Publisher: Sage Publications   (Total: 1166 journals)

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Showing 1 - 200 of 1166 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 29)
Academic Pathology     Open Access   (Followers: 6)
Accounting History     Hybrid Journal   (Followers: 18, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 53, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 396, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 18, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 25, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 9, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 260, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 51)
Advances in Dental Research     Hybrid Journal   (Followers: 11, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 35, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 156, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 20)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 51, SJR: 0.599, CiteScore: 1)
AERA Open     Open Access   (Followers: 14)
Affilia     Hybrid Journal   (Followers: 6, SJR: 0.496, CiteScore: 1)
Africa Spectrum     Open Access   (Followers: 17)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 3)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 68)
Allergy & Rhinology     Open Access   (Followers: 5)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 39, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 12, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
Alternatives to Laboratory Animals     Full-text available via subscription   (Followers: 11, SJR: 0.297, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 26, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 260, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 23, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 9)
American J. of Evaluation     Hybrid Journal   (Followers: 18, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 35, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 47, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 7, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 13, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 11, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 248, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 36, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 28, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 357, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 3)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 5, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 15, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 20, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 59, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 51, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 48, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 14)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal   (Followers: 1)
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 27, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 25, SJR: 0.29, CiteScore: 1)
Arthaniti : J. of Economic Theory and Practice     Full-text available via subscription  
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 49, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 15, SJR: 0.558, CiteScore: 1)
Asia-Pacific J. of Rural Development     Hybrid Journal   (Followers: 2)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 8, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 19, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian J. of Early Childhood     Hybrid Journal   (Followers: 7, SJR: 0.535, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 30, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 545, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 5)
Australian J. of Education     Hybrid Journal   (Followers: 51, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 356, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 17)
Avian Biology Research     Hybrid Journal   (Followers: 6, SJR: 0.401, CiteScore: 1)
Behavior Modification     Hybrid Journal   (Followers: 14, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 27)
Behavioral Disorders     Hybrid Journal   (Followers: 1)
Beyond Behavior     Hybrid Journal   (Followers: 2)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 24, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 55)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 14)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 4, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 29, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Brain Science Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 12, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 9)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 253, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 31, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 39, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 9)
Business & Society     Hybrid Journal   (Followers: 15)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Hybrid Journal   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 37, SJR: 2.209, CiteScore: 4)
Canadian Association of Radiologists J.     Full-text available via subscription   (Followers: 2, SJR: 0.463, CiteScore: 1)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 8, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 15)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 167, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 2)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 10, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription   (Followers: 1)
Cardiovascular and Thoracic Open     Open Access   (Followers: 1)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 6, SJR: 0.889, CiteScore: 3)
Cell Transplantation     Open Access   (Followers: 5, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 4)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 34, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 11, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
China Information     Hybrid Journal   (Followers: 9, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
Christian Education J. : Research on Educational Ministry     Hybrid Journal   (Followers: 1)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 12, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access   (Followers: 1)
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 8, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 13, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (Followers: 1, SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 8, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 4, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 2)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 1, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 34, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 5)
Clinical Pediatrics     Hybrid Journal   (Followers: 25, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 16, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 78, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 28, SJR: 0.36, CiteScore: 1)
Collections : A J. for Museum and Archives Professionals     Full-text available via subscription   (Followers: 3)
Common Law World Review     Full-text available via subscription   (Followers: 17)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 2)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 24, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 292, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, SJR: 0.843, CiteScore: 2)

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Similar Journals
Journal Cover
Clinical Ethics
Journal Prestige (SJR): 0.296
Citation Impact (citeScore): 1
Number of Followers: 13  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1477-7509 - ISSN (Online) 1758-101X
Published by Sage Publications Homepage  [1166 journals]
  • The relationship between workload and adherence to professional codes of
           ethics among a sample of Iranian nurses

    • Free pre-print version: Loading...

      Authors: Mahsa Dadkhah-Tehrani, Mohsen Adib-Hajbaghery
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundMany studies have investigated the adherence to professional codes of ethics by nurses. However, no study has explicitly examined the relationship between workload and adherence to professional codes of ethics among Iranian nurses.ObjectiveThis study aimed to explore the relationships between workload and adherence to professional codes of ethics among a sample of Iranian nurses.Materials and MethodsA cross-sectional descriptive study was conducted on 213 nurses who were randomly selected from the different wards of Shahid Beheshti Hospital of Kashan, Iran. Data collection instruments included a personal characteristics questionnaire, the Nursing Ethics Questionnaire, and the National Aeronautics and Space Administration Task Load Index. The Chi-square, the Spearman correlation coefficient, the Kruskal–Wallis, and Mann–Whitney U tests were used to analyze the data.ResultsA majority of nurses were females (77.5%), married (79.3%), and permanently employed (55.4%). The mean of the overall perceived workload and adherence to professional codes of ethics were 76.36 ± 13.64 and 13.98 ± 2.58, that were at high and moderated level, respectively. Spearman correlation test showed no significant correlation between perceived workload and adherence to professional codes of ethics (r = 0.03, P = 0.6). A significant difference was found between the mean scores of adherence to professional codes of ethics in nurses working in different departments (P 
      Citation: Clinical Ethics
      PubDate: 2021-10-19T10:15:06Z
      DOI: 10.1177/14777509211040183
       
  • Association between moral intelligence, burnout and quality of nursing
           care

    • Free pre-print version: Loading...

      Authors: Tahereh Heidari, Hamideh Azimilolaty, Majid Khorram, Soraya Rezaei, Seyed-Nouraddin Mousavinasab, Roya Nikbakht
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundProviding quality care is of the fundamental elements of holistic nursing practice, and burnout and moral intelligence of nurses be mentioned as the important factors influencing the quality of nursing care. The present study was conducted to investigate the relationship between moral intelligence, burnout, and the quality of nursing care.MethodsThis descriptive-correlative study was conducted on 125 nurses working in Sari-based Educational hospitals affiliated to Mazandaran University of Medical Sciences, Iran, between June and August 2020. The sample was selected via random sampling. The data were collected by the Maslach Burnout Inventory, Lennick and Kiel Moral Intelligence Scale, and Quality of Patient Care Scale. The data were analyzed by SPSS-21 and Amos-24.ResultsA direct and significant relationship was found between the quality of nursing care and moral intelligence (r = 0.285, p = 0.001). Quality of care had an inverse relationship with subscales of frequency of burnout including emotional exhaustion (r = −0.369, p 
      Citation: Clinical Ethics
      PubDate: 2021-09-24T02:54:00Z
      DOI: 10.1177/14777509211040168
       
  • Over my dead body: Self-determination, proxy consent, and proportionate
           reason in the treatment of a Jehovah's Witness patient with severe
           traumatic hemorrhagic shock

    • Free pre-print version: Loading...

