are associated with moral judgment and ethical decision. Conclusion: Organizations of academic nursing education should provide a supportive work environment to help their academic staff to develop their self-awareness and knowledge of their ethical position and promoting their ethical ideologies and, in turn, enhance their moral judgment as well as develop ethical reasoning and decision-making capability of nursing students. More emphasis in nursing curricula is needed on ethical concepts for developing nursing competencies.
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Almpani, Sofia, Petros Stefaneas, and Panayiotis Frangos. "Formalization of Ethical Decision Making." International Journal of Extreme Automation and Connectivity in Healthcare 5, no. 1 (March 24, 2023): 1–13. http://dx.doi.org/10.4018/ijeach.320488.
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As automation in robotics and artificial intelligence is increasing, we will need to automate a growing amount of ethical decision making. However, ethical decision-making raises novel challenges for designers, engineers, ethicists, and policymakers, who will have to explore new ways to realize this task. For example, engineers building wearable robots should take into consideration privacy aspects and their different context-based scenarios when programming the decision-making procedures. This in turn requires ethical input in order to respect norms concerning privacy and informed consent. The presented work focuses on the development and formalization of models that aim at ensuring a correct ethical behavior of artificial intelligent agents, in a provable way, extending and implementing a logic-based proving calculus. This leads to a formal theoretical framework of moral competence that could be implemented in artificial intelligent systems in order to best formalize certain parameters of ethical decision-making to ensure safety and justified trust.
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Nyamori, Divine. "Exploring the Relationship between Moral Decision-Making and Emotional Intelligence." International Journal of Philosophy 3, no. 1 (May 3, 2024): 13–24. http://dx.doi.org/10.47941/ijp.1866.
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Purpose: The general objective of the study was to explore the relationship between moral decision- making and emotional intelligence. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the relationship between moral decision- making and emotional intelligence. Preliminary empirical review revealed that emotional intelligence significantly influences individuals' ability to make ethically sound decisions, as evidenced by positive correlations between emotional intelligence and various aspects of moral decision-making. It found that individuals with higher emotional intelligence demonstrated superior emotional awareness, regulation, and empathy, enabling them to navigate moral dilemmas more effectively. The study highlighted the practical implications of these findings, suggesting that interventions aimed at enhancing emotional intelligence could promote ethical behavior in educational, organizational, and societal contexts. Overall, the research provided valuable insights into the intricate interplay between emotional intelligence and morality, informing strategies for fostering ethical leadership and social responsibility. Unique Contribution to Theory, Practice and Policy: The Social Learning theory, Cognitive Developmental theory and Dual Process theory may be used to anchor future studies on moral decision- making and emotional intelligence. The study offered recommendations that contributed significantly to theory, practice, and policy. It suggested further investigation into the underlying mechanisms of the relationship between moral decision-making and emotional intelligence. Practical implications included integrating emotional intelligence training into educational curricula and organizational practices, fostering ethical leadership and decision-making. Policy-wise, the study advocated for the integration of emotional intelligence and ethical education initiatives into broader societal frameworks. Collaboration among stakeholders was recommended to design evidence-based interventions promoting moral development and emotional competence, ultimately contributing to positive social change. Keywords: Moral Decision-Making, Emotional Intelligence, Education, Leadership, Ethical Dilemmas, Interventions, Stakeholders, Collaboration
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Alba, Barbara. "Factors that impact on emergency nurses’ ethical decision-making ability." Nursing Ethics 25, no. 7 (November 10, 2016): 855–66. http://dx.doi.org/10.1177/0969733016674769.
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Background: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Research purpose: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. Research design and context: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions. Participants: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Ethical considerations: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. Findings: A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study. Discussion: This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability. Conclusion: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.
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Kucukkelepce, Gulhan Erkus, Leyla Dinc, and Melih Elcin. "Effects of using standardized patients on nursing students’ moral skills." Nursing Ethics 27, no. 7 (July 30, 2020): 1587–602. http://dx.doi.org/10.1177/0969733020935954.
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Background: Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills. Aim: This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students’ moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case analyses. Research design: This is a quasi-experimental study. Participants and research context: The sample comprised 89 students in Hacettepe University’s Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest’s Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23. Ethical considerations: Ethical approval and official permission were obtained. All participating students completed informed consent forms. Findings: According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant. Conclusion: Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education.
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Perry, Joshua E., Ilene N. Moore, Bruce Barry, Ellen Wright Clayton, and Amanda R. Carrico. "The Ethical Health Lawyer: An Empirical Assessment of Moral Decision Making." Journal of Law, Medicine & Ethics 37, no. 3 (2009): 461–75. http://dx.doi.org/10.1111/j.1748-720x.2009.00407.x.