      Authors: Reginald Alouidor, Peter A. DePergola, Milagros Lopez-Garena, Yasmin Bungash, Edward Kelly, Nicolas Jabbour
      Abstract: Clinical Ethics, Ahead of Print.
      When a Jehovah’s Witness patient is traumatically injured, the lack of uniform professional consensus guidelines and the cultural knowledge deficit of many clinicians adds an additional layer of legal and ethical complexity to the inherent difficulty of managing a critically ill patient. We present here the case of an incapacitated Jehovah's Witness patient with severe traumatic hemorrhagic shock. We go on to discuss the historical and contemporary case law on proxy refusal of blood transfusion for the incapacitated adult, as well as the ethics of self-determination and the application of the principle of proportionate reason in the management of the critically injured Jehovah's Witness patient.
      Citation: Clinical Ethics
      PubDate: 2021-09-23T12:27:39Z
      DOI: 10.1177/14777509211034540
       
  • Protecting nurse survey participants: Ethical considerations for
           conducting survey research among nurses

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      Authors: Caitlin M Campbell, Tanekkia Taylor-Clark, Lori A Loan
      Abstract: Clinical Ethics, Ahead of Print.
      The nurse perspective is critical in survey research investigating various aspects of healthcare services, staff, and patient outcomes. Researchers are responsible for ensuring that survey research utilizing survey questionnaires employs research methodological strategies that are aligned with the ethical principles of beneficence, respect for persons, and justice. The purpose of this paper is to discuss best practices to facilitate high-quality survey data collection for nurse survey participants. Recommendations are based on the fundamental ethical principles described in the Belmont Report, an overview of evidence published in the current literature, and the application of practical knowledge. Literature searches conducted in PubMed resulted in the inclusion of over 50 articles from a wide range of disciplines. The results include actionable methods for researchers to consider and follow when conducting survey research utilizing nurse participants. This article serves as a resource to guide researchers through ethically responsible design, implementation, and reporting of nurse survey research.
      Citation: Clinical Ethics
      PubDate: 2021-09-06T07:03:23Z
      DOI: 10.1177/14777509211036639
       
  • What are the ethical conflicts faced by Mexican internists'

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      Authors: Octavio Márquez Mendoza, José de Jesús Garduño García, Marcela Veytia López, Jorge Rodríguez García, Rosalía García Peña, Benjamin Herreros
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundNo studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts.MethodsVoluntary survey to the members of the Internal Medicine Association of Mexico.ResultsResponses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most commonplace and relevant conflicts are those resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them.Conclusions1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants.
      Citation: Clinical Ethics
      PubDate: 2021-09-03T10:48:55Z
      DOI: 10.1177/14777509211036641
       
  • Acts and distance—a commentary on Brummett's ‘when conscientious
           objection runs amok’

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      Authors: Michal Pruski
      Abstract: Clinical Ethics, Ahead of Print.
      In his ‘When conscientious objection runs amok: A physician refusing human immunodeficiency virus (HIV) preventative to a bisexual patient’, Brummett has argued that Catholic physicians (or indeed any other healthcare practitioner) should not be able to raise conscientious objections to HIV pre-exposure prophylaxis for bisexual patients, as this constitutes discrimination. Brummett argues that such a conscientious objection represents an instance of conscience creep, which he argues is undesirable. Here I re-analyse the case presented by Brummett using a teleological framework and making reference to Catholic teaching on cooperation with evil. While I agree with Brummett that in this case the physician should not have had the right to conscientiously object, I argue that the teleological framework offers advantages over the argument Brummett has presented. I also comment on why only considering empirically measurable harm as a publicly defensible reason for one to hold a conscientious objection is problematic, as well as on the difficulties associated with cases of discrimination in a pluralistic society.
      Citation: Clinical Ethics
      PubDate: 2021-09-01T04:14:02Z
      DOI: 10.1177/14777509211040158
       
  • Colombian people's positions regarding physician-assisted suicide

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      Authors: Claudia Pineda Marín, Lina Franco Sierra, Paul Clay Sorum, Etienne Mullet
      Abstract: Clinical Ethics, Ahead of Print.
      The views on the acceptability of physician-assisted suicide of lay people in a Latin American country, Colombia, have been examined. In July 2019–January 2020, 134 lay people in Bogota judged the acceptability of physician-assisted suicide in 48 realistic scenarios composed of all combinations of four factors: (a) the patient's age, (b) the level of incurability of the illness, (c) the type of suffering, and (d) the patient's request for physician-assisted suicide. In all scenarios, the patients were women receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Three qualitatively different positions were found: Never Acceptable (13% of the sample), Depends on the Patient's Request (77%), and Always Acceptable (10%). The only important factor in increasing acceptability among people not systematically opposed was the patient's request to have her life ended. The young age of some patients did not affect participants’ positions. These empirical findings suggest that most Colombian lay people are not categorically for or against physician-assisted suicide, but judge its degree of acceptability as a function of patients’ requests and other circumstances.
      Citation: Clinical Ethics
      PubDate: 2021-09-01T01:22:21Z
      DOI: 10.1177/14777509211040166
       
  • Psychiatrists’ motives for compulsory care of patients with borderline
           personality disorder – a questionnaire study

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      Authors: Antoinette Lundahl, Johan Hellqvist, Gert Helgesson, Niklas Juth
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionBorderline personality disorder patients are often subjected to inpatient compulsory care due to suicidal behaviour. However, inpatient care is usually advised against as it can have detrimental effects, including increased suicidality.AimTo investigate what motives psychiatrists have for treating borderline personality disorder patients under compulsory care.Materials and MethodsA questionnaire survey was distributed to all psychiatrists and registrars in psychiatry working at mental health emergency units or inpatient wards in Sweden. The questionnaire contained questions with fixed response alternatives, with room for comments, about the respondents’ motives for practising compulsory care of borderline personality disorder patients. The responses were analysed quantitatively with descriptive statistics, and comments were analysed with qualitative descriptive content analysis.ResultsThe psychiatrists’ views were divided on when it was justified to treat borderline personality disorder patients under compulsory care, as were their views on borderline personality disorder patients’ decision competence. When there was an assessed risk of harm, 53% were positive to compulsory care of decision-competent borderline personality disorder patients and another 31% because they considered the patients to be decision incompetent in such situations. Adding the risk of harm caused many respondents to alter their assessment of the patient from decision competent to decision incompetent.ConclusionThe large variations in doctors’ opinions indicate that the care of borderline personality disorder patients is arbitrary. Further, the assessed risk of harm increases the use of compulsory care, even though such care is advised against in clinical guidelines, has questionable legal support, and could lead to an increased suicide risk over time.
      Citation: Clinical Ethics
      PubDate: 2021-08-31T11:30:44Z
      DOI: 10.1177/14777509211040190
       
  • Bone marrow donation in Poland: 2021 update, and the impact of the
           coronavirus disease 2019 pandemic on haematopoietic stem cell
           transplantation

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      Authors: Aleksandra Janowiak-Majeranowska, Filip Lebiedziński, Alan Majeranowski
      Abstract: Clinical Ethics, Ahead of Print.
      Haematopoietic stem cell transplantation is a treatment modality that saves the health and lives of a growing number of patients around the world. In the majority of cases, the procedure is conducted to treat haematologic neoplasms, although it can also be used as a therapy for some non-haematooncological diseases. The progress that has been taking place in the field of haematopoietic stem cell transplantation involves the need for recruiting more and more potential unrelated bone marrow donors for allotransplantation. In Poland, the number of people registering as potential bone marrow donors has been continuously growing and in order to maintain this trend, it is necessary, above all, to consistently spread the noble idea of bone marrow donation and to raise Poles’ awareness and knowledge about haematopoietic stem cell transplantation. Unfortunately, the situation caused by the severe acute respiratory syndrome coronavirus 2 pandemic limited the opportunities to act in public space and, as a consequence, it has become more difficult to achieve the objectives associated with recruiting new potential donors. The article provides a presentation of ethical and practical aspects associated with bone marrow donations as well as an overview of the legal situation concerning bone marrow donating and transplantation in Poland. The purpose of the paper is to also present some of the changes in transplantation procedures that have emerged as a consequence of the current epidemiological situation. The authors would like to emphasize the importance and the rightfulness of taking action that enables further development of transplantology.
      Citation: Clinical Ethics
      PubDate: 2021-08-31T10:08:21Z
      DOI: 10.1177/14777509211036643
       
  • Ethical considerations and clinical trials during a pandemic: A blessing
           with a burden

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      Authors: Madhan Ramesh, Jehath Syed, Chalasani Sri Harsha
      Abstract: Clinical Ethics, Ahead of Print.
      Any healthcare systems during a pandemic undergo tremendous pressure in pursuit of effective treatment to treat and limit the spread of the disease and its implications. Conducting clinical trials to find the potential therapy is the only way to battle the current coronavirus disease-2019 pandemic. The majority of the countries have joined the cause and are carrying out clinical studies in various capacities. As a result, the ethical committees have encountered a sudden inflow of a large number of trial proposals that have placed them under pressure. Although ethical committees play a vital role in protecting patient safety and preserving research integrity, they need to make sure the efficiency and integrity of review are preserved and the standards of review are not relaxed. Thus, the participants’ dignity is well guarded while keeping a close check on their safety.
      Citation: Clinical Ethics
      PubDate: 2021-08-16T12:41:17Z
      DOI: 10.1177/14777509211034138
       
  • An observational study on the process of collaborative deliberation in
           arranging long-term care: The perception of clients and professionals

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      Authors: Catharina M van Leersum, Ben van Steenkiste, Judith RLM Wolf, Trudy van der Weijden, Albine Moser
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundClients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients’ perception of arranging long-term care.DesignA descriptive qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis.FindingsConstructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations.Discussion/conclusionAlthough all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional.
      Citation: Clinical Ethics
      PubDate: 2021-08-09T12:00:36Z
      DOI: 10.1177/14777509211036647
       
  • ‘Who Ya Gonna Call …'’ Ethical and legal dilemmas in specialist
           children centres and district general hospitals

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      Authors: Harika Avula, Mariana Dittborn, Joe Brierley
      Abstract: Clinical Ethics, Ahead of Print.
      The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.
      Citation: Clinical Ethics
      PubDate: 2021-08-05T10:59:05Z
      DOI: 10.1177/14777509211036649
       
  • Clinical genomics in the 21st century: The fine balance between ethics and
           science

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      Authors: Terence YS Liew, Chun Y Khoo
      Abstract: Clinical Ethics, Ahead of Print.
      The 21st century has been revolutionary for the field of clinical genomics, with major advancements and breakthroughs over the years. It is now considered an instrumental tool in clinical and preventive medicine and has been used on a day-to-day basis to complement current clinical practice. However, with advancements in genomics comes greater bioethical concerns, which becomes increasingly complex with more cutting-edge technology. Some of the major ethical concerns include obtaining informed consent, possibility for genetic enhancements and eugenics, genomic equity and potential discrimination and cloning. It is imperative that we appreciate the benefits of genomic medicine in complementing traditional practices, identify and address the ethical concerns with relation to the practice of genomic medicine, and to ensure a common goal of improving human lives. With these in mind, the practice of genomics can have maximum impact in the collective health of the population, with greater benefit to all.
      Citation: Clinical Ethics
      PubDate: 2021-08-03T02:27:05Z
      DOI: 10.1177/14777509211036646
       
  • Does the light at the end of the tunnel shine for everyone' The need
           for early paediatric participation in vaccine trials during infectious
           pandemics

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      Authors: Erin M Kwolek
      Abstract: Clinical Ethics, Ahead of Print.
      While most of the mortality associated with severe acute respiratory syndrome coronavirus 2 has been in elderly populations and adults with significant medical comorbidities, there has been death and morbidity in paediatric populations. As vaccine trial data is released to the public, many people look to the future with hope ; with good vaccine uptake there is the opportunity to reduce the spread of infectious pandemics. Initial vaccine trials were completed with adults and were expanded to include paediatric populations delaying paediatric COVID-19 vaccine initiatives. The exclusion of children from initial vaccine trials during a pandemic is not morally justifiable and fosters distrust with the pharmaceutical and medical industries and inevitably postpones vaccinating children when there is a surplus of available vaccines. The delayed vaccination of children under twelve may have significant public health and economic consequences as there may be ongoing viral transmission in the context of reopening strategies. The safety and efficacy of these candidate vaccines in children should be assessed expeditiously so that distribution to vulnerable paediatric populations is not impacted. Vaccine uptake compliance in the general population is important in establishing herd immunity and ensuring that there is thorough scientific evidence to support vaccination for children is important in establishing community trust
      Citation: Clinical Ethics
      PubDate: 2021-07-30T12:34:28Z
      DOI: 10.1177/14777509211036661
       
  • A “Talent Agency” refers children for research: A case study

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      Authors: David C Schwebel, Anna Johnston, Leslie A McClure
      Abstract: Clinical Ethics, Ahead of Print.
      ObjectiveEthical standards state research participation must be voluntary and free of coercion and undue influence, but what if a third party appears to engage in research-relevant coercion, without the researchers’ knowledge' This case study describes this type of situation and its resolution.MethodsWe are engaged in a randomized clinical trial evaluating pedestrian safety with 7- and 8- years old. Depending on children's rate of learning, families receive up to $1275 for their time. We recently learned a third-party “talent agency,” a firm placing children in modeling and acting jobs, was referring families to our research with the expectation that families would share 20% of study reimbursements.ResultsWe sensed clear impropriety, but identified no ethical violations on our part as researchers. Once paid a study reimbursement, participants can spend funds how they wish. We were concerned, however, that the third-party was exploitatively coercing families to participate.ConclusionsWe pursued four avenues to resolve the issue. First, we documented the situation to our university Institutional Review Board. Second, we contacted the talent agency and requested they stop referring families to our research. They agreed. Third, we retained children engaged in our study who were referred from the talent agency; removing them partway through the clinical trial could impact study results. In doing so, we explained that we were unaware of the talent agency referral and that they were not obligated by us to offer a portion of the study reimbursement to the talent agency. Last, we asked newly enrolled families about their referral source.
      Citation: Clinical Ethics
      PubDate: 2021-07-30T12:33:08Z
      DOI: 10.1177/14777509211036644
       
  • Physician use of the phrase “due to old age” to address complaints of
           elderly symptoms in Japanese medical settings: The merits and drawbacks

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      Authors: Atsushi Asai, Taketoshi Okita, Masashi Tanaka, Seiji Bito, Motoki Ohnishi
      Abstract: Clinical Ethics, Ahead of Print.
      In everyday medical settings in Japan, physicians occasionally tell an elderly patient that their symptoms are “due to old age,” and there is some concern that patient care might be negatively impacted as a result. That said, as this phrase can have multiple connotations and meanings, there are certain instances in which the use of this phrase may not necessarily be indicative of ageism, or prejudice against the elderly. One of the goals in medical care is to address pain and suffering that develops with age in elderly individuals, and whether or not aging is a disease is inconsequential. However, assuming that an individualized and thorough examination has been performed, there are some conditions that can be attributed only to age. Accordingly, physicians must acknowledge the merits and drawbacks of using the phrase “due to old age,” and exercise caution when using it. Both physicians and their elderly patients must share a common awareness of the incomplete and limited nature of modern medicine and its scope, and physicians must help their elderly patients accept and live with the aging phenomenon.
      Citation: Clinical Ethics
      PubDate: 2021-07-30T12:31:48Z
      DOI: 10.1177/14777509211036640
       
  • Living bioethics, clinical ethics committees and children's consent to
           heart surgery

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      Authors: Priscilla Alderson, Deborah Bowman, Joe Brierley, Martin J. Elliott, Romana Kazmi, Rosa Mendizabal-Espinosa, Jonathan Montgomery, Katy Sutcliffe, Hugo Wellesley
      Abstract: Clinical Ethics, Ahead of Print.
      This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees.
      Citation: Clinical Ethics
      PubDate: 2021-07-30T12:30:10Z
      DOI: 10.1177/14777509211034145
       
  • Moral distress in nurses: Resources and constraints, consequences, and
           interventions