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The empirical literature exploring lawyers and their moral decision making is limited despite the “crisis” of unethical and unprofessional behavior in the bar that has been well documented for over a decade. In particular we are unaware of any empirical studies that investigate the moral landscape of the health lawyer’s practice. In an effort to address this gap in the literature, an interdisciplinary team of researchers at Vanderbilt University designed an empirical study to gather preliminary evidence regarding the moral reasoning of health care attorneys. The primary research question was how health lawyers respond when they encounter ethical or moral dilemmas in their practice for which the law fails to offer a bright-line solution. In exploring this question, we sought to understand better what motivations or influences guide action when health lawyers confront ethical quandaries, and whether there are specific differences, e.g., gender, experience, or religiosity, that are associated with specific responses to situations testing ethical or moral boundaries.
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Monteverde, Settimio. "The Importance of Time in Ethical Decision Making." Nursing Ethics 16, no. 5 (August 11, 2009): 613–24. http://dx.doi.org/10.1177/0969733009106653.
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Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both ‘dramatic’ issues, which constitute the dominant focus of bioethical decision making, and ‘undramatic’ issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of ‘synchronizing’ the clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors.
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Cervantes, José-Antonio, Luis-Felipe Rodríguez, Sonia López, Félix Ramos, and Francisco Robles. "Cognitive Process of Moral Decision-Making for Autonomous Agents." International Journal of Software Science and Computational Intelligence 5, no. 4 (October 2013): 61–76. http://dx.doi.org/10.4018/ijssci.2013100105.
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There are a great variety of theoretical models of cognition whose main purpose is to explain the inner workings of the human brain. Researchers from areas such as neuroscience, psychology, and physiology have proposed these models. Nevertheless, most of these models are based on empirical studies and on experiments with humans, primates, and rodents. In fields such as cognitive informatics and artificial intelligence, these cognitive models may be translated into computational implementations and incorporated into the architectures of intelligent autonomous agents (AAs). Thus, the main assumption in this work is that knowledge in those fields can be used as a design approach contributing to the development of intelligent systems capable of displaying very believable and human-like behaviors. Decision-Making (DM) is one of the most investigated and computationally implemented functions. The literature reports several computational models that enable AAs to make decisions that help achieve their personal goals and needs. However, most models disregard crucial aspects of human decision-making such as other agents' needs, ethical values, and social norms. In this paper, the authors present a set of criteria and mechanisms proposed to develop a biologically inspired computational model of Moral Decision-Making (MDM). To achieve a process of moral decision-making believable, the authors propose a cognitive function to determine the importance of each criterion based on the mood and emotional state of AAs, the main objective the model is to enable AAs to make decisions based on ethical and moral judgment.
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Woods, Martin. "Balancing Rights and Duties in ‘Life and Death’ Decision Making Involving Children: a role for nurses?" Nursing Ethics 8, no. 5 (September 2001): 397–408. http://dx.doi.org/10.1177/096973300100800504.
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In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.
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Li, Yutong. "Cognitive and Emotional Factors in Moral Decision-Making." Journal of Education, Humanities and Social Sciences 22 (November 26, 2023): 774–79. http://dx.doi.org/10.54097/ehss.v22i.13390.
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Moral decision-making happens in every individual’s life on a daily basis. It is having people to decide which is the right action when people have spotted an ethical issue. A lot of studies have been conducted focusing on cognition, emotion and moral decision making. Numerous studies are carried out to explore how moral decision-making is affected. This paper will be looking at the role cognitive and emotional factors play in moral decision-making in several aspects. First, the paper will focus on the role of emotional factors and cognitive factors separately, so to investigate the relationship between emotional and cognitive traits and moral decision making. Finally, the paper will look at how moral choices are affected when cognitive and emotional factors begin to be manipulated. Some limitations of previous studies were also analyzed and discussed. Directions of future research were demonstrated as well. This paper can provide some suggestions for the design of prevention and intervention courses for moral decision-making.
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Lee, Susan, Ellen M. Robinson, Pamela J. Grace, Angelika Zollfrank, and Martha Jurchak. "Developing a moral compass: Themes from the Clinical Ethics Residency for Nurses’ final essays." Nursing Ethics 27, no. 1 (April 28, 2019): 28–39. http://dx.doi.org/10.1177/0969733019833125.
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Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making.
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Linder, G. Fletcher, Allison J. Ames, William J. Hawk, Lori K. Pyle, Keston H. Fulcher, and Christian E. Early. "Teaching Ethical Reasoning." Teaching Ethics 19, no. 2 (2019): 147–70. http://dx.doi.org/10.5840/tej202081174.
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This article presents evidence supporting the claim that ethical reasoning is a skill that can be taught and assessed. We propose a working definition of ethical reasoning as 1) the ability to identify, analyze, and weigh moral aspects of a particular situation, and 2) to make decisions that are informed and warranted by the moral investigation. The evidence consists of a description of an ethical reasoning education program—Ethical Reasoning in Action (ERiA)—designed to increase ethical reasoning skills in a variety of situations and areas of life. ERiA is housed at a public, major comprehensive U.S. university—James Madison University—and assessment of the program focuses on interventions delivered prior to and during orientation for incoming first-year students. Findings indicate that the interventions measurably enhance the ability of undergraduate students to reason ethically. ERiA’s competency-targeted program and positive student learning outcomes offers a promising model for higher education ethics programs seeking to connect classroom learning in ethics to decision-making in everyday life.