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      Authors: Mohammad Javad Ghazanfari, Amir Emami Zeydi, Reza Panahi, Reza Ghanbari, Fateme Jafaraghaee, Hamed Mortazavi, Samad Karkhah
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundMoral distress is a complex and challenging issue in the nursing profession that can negatively affect the nurses’ job satisfaction and retention and the quality of patient care. This study focused on describing the resources and constraints, consequences, and interventions of moral distress in nurses.MethodsIn a literature review, an extensive electronic search was conducted in databases including PubMed, ISI, Scopus as well as Google Scholar search engine using the keywords including “moral distress” and “nurses” to identify resources, constraints, consequences, and interventions about moral distress in nurses, from the earliest records up to 26 December 2020. The required data were extracted from 61 relevant studies by two independent reviewers.ResultsResources and constraints in the occurrence of moral distress among nurses can be divided into three general categories including internal factors, clinical factors, and external factors. The consequences of moral distress on nurses and the medical system reduced moral sensitivity, development of psychological and physical health problems, and the intention to leave the profession. The potential effective interventions were the implementation of integrated communication programs, strengthening physician–nurse collaboration, nursing involvement in clinical decision-making and end-of-life issues, social support, using a resiliency bundle, interdisciplinary discussion, and promoting nurses’ ethical and communication skills.ConclusionThere are a wide range of resources and constraints impacting moral distress in nurses that could lead to negative consequences. Further studies are necessary to identify, evaluate, and implement a range of potential effective interventions for the management of moral distress in nurses.
      Citation: Clinical Ethics
      PubDate: 2021-07-26T04:02:37Z
      DOI: 10.1177/14777509211034142
       
  • Comparison of ethical decision-making and interpersonal communication
           skills training effects on nurses’ ethical climate

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      Authors: Shahrokh Maghsoudi, Mohaddeseh Mohsenpour, Hamed Nazif
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionEthical climate in medical contexts is referred to the organizational environment consisting of medical staff interpersonal relationships regarding patient care. This element affects staff behavior in an organization. The investigation and comparison of the effects of the interventions promoting ethical climate are among important nursing challenges that should be considered by researchers. The present study was conducted to compare the effect of nurses’ ethical decision-making skills and interpersonal communication training on their ethical climate.Materials and methodsThis experimental study was performed on 90 nurses working in the general teaching hospitals of Mashhad, Iran. The sampling process was conducted in two stages. Nurses were divided into three groups: intervention 1 (ethical decision-making skills group), intervention 2 (interpersonal communication skills group) and control group. The intervention was separate 12-h workshops for each of the intervention groups. The ethical climate questionnaire by Victor and Cullen was used to assess the score of ethical climate in the three groups both at the beginning and 4 weeks after the workshop. The data were analyzed in Statistical Package for Social Sciences software (version 16) using descriptive statistics, analysis of variance, Kruskal–Wallis, paired sample t-test, Wilcoxon test, and post hoc Tukey’s test. Ethical considerations were as follows: The study design was approved by the Research Ethics Committee of Mashhad University of Medical Sciences. Informed consent was obtained from all subjects, and they were ensured about the confidentiality terms.ResultsThe mean scores of the ethical climate test at the first stage were obtained as 66.0 ± 5.5, 67.8 ± 6.9, and 67.7 ± 7.2 in the ethical decision-making, interpersonal communication, and control groups, respectively. Accordingly, the three groups were not significantly different in terms of this variable (df = 87, f = 0.70, P = 0.005). However, after the intervention (i.e. second stage), a significant difference was observed among the three groups regarding the mean scores of the ethical climate test In this regard, the calculated mean scores in the ethical decision-making, interpersonal communication, and control groups were 99.3 ± 6.3, 90.4 ± 7.7, and 67.4 ± 7.9, respectively (df = 87, f = 152.00, P 
      Citation: Clinical Ethics
      PubDate: 2021-07-23T03:10:49Z
      DOI: 10.1177/14777509211034139
       
  • Administration of pro re nata medications by the nurse to incapacitated
           patients: An ethical perspective

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      Authors: Mojtaba Vaismoradi, Cathrine Fredriksen Moe, M Flores Vizcaya-Moreno, Piret Paal
      Abstract: Clinical Ethics, Ahead of Print.
      The administration of pro re nata medications is the responsibility of the nurse. However, ethical uncertainties often happen due to the inability of incapacitated patients to collaborate with the nurse in the process of decision making for pro re nata medication administration. There is a lack of integrative knowledge and insufficient understanding regarding ethical considerations surrounding the administration of pro re nata medications to incapacitated patients. Therefore, they have been discussed in this paper and practical strategies to avoid unethical practices have been suggested. The complicated caring situation surrounding the administration of pro re nata medications is intertwined with ethical issues affecting the consideration of the patient's wishes and interventions that override them. The patient's right of autonomy and treatment refusal, surrogacy role, paternalism, and coercion are the main ethos of ethical pro re nata medication administration. Education and training can help nurses avoid legal and ethical issues in pro re nata medicines management and improve the quality and safety of healthcare. Empirical research is needed to improve our understanding of this phenomenon in the multidisciplinary environment of medicines management.
      Citation: Clinical Ethics
      PubDate: 2021-07-23T02:33:54Z
      DOI: 10.1177/14777509211034146
       
  • Ethical concerns in maternal and child healthcare in Malawi

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      Authors: Gladys Msiska, Tiwonge Munkhondya, Berlington Munkhondya, Lucy Ngoma, Hlalapi Kunkeyani, Andrew Simwaka, Pam Smith, Lucy Kululanga, Rodwell Gundo, Ezereth Kabuluzi, Patrick Mapulanga, Chisomo Mulenga
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundCaring is a core function of nurses and it confers upon them ethical obligations as ethical agents. Failure to carry out such ethical obligations raises ethical concerns. This study was not intended to explore ethical concerns, but the reported findings reveal problems which have ethical implications. This paper aims to elucidate the ethical issues inherent in the findings and propose strategies to mitigate them.Research design and methodsAn exploratory-descriptive qualitative design was used within a larger Action Research Study. Data were collected through focus group discussions with nurse/midwives, and through exit interviews which were conducted with the women who participated in the study on their day of discharge. Six focus group discussions and thirty exit interviews were conducted, and data were analysed through thematic analysis.Participants and research contextThe study took place at selected maternal and child healthcare settings in Lilongwe, Malawi. The participants were nurse/midwives and women who were admitted in maternal and child healthcare settings and were purposively sampled.Ethical considerationsEthical approval was obtained from the relevant ethics committee and all ethical guidelines were followed in the conduct of the study.FindingsThe findings are presented under three themes which emerged from the data. The findings reveal effects of staff shortages on patient outcomes, problems experienced in low resource clinical settings and disrespectful nurse/patient communication.ConclusionThe findings reveal that institutional factors constrain moral agency and patient safety is severely compromised in some of the clinical settings in Malawi which raises serious ethical concerns.
      Citation: Clinical Ethics
      PubDate: 2021-07-22T03:57:09Z
      DOI: 10.1177/14777509211034132
       
  • Shared decision-making in patient–doctor consultations – How does it
           relate to other patient-centred aspects and satisfaction'

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      Authors: Helene Bodegård, Gert Helgesson, Daniel Olsson, Niklas Juth, Niels Lynøe
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThis study was designed to investigate how patient-reported shared decision-making relates to other aspects of patient centredness and satisfaction.MethodsQuestionnaire study with patients. Consecutive patients in primary care responding post visit. Associations are presented as proportions, positive predictive values, with 95% confidence intervals.Results223 patient questionnaires were included. 62% (95% Confidence interval (CI): 55–69) of the patients indicated the highest possible rating of being involved in the decisions about their ongoing care (self-reported SDM). Self-reported SDM had a positive predictive value (PPV) of between 85% (CI: 77–90) and 95% (CI: 90–98) for five other patient-centred aspects and satisfaction.ConclusionThe results suggest that shared decision making is the patient-centred aspect hardest to achieve and that a patient-centred process leading up to the decision-making increases the chance of the patient being involved in the decision-making.
      Citation: Clinical Ethics
      PubDate: 2021-06-12T11:22:12Z
      DOI: 10.1177/14777509211015897
       
  • Investigating the relationship between moral sensitivity and attitude
           towards euthanasia in nursing students of Birjand University of Medical
           Sciences

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      Authors: Elnaz Yazdanparast, Malihe Davoudi, Seyed Hasan Ghorbani, Amirhossein Akbarian, Hadi Ahmadi Chenari
      Abstract: Clinical Ethics, Ahead of Print.
      Euthanasia is one of the most controversial issues in medical ethics and one of the ten major ethical challenges in medicine and health sciences. The present study was conducted to evaluate the relationship between moral sensitivity and attitudes toward euthanasia among nursing students at Birjand University of Medical Sciences in 2020. Birjand University of Medical Sciences has four nursing schools. Cluster sampling method was used for selection of samples. After sampling Ferdows nursing school was selected. Nursing students of Ferdows School were 156 person which 144 participated in the study based on inclusion and exclusion criteria. Students completed demographic information questionnaire, moral sensitivity questionnaire and euthanasia attitude questionnaire. Data were entered into SPSS software version 19 using descriptive and inferential statistical methods. Findings of this study showed that among nursing students, the mean score of moral sensitivity was 59.59 ± 11.21 and was moderate. The mean score of attitudes towards euthanasia was 0.981 ± 0.336. In addition, according to the results, correlation test showed that there is a significant direct but weak relationship between moral sensitivity and attitude to euthanasia in students (P 
      Citation: Clinical Ethics
      PubDate: 2021-06-12T11:22:12Z
      DOI: 10.1177/14777509211016294
       
  • Diminished autonomy and justice in liver transplantation – The price
           of scarcity'

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      Authors: Philip Berry, Sreelakshmi Kotha
      Abstract: Clinical Ethics, Ahead of Print.
      Patient autonomy and distributive justice are fundamental ethical principles that may be at risk in liver transplant units where decisions are dictated by the need to maximise the utility of scarce donor organs. The processes of patient selection, organ allocation and prioritisation on the wait list have evolved in a constrained environment, leading to high levels of complexity and low transparency. Regarding paternalism, opaque listing and allocation criteria, patient factors such as passivity, guilt, chronic illness and sub-clinical encephalopathy are cited as factors that may inhibit patient engagement. Regarding justice, established regional, gender and race based inequities are described. The paradox whereby hepatologists both advocate for individual patients and discharge their duty of stewardship to apportion organs according to larger utilitarian principles is explored. Competing subjective factors such as physicians’ perception of moral responsibility, the qualitative nature of expert medical assessment and institutional or personal loyalty to re-transplantation candidates are described. Realistic limits of self-determination and justice are discussed, and possible future directions in terms of patient involvement proposed.
      Citation: Clinical Ethics
      PubDate: 2021-05-27T12:48:39Z
      DOI: 10.1177/14777509211016286
       
  • Planning for scarcity: Developing a hospital ventilator allocation policy
           for Covid-19

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      Authors: Emily Ferrell, Katherine Drabiak, Mary Alfano-Torres, Salman Ahmed, Azzat Ali, Brad Bjornstad, John Dietrick, Mary M Foley, Alex Garcia-Gonzalez, Shannon Robb, Douglas Ross
      Abstract: Clinical Ethics, Ahead of Print.
      ObjectiveTo develop an ethically, legally, and clinically appropriate ventilator allocation policy for AdventHealth Tampa and AdventHealth Carrollwood in Tampa, Florida, which could be enacted swiftly during the Covid-19 pandemic.MethodsDuring Spring 2020, a subcommittee of the Medical Ethics Committee established consensus on the fundamental principles of the policy, then built on existing ethical, legal, and clinical guidance. Results The plan was finalized in May 2020. The plan triages patients based on exclusion criteria (imminent mortality), prognosis and expected benefit of ventilation (using the Sequential Organ Failure Assessment), and change in prognosis over time. Decisions are made by committee in order to minimize moral distress among individual patient care providers.ConclusionsDue to international concerns about healthcare resource shortages during the Covid-19 pandemic, hospitals need allocation policies informed by the crisis standard of care, the hospital’s ethical duty to plan for an emergency, and federal civil rights laws Policy Implications: This type of policy can serve as a model for other institutions to develop crisis standards of care resource allocation policies, which are a necessary component of disaster planning.
      Citation: Clinical Ethics
      PubDate: 2021-05-20T09:01:16Z
      DOI: 10.1177/14777509211016287
       
  • Ethical leadership, psychological empowerment and caring behavior from the
           nurses’ perspective

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      Authors: Mojtaba Dehghani-Tafti, Maasoumeh Barkhordari-Sharifabad, Khadijeh Nasiriani, Hossein Fallahzadeh
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundCare is the basis of the nursing profession and nurse’s caring behavior is one of the important factors in patient satisfaction. On the other hand, psychological empowerment can improve the provision of care services, and leaders have a significant impact on the behavior of followers. This study determined the correlation between ethical leadership, psychological empowerment, and caring behavior from nurses’ perspective.MethodsThis cross-sectional descriptive study was conducted in 2019. A total of 200 nurses were selected by stratified random sampling. Data were collected with ethical leadership, caring behavior and psychological empowerment questionnaires and analyzed with descriptive statistics (mean and standard deviation, frequency distribution) and inferential statistics (Pearson correlation coefficient, regression, and t-test) using SPSS20.ResultsThe findings showed a significant correlation between ethical leadership, psychological empowerment (P 
      Citation: Clinical Ethics
      PubDate: 2021-05-18T06:26:46Z
      DOI: 10.1177/14777509211016297
       
  • The effect of professional ethics workshop with virtual follow-up on
           nurses moral distress

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      Authors: Ali Ghahremani, Fatemeh Esmaelzadeh, Mahboobeh Khosravani, Mohaddeseh Mohsenpour
      Abstract: Clinical Ethics, Ahead of Print.
      Research objectivesMoral distress is a common phenomenon among nurses and can negatively affect their mental health and quality of the care. This study aimed to determine the effect of professional ethics workshop with virtual follow-up on the moral distress of nurses.MethodsThis experimental study was performed on 50 nurses in Ghaem Hospital, Mashhad, Iran. The intervention group received 8-hour professional ethics workshop and 4 weeks follow-up through social network. The moral distress was evaluated through the Moral Distress Scale-Revised at the beginning of the study, two weeks after the workshop and at the end of follow-up. Data were analyzed using SPSS21 by descriptive and statistical analysis.This study approved by Mashhad university Medical Ethics Committee and publishing ethics were also observed.ResultsThe changes in the mean value of the frequency of moral distress in the intervention group was not significant, while these changes were significant in the control group (p 
      Citation: Clinical Ethics
      PubDate: 2021-05-18T06:26:41Z
      DOI: 10.1177/14777509211016282
       
  • Limit prison guards in the ICU during the coronavirus pandemic

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      Authors: Ellery Altshuler
      Abstract: Clinical Ethics, Ahead of Print.
      In a time when controlling the spread of the virus in the United States requires drastic measures to limit the number of people coming in and out of intensive care units (ICU), the presence of prison guards in not justified. Transfers from American prisons to hospitals have increased dramatically during the pandemic and with each prison patient comes a cohort of prison guards. The theoretical benefits of having prison guards–such as preventing escape, protecting staff, and stopping unwanted visitation–are minimal: critically ill prisoners are chained to their bed and pose minimal threat to the staff or flight risk. Unwanted visitation is already heavily regulated by the hospital. The risks of having more people in the ICU are significant during the pandemic: more potential exposures for staff, other patients, and the guards themselves. In order to limit the spread of the virus, the number of prison guards in the ICU should be limited.
      Citation: Clinical Ethics
      PubDate: 2021-05-18T06:26:39Z
      DOI: 10.1177/14777509211016288
       
  • The role of emotions in Moral Case Deliberation: Visions and experiences
           of facilitators