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Barlow, Nichola Ann, Janet Hargreaves, and Warren P. Gillibrand. "Nurses’ contributions to the resolution of ethical dilemmas in practice." Nursing Ethics 25, no. 2 (May 3, 2017): 230–42. http://dx.doi.org/10.1177/0969733017703700.
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Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. Findings: Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion: Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas.
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Jamshidian, Fatemeh, Mohsen Shahriari, and Mohsen Rezaei Aderyani. "Effects of an ethical empowerment program on critical care nurses’ ethical decision-making." Nursing Ethics 26, no. 4 (March 7, 2018): 1256–64. http://dx.doi.org/10.1177/0969733018759830.
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Background: Nurses require empowerment if they are to make ethical decisions. Ethical empowerment has always been one of the main concerns in nurse training programs. Research aim: The present study was conducted to determine the effect of an ethical empowerment program on critical care nurses’ ethical decision-making. Research design: This is a clinical trial study with two groups and pre and post design. Participants and research context: In this study, 60 nurses working in Intensive Care Unit were selected through random sampling and then divided into a control and an experimental group after filling out the Moral Sensitivity Questionnaire. Both groups completed the questionnaire again immediately and 2 months after the ethical empowerment workshop had been held for the experimental group. The collected data were analyzed in SPSS-16 using descriptive and inferential statistics. Ethical considerations: The goals of the study were explained to the participants and then a written informed consent was received from them. Findings: The results showed no significant differences between the two groups in terms of their ethical sensitivity scores at the beginning of the study; however, immediately and 2 months after the intervention, the mean score increased significantly in the experimental group. Moreover, the scores obtained 2 months after the workshop increased compared to the pre-intervention scores but showed a drop compared to the scores reported immediately after the workshop. Discussion: The ethical empowerment program, given to the critical care nurses in this study, improved their ethical sensitivity in making decisions significantly over time. Despite the extensive methods, available for teaching nursing ethics, the ethical empowerment program, adopted in this study, had long-lasting effects in terms of ameliorating the process of ethical decision-making in clinical situations. Conclusion: The ethical empowerment of nurses requires the adoption and application of proper methods and patterns of complying with nursing ethics.
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Moser, Albine, Rob Houtepen, Harry van der Bruggen, Cor Spreeuwenberg, and Guy Widdershoven. "Autonomous Decision Making and Moral capacities." Nursing Ethics 16, no. 2 (March 2009): 203–18. http://dx.doi.org/10.1177/0969733008100080.
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This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.
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Dempsey, Ronald P., Elizabeth E. Eskander, and Veljko Dubljević. "Ethical Decision-Making in Law Enforcement: A Scoping Review." Psych 5, no. 2 (June 20, 2023): 576–601. http://dx.doi.org/10.3390/psych5020037.
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Decision-making in uncertain and stressful environments combined with the high-profile cases of police violence in the United States has generated substantial debates about policing and created challenges to maintaining public confidence and trust in law enforcement. However, despite the manifestations of reactions across the ideological spectrum, it is unclear what information is available in the literature about the convergence between ethical decision-making and policing. Therefore, an interdisciplinary scoping review was conducted to map the nature and extent of research evidence, identify existing gaps in knowledge, and discuss future implications for ethical decision-making in law enforcement. This review investigates the interaction between the job complexities of policing (psychological and normative factors) and aspects of ethical decision-making, synthesizing three distinct themes: (1) socio-moral dimensions impact the job complexities of police work, (2) lethal means and moral injury influence intuitive and rational decision-making, and (3) police wellness and interventions are critical to sustaining police readiness. Gaps in recruiting, training, and leadership and managerial practices can be broadly transformed to fundamentally emphasize officer wellness and a holistic approach to ethical practices, enabling police officers to uphold the rule of law, promote public safety, and protect the communities they serve.
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Repenshek, Mark. "Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?" Nursing Ethics 16, no. 6 (November 2009): 734–42. http://dx.doi.org/10.1177/0969733009342138.
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Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton’s 1984 book Nursing practice. The definition Jameton formulated reads ‘... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Unfortunately, it appears that, despite the frequent use of Jameton’s definition of moral distress, the definition itself remains uncritically examined. It seems as if the context of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing’s discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition’s normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing’s discomfort and as a starting point to recontextualize moral distress.
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Pinch, W. J. Ellenchild, and Mary E. Parsons. "Moral Orientation of Elderly Persons: considering ethical dilemmas in health care." Nursing Ethics 4, no. 5 (September 1997): 380–93. http://dx.doi.org/10.1177/096973309700400504.
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Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons ( n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the reasoning of four women. The implications for ethical decision-making and future research are discussed.
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Pramana, I. Kadek Adhi, I. Gusti Ayu Nyoman Budiasih Budiasih, Anak Agung Ngurah Bagus Dwirandra, and I. Gusti Ayu Made Asri Dwija Putri. "Insightfully Explore the Ethical Decision Making of Tax Consultants During COVID-19 Pandemic." Jurnal Ilmiah Akuntansi dan Bisnis 17, no. 1 (January 8, 2022): 159. http://dx.doi.org/10.24843/jiab.2022.v17.i01.p11.
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Weakening economic performance during COVID-19 pandemic has an impact on state revenues in the tax sector caused dilemma for a tax consultant. This study aims to explore various ethical decisions making by tax consultants. Transcendental phenomenology Husserl's is used to obtain pure consciousness from informants. Data was collected by interview and based on the interpretation, the dilemma caused by non-optimal income and client's internal policies. In addition, several clients experience tax audits during the pandemic. Ethical assessment of decision making is considered into several aspects, such as: moral considerations, commitment to providing optimal services, and awareness that the role of tax consultants is helping the government to gain state revenue in tax sector. This study provides the relevance use of ethical theory and the theory of planned behaviour. For practitioners, this research can be used as advice in making decisions both in pandemic situations and other unexpected events.
Keywords: phenomenology, dilemma, tax consultant, explore, ethical decision
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Han, Sung-Suk, and Sung-Hee Ahn. "An Analysis and Evaluation of Student Nurses’ Participation in Ethical Decision Making." Nursing Ethics 7, no. 2 (March 2000): 113–23. http://dx.doi.org/10.1177/096973300000700204.
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This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced were ‘family giving up on a patient because he or she could not be cured’, and ‘not telling the truth to the patient’. The Korean Nurses’ Code of Ethics was applied, in particular the preamble, and the third, fourth, seventh and tenth clauses. The most common rule of ethics and principle applied in these nurses’ ethical decision making were veracity and nonmaleficence. With regard to the moral reasoning process, the primary concern was the welfare of the patients. These students were equipped with the ability to exercise critical and reflective thought when they experienced ethical dilemmas.
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Molloy, Jennifer, Marilyn Evans, and Kevin Coughlin. "Moral distress in the resuscitation of extremely premature infants." Nursing Ethics 22, no. 1 (April 8, 2014): 52–63. http://dx.doi.org/10.1177/0969733014523169.
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Objective: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. Design: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. Setting: A regional, tertiary academic referral hospital in Ontario offering a perinatal program. Participants: A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. Methods: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. Ethical considerations: Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. Results: Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses’ perceived lack of power and influence in the neonatal resuscitation decision-making process. Conclusion: Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration.
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Bagrationi, Irma. "On the Risks of Ethical Decision-Making from the History of the Political Thought." Cybernetics and Computer Technologies, no. 4 (December 30, 2021): 89–94. http://dx.doi.org/10.34229/2707-451x.21.4.9.
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Introduction: We are interested in the theoretical considerations of the actual pragmatic questions about ethical worldview meaning of understanding of the innovation dealings world, the nature of its conceptual risk dilemmas and problems and sententious thinking in the sphere of political business industry. Our viewpoint is dedicated to the most important aspects of the essence and peculiarities of the social moral standards of innovation approaches in the context of a political solution through methodology of modern mental technology - especially: cognitive methods with gnostic wisdom research and utilitarian creative knowledge and axiological methodology with overestimation ethical values and demonstrating intellectual concepts. Into the framework of the main goal of the research are reviewed the basic theoretical paradigms on the background of ethical worldview analysis (through comparative historical technique of thinking) of the leading-edge conceptual theories of the famous contemporary Russian, American and European thinkers. The purpose of the article is to prove, substantiate and confirm the following thesis. In order for the ethical of timely paroemiac responsibility and political freedom to be able to fulfill its axiological tasks, it is necessary to reach some worldview ideas: ??to create an universal model of moral consciousness and high valuable behavior; overcome mental and sociocultural biases regarding the debatable assessment of the convincingness of events and determine the relevant logical reaction of society not only to a certain risk of eatable technical thinking, but also to uncertainty regarding their intellectual decision in relation to approved ethical, operational, empirical and principled notions, proposals, expression views and suggestions. The results. Scientific conceptual alternatives of optimization of practical and urgent ethical valuable dilemmas are given. The issues of the possibility of formation of a worldview system through practical ethical requirements that standard regulates the reactionary politics of intellectual reality to probabilistic hazards are discussed. The ethical standards of universal prohibitions, the moral responsibility of human nature and the ethics of virtue make a conflict of social and political interests through insurmountable cognitive, discussible, reviewable and discursive difficulties are demonstratively shown. Conclusions. Taking into dominant the essence of the main backgrounds of the existential specific theoretical approaches for worldview methods solving moral political problems is integrated some innovation decisions through valuable considerations. The fundamental ethical concepts of utilitarian thought of historical reminiscences synthesize the possibility problematic circumstances into the logical model of making morally important and useful decisions much easier are analyzed, but through in the valuating pragmatic context needs a main transformation in mental formation of ideological metric and social-political structure. Keywords: ethical worldview decision, political industry, innovation approaches, moral values, mental technologies, risk decision methods, conceptual risk dilemmas.