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      Authors: Benita Spronk, Guy Widdershoven, Hans Alma
      Abstract: Clinical Ethics, Ahead of Print.
      Moral Case Deliberation is intended to assist healthcare professionals faced with difficult dilemmas in their work. These are situations that involve emotions. During Moral Case Deliberation, participants are invited to reflect on moral views and deliberate on them. Emotions are not explicitly addressed. This article aims to elucidate the role of emotions in Moral Case Deliberation, by analysing experiences of Moral Case Deliberation facilitators. Our research shows the role of emotions varies according to the phase of the Moral Case Deliberation process. One negative aspect of emotions is that they can obstruct the Moral Case Deliberation discussion or distract from the moral question. A positive aspect is that they bring the dilemma into sharper focus. Devoting attention to emotions can help to ensure that responsible decisions are made, while also increasing the moral resilience of participants.
      Citation: Clinical Ethics
      PubDate: 2021-04-29T04:54:20Z
      DOI: 10.1177/14777509211011424
       
  • Development and validation of the ethical challenges in clinical
           situations-questionnaire (ECCS-Q) by involving health-care providers from
           a tertiary care health setting

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      Authors: Snehil Gupta, Swarndeep Singh, Siddharth Sarkar, Atul Batra
      Abstract: Clinical Ethics, Ahead of Print.
      Background and rationaleClinicians often encounter a variety of ethical challenges in their routine clinical practice, and it varies across healthcare and cultural settings of their practice. Despite of this, there are no clear-cut available guidelines concerning the right course of action in a given ethically challenging situation. A validated instrument that could capture the health care providers’ (HCP’s) viewpoints in this regard is lacking from Indian settings. Thus, the current study aimed at developing an instrument to assess the HCP’s perspective regarding different ethically challenging situations encountered in the Indian settings.MethodsThe questionnaire was developed by involving 15 medical experts. A mixed-method approach, Delphi-technique, and online survey were used for item generation and validation.ResultsThe questionnaire comprised of 11 items (accounts 57% variance; having an α = 0.68) representing four factors: health-resource constraints, medical responsibility of the HCP, obtaining patients/family members’ consent for the treatment, and treatment beyond the standard protocol. The gender and clinical disciplines of the participants were related to their level of endorsement for various domains of the ECCS-Q.ConclusionsEthical challenges in the clinical practice fall in different clusters. The clinicians’ course of action in such situations have many socio-demographic and professional determinants. Future studies are warranted to investigate these phenomena.
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:17Z
      DOI: 10.1177/14777509211011427
       
  • Addressing organ shortage: An automatic organ procurement model as a
           proposal

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      Authors: Marina Morla-González, Clara Moya-Guillem, David Rodríguez-Arias, Íñigo de Miguel Beriain, Alberto Molina-Pérez, Iván Ortega-Deballon
      Abstract: Clinical Ethics, Ahead of Print.
      Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals.
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:17Z
      DOI: 10.1177/14777509211011429
       
  • Ethical dimensions in randomized trials and off-label use of
           investigational drugs for COVID-19 treatment

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      Authors: Pooja Dhupkar, Seema Mukherjee
      Abstract: Clinical Ethics, Ahead of Print.
      Coronavirus disease 2019 (COVID-19) is a fast-developing viral pandemic spreading across the globe. Due to lack of availability of proven medicines against COVID-19, physicians have resorted to treatments through large trials of investigational drugs with poor evidence or those used for similar diseases. Large trials randomize 100–500+ patients at multiple hospitals in different countries to either receive these drugs or standard treatment. In order to expedite the process, some regulatory agencies had also given permission to use drugs approved for other diseases, despite a lack of evidence of efficacy in COVID-19. In this review, we highlight the potential ethical issues that should be addressed during the use of investigational drugs with little prior evidence as a treatment options during a pandemic. We discuss the impact of design of randomized clinical trials using LOTUS trial as an example and that of off-label use of drugs like chloroquine/hydroxychloroquine (CQ/HQ) on the safety of patients during COVID-19. We conclude that the adaptive randomized clinical trial designs offer a flexible and efficient approach, enabling patients to quickly switch to successful treatments, while minimizing the number of patients on standard of care. Randomized clinical trial design should consider blinding of investigators and only representative patients who can provide consent should be included. We also conclude the emergency approvals of drugs should be carefully issued and off-label use should be restricted in pandemics. Streamlined regulatory guidelines for emergency drug use in a pandemic can also help in providing benefit and minimizing harm to patients in the future.
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:16Z
      DOI: 10.1177/14777509211011431
       
  • The ethical impact of mandating childhood vaccination: The importance of
           the clinical encounter

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      Authors: Laura Williamson
      Abstract: Clinical Ethics, Ahead of Print.
      Health ethics can justify the use of vaccination mandates. However, policies that pressurize parents to vaccinate their children can undermine traditional clinical ethics standards (e.g. autonomy and informed consent). The aim of this paper is to argue that the ethical impact of vaccination mandates can only be determined in the context of the clinical encounter. Public debate on the topic tends to be general in nature and, as a result, issues that require clarification to help sustain the trust of service users are underexamined. In addition, ethical debates are hampered by a toxic dichotomy in the public sphere between those (anti-vaccinators) who claim a move away from parental choice is necessarily a serious ethical violation; and others (often health scientists) who neglect serious consideration of ethical issues. This predicament permits flawed ethical claims to be made, and to remain unchallenged. Despite this, ethical concerns – including those relating to trust and individual freedom – are fundamental to sustaining confidence in vaccination. This has recently been highlighted by the Covid-19 pandemic which made accessing childhood vaccinations harder, leading to a further decline in uptake. The pandemic has also revealed the strength of public feeling towards infection control measures that restrict peoples’ freedoms. In this paper I argue that to minimize the ethical disruption associated with the use of vaccination mandates, it is essential to focus more attention on their impact in the clinic and to accurately identify the drivers of such tensions.
      Citation: Clinical Ethics
      PubDate: 2021-04-24T05:21:50Z
      DOI: 10.1177/14777509211011422
       
  • Death, taxes and uncertainty: Economic motivations in end-of-life decision
           making

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      Authors: George Slade Mellgard, Jacob M Appel
      Abstract: Clinical Ethics, Ahead of Print.
      Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests' Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.
      Citation: Clinical Ethics
      PubDate: 2021-04-23T05:16:46Z
      DOI: 10.1177/14777509211011425
       
  • Ethical pause as a framework for high-value care of hospitalized COVID-19
           patients

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      Authors: Benjamin J Martin, Margaret Plews-Ogan, Andrew S Parsons
      Abstract: Clinical Ethics, Ahead of Print.
      Caring for hospitalized patients with COVID-19 raises ethical dilemmas in which clinicians must weigh the unknown value of an intervention against the unknown risk of viral transmission. Current guidelines for delivering high-value care in the time of the COVID-19 pandemic do not directly address ethical dilemmas that arise from the unique concerns of individual patients. We propose an “ethical pause” in which clinicians address ethical dilemmas by taking time to ask three questions that invoke the major bioethical principles of beneficence, nonmaleficence, and distributive justice: will this intervention help my patient' Could this intervention harm my patient' Could this intervention harm or help others' Using two exemplar cases, we demonstrate how the process of deliberately asking and answering structured ethical questions is a mindful problem-solving strategy that facilitates delivery of high-value care.
      Citation: Clinical Ethics
      PubDate: 2021-04-23T05:16:45Z
      DOI: 10.1177/14777509211011434
       
  • Opinions among pediatric critical care physicians regarding the ethics of
           withdrawal of ventricular assist devices and extracorporeal membrane
           oxygenation

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      Authors: Antonia A Melas, Leanna L Huard, Rong Guo, Robert B Kelly
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundPediatric critical care physician attitudes about withdrawal of ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO) in cases of medical futility are poorly defined. Our aim was to define current attitudes regarding the withdrawal of these devices.MethodsIRB-approved, cross-sectional observational survey conducted among pediatric critical care attending physicians and fellow physicians in the United States between 2016 and 2017. Data was collected anonymously and statistically analyzed.ResultsA total of 158 physicians responded with 67% being attending physicians. Compared to a VAD, a higher percentage had taken care of a patient on ECMO where the device was turned off because care was believed to be futile (99% vs. 84%), including currently (95% vs. 57%). Nearly all reported that it can be ethically permissible to withdraw support from a patient with a VAD and on ECMO (97% vs. 99%), but varied opinions existed as to who should ultimately make this decision if the patient/their family disagrees. More respondents agreed that a patient/their family should agree to withdrawal of VAD or ECMO support prior to initiation if futility is later determined (60% vs. 58%) and that protocols should be created for VAD and ECMO withdrawal (77% vs. 76%).ConclusionMost pediatric critical care physicians felt that it can be ethically permissible to withdraw VAD and ECMO support. Our study indicates that pediatric VAD and ECMO withdrawal protocols are desired, but further investigation is needed to determine how to best design protocols that would incorporate multiple stakeholders.
      Citation: Clinical Ethics
      PubDate: 2021-03-17T05:36:20Z
      DOI: 10.1177/14777509211001560
       