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Tariq, Rubab, and Asifa Jamil. "Commentary on the Article: End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, Ethical, and Religio-Cultural Considerations." Middle East Journal of Applied Science & Technology 07, no. 02 (2024): 129–33. http://dx.doi.org/10.46431/mejast.2024.7213.
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Background: In medical society, there are controversial issues that called withholding and withdrawing life support. Withholding life support is delaying the provision of new or advanced life support therapy without stopping ongoing life support therapy, and withdrawing life support is stopping some or all of the life support therapy given to patients. This decision was not only based on medical aspects but also related to bioethics and medico-legal aspects and presented moral dilemmas for healthcare practitioners. Maria Fidelis C. Manalo's article, "End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, Ethical, and Religio-Cultural Considerations," provides a comprehensive review of the complex considerations involved in making these decisions. Purpose: This commentary article aims to critically examine the ethical dimensions of resuscitation decision-making, particularly regarding Do Not Resuscitate (DNR) orders. Conclusion: The commentary advocates for a patient-centered approach to end-of-life care that integrates medical expertise, ethical principles, and cultural considerations. It emphasizes the necessity of proactive communication and advance care planning to ensure that patient's wishes are understood and respected, thereby mitigating potential ethical conflicts
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Kucher, D. E., and S. G. Kharchenko. "The Precautionary Principle as a Decision-Making Criterion." Ecology and Industry of Russia 26, no. 1 (January 18, 2022): 66–71. http://dx.doi.org/10.18412/1816-0395-2022-1-66-71.
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A comprehensive analysis of the precautionary principle is carried out in the article. The essence of the "precautionary principle" concept and its main elements are analyzed, the concept of "morally unacceptable harm"is interpreted. A retrospective analysis of the emergence of the "precautionary principle" concept is carried out, the place and role of the precautionary principle in various international treaties is investigated. It is emphasized that scientific uncertainty is not an excuse for inaction when there is convincing evidence of potentially serious damage. The moral and ethical basis of the precautionary principle is noted. The place of the precautionary principle in the theory and practice of decisionmaking is investigated in the article. It is emphasized that the precautionary principle must be applied in conditions of uncertainty, when the boundaries of possible results are unknown and there are no reliable grounds for quantifying probabilities, and the ethical aspects of equality between and within generations are at stake, other decision-making principles cannot satisfactorily solve these problems.
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Tuvesson, Hanna, and Kim Lützén. "Demographic factors associated with moral sensitivity among nursing students." Nursing Ethics 24, no. 7 (January 28, 2016): 847–55. http://dx.doi.org/10.1177/0969733015626602.
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Background: Today’s healthcare environment is often characterized by an ethically demanding work situation, and nursing students need to prepare to meet ethical challenges in their future role. Moral sensitivity is an important aspect of the ethical decision-making process, but little is known regarding nursing students’ moral sensitivity and its possible development during nursing education. Objectives: The aims of this study were to investigate moral sensitivity among nursing students, differences in moral sensitivity according to sample sub-group, and the relation between demographic characteristics of nursing students and moral sensitivity. Research design: A convenience sample of 299 nursing students from one university completed a questionnaire comprising questions about demographic information and the revised Moral Sensitivity Questionnaire. With the use of SPSS, non-parametric statistics, including logistic regression models, were used to investigate the relationship between demographic characteristics and moral sensitivity. Ethical considerations: The study followed the regulations according to the Swedish Ethical Review Act and was reviewed by the Ethics Committee of South-East Sweden. Findings: The findings showed that mean scores of nursing students’ moral sensitivity were found in the middle to upper segment of the rating scale. Multivariate analysis showed that gender (odds ratio = 3.32), age (odds ratio = 2.09; 1.73), and parental status (odds ratio = 0.31) were of relevance to nursing students’ moral sensitivity. Academic year was found to be unrelated to moral sensitivity. Discussion and conclusion: These demographic aspects should be considered when designing ethics education for nursing students. Future studies should continue to investigate moral sensitivity in nursing students, such as if and how various pedagogical strategies in ethics may contribute to moral sensitivity in nursing students.
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Doane, Gweneth, Bernadette Pauly, Helen Brown, and Gladys McPherson. "Exploring The Heart Ofethical Nursing Practice: implications for ethics education." Nursing Ethics 11, no. 3 (May 2004): 240–53. http://dx.doi.org/10.1191/0969733004ne692oa.
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The limitations of rational models of ethical decision making and the importance of nurses’ human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses’ ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice.
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Howells, Amy J. "Are we creating ethical dilemmas where there are none?" Clinical Ethics 13, no. 4 (September 30, 2018): 220–24. http://dx.doi.org/10.1177/1477750918802424.
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This case study focuses on decision-making for minors who are permanently unconscious and dependent on life-sustaining therapies. Cases of this type often cause anguish and angst for health care providers and caregivers and can lead to mistrust, moral distress, and communication problems. After presenting a particular case, an ethical analysis is applied to determine whether there is an apparent course of action or an ethical dilemma. The ethical analysis focuses on the currently accepted guidance principle for surrogate decision-making for minors and applies them to the case. The conclusion drawn shows that the case was not, in fact, an ethical dilemma by definition and that there is a reasonable course of action to be taken.
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Skott, Carola. "Storied Ethics: conversations in nursing care." Nursing Ethics 10, no. 4 (July 2003): 368–76. http://dx.doi.org/10.1191/0969733003ne619oa.
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The purpose of this article is to discuss narration of ethical themes in nursing care. The text represents part of the findings of an ethnographic study aimed at description of everyday work on an oncology ward. Nurses on this ward are constantly involved in ethical care issues and narratives are told to share experiences. Of vital importance in ethical decision making is the perpetual creation of a mediating moral world constituted by daily experience. The need for making space in nursing for a continual learning conversation is expressed and in this I include writings of nursing theorists.
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Khatiban, Mahnaz, Seyede Nayereh Falahan, Roya Amini, Afshin Farahanchi, and Alireza Soltanian. "Lecture-based versus problem-based learning in ethics education among nursing students." Nursing Ethics 26, no. 6 (May 1, 2018): 1753–64. http://dx.doi.org/10.1177/0969733018767246.
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Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics. Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students. Research design: This is a repeated measurement quasi-experimental study. Participants and research context: The participants were nursing students in a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software. Ethical considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline. Findings: The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups. Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students.
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Krawczyk, Rosemary M. "Teaching Ethics: Effect on Moral Development." Nursing Ethics 4, no. 1 (January 1997): 57–65. http://dx.doi.org/10.1177/096973309700400107.
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The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest’s Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students’ development of moral judgement.
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Sun, Linhui. "Culture's Ethical Palette: Cultural Influences in the Moral Machine Era." Journal of Education, Humanities and Social Sciences 26 (March 2, 2024): 510–15. http://dx.doi.org/10.54097/81t5jr86.
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Culture, an intricate tapestry of beliefs, values, and traditions, serves as both a mirror reflecting an individual's identity and a potent force shaping their very being. This cultural mosaic imparts a unique hue to each person's outlook and molds their moral compass. Indeed, the multifaceted influence of culture extends its reach into the realm of moral decision-making, where diverse cultural backgrounds yield a kaleidoscope of choices. As observed in the Moral Machine experiment, cultural nuances are pivotal in shaping preferences when confronted with ethical dilemmas. Varied cultural aspects, such as religion and collectivism, cast their distinct shadows on individuals' choices. These cultural imprints infuse complexity into the moral calculus, offering a window into the diverse ethical landscapes that emerge from different cultural backgrounds. In the context of emerging technologies like automated cars, the impact of culture on decision-making is particularly significant. It is plausible that vehicles equipped with artificial intelligence may make distinct choices when operating in diverse cultural settings. These differences, rooted in cultural backgrounds, are not arbitrary but arise from deeply ingrained cultural values and norms.
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Axelsson, Lena, Eva Benzein, Jenny Lindberg, and Carina Persson. "Processes toward the end of life and dialysis withdrawal Physicians’ and nurses’ perspectives." Nursing Ethics 27, no. 2 (June 11, 2019): 419–32. http://dx.doi.org/10.1177/0969733019848050.
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Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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Macpherson, Ignacio, María Victoria Roqué, and Ignacio Segarra. "Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum." Nursing Ethics 27, no. 5 (April 29, 2020): 1238–49. http://dx.doi.org/10.1177/0969733020914382.
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Background Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant. Objective The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency. Research design The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies. Ethical considerations No significant ethical considerations as this is a discussion paper. Findings The model was structured from the anthropology’s concepts and decision-making process, applied to real situations. The structure of the three domains theoretical–practical–communicative is present in each session. Discussion It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students’ resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied. Conclusion We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.
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Ejder Apay, Serap, Ayşe Gürol, Elif Yağmur Gür, and Sarah Church. "Midwifery students’ reactions to ethical dilemmas encountered in outpatient clinics." Nursing Ethics 27, no. 7 (May 21, 2020): 1542–55. http://dx.doi.org/10.1177/0969733020922875.
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Background: Midwives are required to make ethical decisions with the support of respective codes of professional ethics which provide a framework for decision making in clinical practice. While each midwife should be ethically aware and sensitive to the ever-changing issues within reproduction, few empirical studies have examined the views of student midwives in relation to reproductive ethical dilemmas. Objective: The aim of this study was to explore midwifery students’ reactions to a number of ethical dilemmas relating to women’s experiences of reproductive decision making. Design: A series of focus groups were conducted with midwifery students who were asked to discuss five culturally significant scenarios including issues of knowledge acquisition regarding methods of family planning, removal or insertion of an intrauterine device, and abortion. Setting: A University in Turkey was the setting for this study. Participants: Purposeful sampling was adopted which resulted in five focus groups with a total of 57 midwifery students. Ethical considerations: The study was reviewed and granted formal ethical approval by an ethical committee at the Faculty of Health Science in Atatürk University. The head of the Faculty of Health Science approved the investigation. The participants received both oral and written information about the study and they gave their consent. Results: Five themes were identified from the analysis of the focus group data related to all five scenarios. These themes were ‘the right to information’, ‘choice and protection’, ‘parental rights and welfare of the women’, ‘make a decision’ and ‘women rights and sexual abuse’. Conclusion: This study has shown that while students respected women’s choice, they also expressed great ambivalence in some situations when personal values conflict with dominant societal beliefs and professional ethics. A focus on ethics education to include human rights is suggested as a means to enable students to explore their own social-value judgements, and as a means to limit the possible development of ethical confusion and moral distress.