  • Moral sensitivity and moral distress correlation in nurses caring of
           patients with spinal cord injury

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      Authors: Naser Sedghi Goyaghaj, Amir Zoka, Mohaddeseh Mohsenpour
      Abstract: Clinical Ethics, Ahead of Print.
      Background and aimEthical sensitivity of nurses often plays an important role in their occupational commitment and moral decision-making. In some working conditions, nurses are affected by ethical distress and fail to pursue correct ethical actions despite having knowledge and a tendency for moral practice. Therefore, the present study aimed to investigate the correlation between sensitivity and ethical distress in the nurses of patients with spinal cord injuries.Materials and methodsThis descriptive-analytical study was performed on 160 of the nurses of patients with spinal cord injuries. The participants were selected through the purposive sampling method out of the nurses in Khatamolanbia and Sasan hospitals, Tehran, Iran. Data collection tools included the Moral Sensitivity Questionnaire by Han and Corley’s Moral Distress Scale. Data were analyzed by the independent t-test and Pearson correlation coefficient using the SPSS software version 19.ResultsThe mean values of ethical sensitivity was 80.48 ± 14.45 and ethical distress among the subjects was 62.39 ± 3.54. Moreover, a significant negative correlation was observed between moral sensitivityand moral distress (P
      Citation: Clinical Ethics
      PubDate: 2021-02-12T06:01:39Z
      DOI: 10.1177/1477750921994279
       
  • A taxonomy of conscientious objection in healthcare

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      Authors: Nathan Gamble, Toni Saad
      Abstract: Clinical Ethics, Ahead of Print.
      Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.
      Citation: Clinical Ethics
      PubDate: 2021-02-11T05:07:28Z
      DOI: 10.1177/1477750921994283
       
  • The relationship between nurses’ conscientious intelligence levels and
           care behaviors: A cross-sectional study

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      Authors: Sadiye Ozcan
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundNurses are the main protectors of goodness, honesty and morality in patient care. Conscience allows nurses to be understanding and careful while they provide patient care. In this research the researcher aimed to determine the relationship between conscientious intelligence levels and caring behaviours of nurses and to determine the factors affecting the conscientious intelligence levels and caring behaviours.MethodsThis research designed as a descriptive, cross-sectional and correlation study included 314 nurses working at three hospitals in eastern Turkey. The data were collected by the researcher at a time when the nurses were available and not working. Written and oral informed consent was obtained from all the participants.ResultsA moderate significant positive correlation was observed between conscientious intelligence levels and caring behaviours of nurses. The length of service in nursing, sex and being pleased with the nursing profession were associated with conscientious intelligence levels and caring behaviours.ConclusionAt the end of this research, it was determined that nurses with high conscientious intelligence had better caring behaviours. Although it is very important for nurses to be knowledgeable of and competent at providing care, taking their conscience into consideration in the care of his or her patients is more important. If a nurse is not pleased with the nursing profession, his or her behaviour should be monitored when he or she provides care for the patient. Persons without conscientious values should not be accepted into the nursing profession.
      Citation: Clinical Ethics
      PubDate: 2021-02-11T05:07:26Z
      DOI: 10.1177/1477750921994286
       
  • Workplace silence behavior and its consequences on nurses: A new Egyptian
           validation scale of nursing motives

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      Authors: Nagah Abd El-Fattah Mohamed Aly, Safaa M El-Shanawany, Maha Ghanem
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundWorkplace silence behavior is a social collective phenomenon. It refers to nurses choosing to withhold their ideas, opinions and concerns about critical issues in their workplace. Workplace silence behavior poses a threat to organizational ethics and success. It also has adverse effects on the performance of nurses in health organizations. Underlying nursing causes of silence behaviors could be related to individual, social and organizational attributes in health care settings.ObjectivesThe study aimed to develop a new Egyptian validation scale for measuring nursing motives of workplace silence behavior and identify consequences of workplace silence behavior on nurses.MethodsA cross-sectional correlational study was implemented using questionnaires on workplace silence behavior, nursing motives and nurses' consequences, collected from 332 nurses working in critical and toxicology care settings of Alexandria Main University Hospital.ResultsEgyptian scale was shown to be a good fit model of exploratory (36 nursing motives emerged in six dimensions with total variance of 73.3%) and confirmatory factor analysis tests (X2 = 1381.47, NNFI =0. 90, CFI = 0.91, RMSEA = 0.057). It also had high reliability tests with coefficient of alpha (0.85), Pearson (0.75) and Kendall coefficient of 0.72. High level of workplace silence behaviors showed a negative association with organizational dis-identification, fair citizenship behavior, and fair nurses' performance and declined reporting of patient adverse events. It also appeared to be in a positive association with higher levels of cynicism.ConclusionThe Egyptian scale was proved to be reliable and valid for measuring the underlying nursing causes of silence behaviors in the hospital workplace. Measuring nursing motives of workplace silence behaviors will help nurse managers to reduce negative outcomes of workplace silence behaviors and improve organizational outcomes.
      Citation: Clinical Ethics
      PubDate: 2021-02-10T04:43:38Z
      DOI: 10.1177/1477750921994284
       
  • The ethics of interpreter use

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      Authors: Ben Gray, Jo Hilder
      Abstract: Clinical Ethics, Ahead of Print.
      Consulting with a patient where there is a language barrier is unethical unless the barrier is overcome. Every patient with a language barrier should have this prominently documented on their file. Much of the literature relating to working with interpreters suggests that a professional interpreter should be used all the time, although in practice this is far from standard practice. In this paper we look at the issue using normative ethics, utilitarian ethics, an argument based on equality of health outcomes before making an argument for an approach based on clinical judgement in each consultation of what form of language assistance is acceptable.
      Citation: Clinical Ethics
      PubDate: 2021-02-09T03:46:22Z
      DOI: 10.1177/1477750921994276
       
  • The practice of obtaining informed consent for elective surgery and
           anesthesia from patients’ perspective: An institutional based
           cross-sectional study

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      Authors: Tadese Tamire, Aragaw Tesfaw
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionInformed consent is a body of shared decision-making process and voluntary authorization of patients to receive medical or surgical intervention. There are limited studies conducted so far to examine the practice of informed consent in Ethiopia. This study aimed to assess the practice of informed consent process for surgery and Anesthesia.MethodA cross-sectional study was conducted from March to May 2019. The data were collected using interviewer-administered structured questionnaire and analyzed in SPSS version 23.ResultsA total of 139 patients were interviewed in this study. Most 42(30.2%) of patients were in the age group of 29–38 years. Nearly half 68 (48.9%) of the patients were informed the benefits of the surgical procedure and 78(56.1%) of the patients were informed on the type of anesthesia to be administered while 65 (46.8%) were not informed on any complication related to the anesthesia. About 66 (47.5%) of patients were informed on alternatives to the surgery. Of these patients, 39(59%) were not informed of any benefits and possible risks associated with the alternative modes of treatment. About half (54%) of the patients were reported as they were understood the information provided during the pre-operative informed consent process.ConclusionThis research revealed that patients were inadequately informed on the complications of proposed procedure, alternative forms of treatment, risks and benefits of the proposed procedure. Therefore, healthcare providers should provide adequate information regarding the proposed procedure and make sure whether patients understood the risks and benefits before the consent.
      Citation: Clinical Ethics
      PubDate: 2021-02-09T03:46:22Z
      DOI: 10.1177/1477750921994281
       