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Leminota, Valtiza. "Street Level Bureaucracy in Public Services to the Elderly in Kosovo." International Journal Papier Public Review 4, no. 3 (October 20, 2023): 18–23. http://dx.doi.org/10.47667/ijppr.v4i3.245.
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The crucial connection between governmental policy and citizens' daily life is represented by street-level bureaucracy. This article examines the various aspects that affect street-level bureaucrats' decision-making, with a focus on their use of discretion, policy interpretation, resource allocation, communication, ethical considerations, and receptivity to criticism. As a defining characteristic of street-level bureaucracy, discretion gives bureaucrats the freedom to customize policies to specific situations, improving the usefulness of services. To maintain equity and accountability, it is crucial to strike the correct balance of discretion. The decision-making process is heavily influenced by the interpretation of policies, the distribution of scarce resources, and the involvement of ethical considerations. It's crucial to communicate with service users clearly and sympathetically. Continuous improvement is made possible via accountability and feedback mechanisms. Maintaining openness and public confidence requires keeping records of decisions and preserving moral principles. The success and fairness of public services depend heavily on the sound, moral, and compassionate decisions made by street-level bureaucrats, who act as the backbone of public administration. To support them in meeting the different demands of the public and creating responsive, egalitarian, and accountable public administration, it is crucial to provide them with training, resources, and ethical advice.
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Hasanlo, Masoumeh, Arezo Azarm, Parvaneh Asadi, Kourosh Amini, Hossein Ebrahimi, and Mohammad Asghari Jafarabadi. "Analytical study of care quality and moral distress in clinical situations and patient care." Frontiers of Nursing 6, no. 4 (December 31, 2019): 327–34. http://dx.doi.org/10.2478/fon-2019-0037.
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Abstract Objective Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality. Methods In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13. Results Investigating moral distress domains (ignoring patient, decision-making power, and professional competence) and care quality domains (psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain (P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical (bodily), and communication domains of care quality. Conclusions Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decision-making domains, improve the professional competence, and pay attention to patients.
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Del Pilar De Antueno, Maria, Gabriela Peirano, Isabel Pincemin, Maria Isabel Iñigo Petralanda, and Eduardo Bruera. "Bioethical perspective for decision making in situations of scarcity of resources during the COVID-19 pandemic." Medicina e Morale 71, no. 1 (April 14, 2022): 25–38. http://dx.doi.org/10.4081/mem.2022.1197.
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Lack of resources available in intensive care units (ICU) during the COVID-19 pandemic requires bioethical guidance to respond to dilemmas presented in health teams. A person-centered ethical analysis (PCEA) for ICU clinicians, becomes the best alternative to morally justify extreme decision-making in the scarcity of available resources. The goal is to make a selection based on bioethical and clinical criteria, considering a holistic view of the person, and not just a utilitarian or first-come, first-served criterion as the one set out by colleagues from Oxford University, known as RAPR (Resource Adjusted Probability Ratio) ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic. For this reason, fundamental bioethical principles emphasizing therapeutic proportionality and how to make an appropriate moral judgment that conveys to a sensible decision-making ethically grounded are explained, considering a flow chart proposed by colleagues from the Pontifical Catholic University of Chile. In this paper we propose the PCEA Algorithm to assist ICU teams in decision making regarding fair resource allocation and care delivery during an overwhelming pandemic scenario.
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Oberle, Kathleen. "Measuring Nurses' Moral Reasoning." Nursing Ethics 2, no. 4 (December 1995): 303–13. http://dx.doi.org/10.1177/096973309500200405.
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The purpose of this exploratory study was to examine the possibility of designing a satisfactory method, using written responses to hypotheical scenarios, for evaluating the quality of moral reasoning in student nurses. Scenarios were developed from interviews with practising nurses. Nurses and student nurses provided written responses to the scenarios, and nursing faculty members from six institutions sorted the responses according to their perceptions of quality (i.e. 'best', 'next best', 'worst' etc.). There was very little agreement among faculty members on the quality of the responses. Consequently, it was impossible to develop a 'best' response on which the faculty members could agree. Analysis revealed a framework used by the participants for ethical decision-making. The results of this study have important implications for the way in which we think about the teaching and the evaluation of nursing ethics.
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Crutchfield, Parker, and Scott Scheall. "Epistemic Burdens, Moral Intimacy, and Surrogate Decision Making." American Journal of Bioethics 20, no. 2 (January 28, 2020): 59–61. http://dx.doi.org/10.1080/15265161.2019.1701737.
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Sasso, Loredana, Annamaria Bagnasco, Monica Bianchi, Valentina Bressan, and Franco Carnevale. "Moral distress in undergraduate nursing students." Nursing Ethics 23, no. 5 (August 2016): 523–34. http://dx.doi.org/10.1177/0969733015574926.
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Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students.
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Wright, David, and Susan Brajtman. "Relational and embodied knowing: Nursing ethics within the interprofessional team." Nursing Ethics 18, no. 1 (January 2011): 20–30. http://dx.doi.org/10.1177/0969733010386165.
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In this article we attempt to situate nursing within the interprofessional care team with respect to processes of ethical practice and ethical decision making. After briefly reviewing the concept of interprofessionalism, the idea of a nursing ethic as ‘unique’ within the context of an interprofessional team will be explored. We suggest that nursing’s distinct perspective on the moral matters of health care stem not from any privileged vantage point but rather from knowledge developed through the daily activities of nursing practice. Because of their position vis-à-vis patients and families in everyday clinical care, nurses cultivate ethical knowledge of at least two forms: (1) relational knowledge; and (2) embodied knowledge. Through the integration of these forms of knowledge, nurses develop a unique moral perspective and can make a meaningful contribution to the realm of ethics in interprofessional care.
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DeRenzo, Evan. "Surrogate Decision Making for Severely Cognitively Impaired Research Subjects: The Continuing Debate." Cambridge Quarterly of Healthcare Ethics 3, no. 4 (1994): 539–48. http://dx.doi.org/10.1017/s0963180100005429.
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As research into Alzheimer's disease and other dementing disorders becomes more complex, risky, invasive, and commonplace, the need intensifies for discussion of the ethics of involving persons with dementia in research, specifically research of greater than minimal risk and of no expected direct benefit to the subject. (It is beyond the scope of this paper to consider the ethical issues related to research involvement of cognitively impaired children or children or adults with intermittent and/or reversible cognitive or psychiatric impairments. For such discussions, refer to the references in notes 1–6.) Reviewing such studies pushes our traditional analysis tools to their limits. Simply balancing and prioritizing the basic ethical principles of respect for persons, beneficence, and justice that serves us well in reviewing the vast majority of studies is inadequate when reviewing research of such ethical complexities as studies with marked risks and no expectation of direct benefit to subjects unable to consent or withdraw. Moving up to the level of theory, placing these principles within the commonly applied frameworks of consequentialism, deontology, or virtue ethics bring us no closer to reducing the tensions such research creates between upholding individual autonomy and advancing society's need to learn how to treat and cure these devastating diseases. What is needed is the introduction of more contemporary moral analyses. Specifically, we need to become more inclusive of the diversity of values perspectives of our general citizenry. In more theoretical terms, we ought to elevate to a more central role a communitarian perspective and a feminist ethics emphasis on relationships and context as we rush to keep in step, ethically, with this rapidly expanding area of medical inquiry.
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de Casterlé, Bernadette Dierckx, Mieke Grypdonck, Magda Vuylsteke-Wauters, and Piet J. Janssen. "Nursing Students’ Responses to Ethical Dilemmas in Nursing Practice." Nursing Ethics 4, no. 1 (January 1997): 12–28. http://dx.doi.org/10.1177/096973309700400103.
Full textAbstract:
In literature as well as in nursing practice a growing concern about nurses’ ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students’ ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg’s definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg’s theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.
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Abdool, Rosalind, Michael Szego, Daniel Buchman, Leah Justason, Sally Bean, Ann Heesters, Hannah Kaufman, Bob Parke, Frank Wagner, and Jennifer Gibson. "Difficult healthcare transitions." Nursing Ethics 23, no. 7 (August 3, 2016): 770–83. http://dx.doi.org/10.1177/0969733015583185.
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Background: In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions. Objectives: We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to be made. Research design: This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made. Participants and research context: We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders. Ethical considerations: The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient. Findings: As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress. Discussion: We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care. Conclusions: One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients.
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Sellman, Derek. "The Virtues in the Moral Education of Nurses: Florence Nightingale Revisited." Nursing Ethics 4, no. 1 (January 1997): 3–11. http://dx.doi.org/10.1177/096973309700400102.
Full textAbstract:
The virtues have been a neglected aspect of morality; only recently has reference been made to their place in professional ethics. Unfashionable as Florence Nightingale is, it is nonetheless worth noting that she was instrumental in continuing the Aristotelian tradition of being concerned with the moral character of persons. Nurses who came under Nightingale’s sphere of influence were expected to develop certain exemplary habits of behaviour. A corollary can be drawn with the current UK professional body: nurses are expected to behave in certain ways and to display particular kinds of disposition. The difference lies in the fact that, while Nightingale was clear about the need for moral education, current emphasis is placed on ethical theory and ethical decision-making.