  • The effect of providing usual care only for control subjects on the
           reliability of results obtained by controlled clinical trials assessing
           the benefits of diabetes self-management educational programs

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      Authors: Ehab Mudher Mikhael, Mohamed Azmi Hassali, Saad Hussain
      Abstract: Clinical Ethics, Ahead of Print.
      Diabetes self-management (DSM) is a crucial part in the management of diabetic patients. Most randomized controlled clinical trials reported significant benefits by diabetes self-management education (DSME) on DSM behaviors and metabolic control. Although the randomized clinical trials are the gold standard method in assessing the effectiveness of any intervention, including DSME interventions, the outcomes of these studies may reflect exaggerated effects; because in most of these studies, subjects in control group receive usual (standard) care with no any DSME. The lack of such education in the control group had many drawbacks: () make blindness impossible; at which non blinded studies may result in false-positive findings; () it may be unethical to recruit patients for participation in DSME studies as control subjects, most of these studies with long periods of follow up, without any direct benefit to them during the study period; the lack of direct benefit to control subjects in any clinical trial may results in high attrition (drop-out) rate. The high attrition rate in clinical trials especially in the control group can lower the statistical power of the study results; thus, the DSME program would appear to have positive effects even if the program had no real benefit. This problem of the DSME exaggerated effects can be solved partially through providing control subjects with education about some DSM behaviors or comparing the effect of DSME through different educational approaches (for example DSME by didactic vs interactive approach).
      Citation: Clinical Ethics
      PubDate: 2021-02-08T07:13:18Z
      DOI: 10.1177/1477750921994282
       
  • Main challenges in adoption of consultation services of hospital ethics
           committees: A systematic review of the literature

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      Authors: Mir Sajjad Seyyed Mousavi, Rahim Khodayari-Zarnaq, Alireza Hajizadeh
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThere are numerous challenges in the consultation services of the Hospital Ethics Committees (HEC) that can impact the means of providing healthcare. This review aimed to identify the main challenges in the application of consultation services of the HEC and propose possible solutions.MethodsThis systematic review was conducted through searching electronic databases including PubMed, Scopus, Science Direct, ProQuest, and Embase. Inclusion criteria included studies published in English language in a peer-reviewed journal, from 2000 to 2019 were identified, which clearly defined the design, method, and results of the study. Study selections, quality assessments, data extraction, and analysis were completed by two researchers, independently. The thematic analysis was used to analyze the data.ResultsThe search yielded 1204 articles and 6 of these, included the analyses. Challenges were categorized into 9 themes: (a) personal views and believes in healthcare professionals, (b) sense of fear in the healthcare professionals, (c) medical culture, (d) environmental factors, (e) managerial and structural factors, (f) characteristics of the HEC members, (g) factors related to the HEC, (h) problematic process for HEC consultations, and (i) weakness of knowledge about HEC. Accordingly, proposed solutions were organized according to five themes: reforming the HEC executive processes, creating the appropriate communications, developing awareness about HEC, improving the competencies of HEC members, and (e) receiving support from HEC consultations.ConclusionsThis review highlights that proposed solutions serve as examples of strategies, which attempt to solve challenges related to the application of the consultation services of HEC by healthcare professionals.
      Citation: Clinical Ethics
      PubDate: 2021-02-08T07:13:16Z
      DOI: 10.1177/1477750921994278
       
  • Regulation in research ethics: a scarecrow for physicians'

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      Authors: T Haaser, D Berdaï, S Marty, V Berger, E Augier, B L’Azou, V Avérous, MC Saux
      Abstract: Clinical Ethics, Ahead of Print.
      Background Regulations on research ethics in France have evolved considerably over the past four years: the implementation of the Jardé law and of the General Data Protection Regulations have changed the landscape of research ethics for research involving or not involving human persons. In a context of creation of an Institutional Review Board at the University of Bordeaux, France, we sought to explore research ethics practices and perceptions in the medical community of our University Hospital.MethodsA short questionnaire was sent to all physicians of the University Hospital of Bordeaux. The questionnaire included closed questions and main topics were: physicians’ education in research ethics, ethics practices concerning researches non implying human persons, and physicians’ perceptions about current regulations.Results86 questionnaires were sent back (response rate: 24.2%). If a majority of physicians have validated Good Clinical Practices (GCPs) trainings (76%), there was a low rate of specific training on fundamental references in research ethics and a high proportion of responders do not consider themselves as educated in research ethics after completion of GCPs (56%). Regulations on research ethics have many implications on medical research, especially by inducing changes in protocols in order to alleviate ethical requirements (57%). Malpractices were acknowledged like false mention of positive opinion from an ethics committee (21%). If If a majority of responders considers regulations as a positive answer to research ethics, a large majority considers it as a constraint and a complexification of research process. For 58%, regulations in research ethics are perceived as a hindrance for research initiatives.ConclusionBecause of their impact on research process, regulations seem to constitute a scarecrow for physicians. Lack of training, bad representations and questionable practices (or even malpractices) highlight the need to improve education and to propose concrete guidance for medical researchers.
      Citation: Clinical Ethics
      PubDate: 2021-01-22T06:14:31Z
      DOI: 10.1177/1477750920983574
       
  • Personal prenatal ultrasound use by women’s health professionals: An
           ethical analysis

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      Authors: Marielle S Gross, Gail Geller, Anne Drapkin Lyerly
      Abstract: Clinical Ethics, Ahead of Print.
      Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women’s healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case wherein a pregnant obstetrician’s personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women’s health professionals’ self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed.
      Citation: Clinical Ethics
      PubDate: 2021-01-12T06:13:25Z
      DOI: 10.1177/1477750920983576
       
  • Siblings and Discordant Eligibility for Gene Therapy Research: Considering
           Parental Requests for Non-Trial "Compassionate Use”

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      Authors: Jamie Webb, Lesha D Shah, Alison Bateman-House
      Abstract: Clinical Ethics, Ahead of Print.
      Deciding whether to grant an expanded access request for a child whose sibling is enrolled in a gene therapy trial involves a number of complex factors: considering the best interests of the child, the psychosocial and economic impact on the family, and the concerns and obligations of researchers. Despite the challenges in coming to a substantively fair outcome in cases of discordant eligibility, creating a procedurally fair decision-making process to adjudicate requests is essential.
      Citation: Clinical Ethics
      PubDate: 2021-01-08T04:51:39Z
      DOI: 10.1177/1477750920983571
       
  • Supporting the call for improving the code of publication ethics to
           incorporate editorial decisions regarding the causation of harm by
           publication

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      Authors: Henk P Giele
      First page: 163
      Abstract: Clinical Ethics, Ahead of Print.
      It is argued that editors have a moral responsibility to reject submissions that they felt publication of which may cause harm. However, Ploeg and others suggest that there may exist better alternatives to rejection. He also called for the code of publication ethics to incorporate acknowledgement of the moral responsibility for the effects of publishing, define benefits and harms of publishing, and specify a range of actions an editor may take. This letter highlights a recent such rejection ostensibly made on the basis of harm, but could easily be construed as editorial bias, and supports the call for improving the code of publication ethics to guide editors and secure consistency in decisions.
      Citation: Clinical Ethics
      PubDate: 2021-01-07T06:01:36Z
      DOI: 10.1177/1477750920983575
       
  • The legal ambiguity of advanced assistive bionic prosthetics: Where to
           define the limits of ‘enhanced persons’ in medical treatment

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      Authors: Tyler L Jaynes
      First page: 171
      Abstract: Clinical Ethics, Ahead of Print.
      The rapid advancement of artificial (computer) intelligence systems (CIS) has generated a means whereby assistive bionic prosthetics can become both more effective and practical for the patients who rely upon the use of such machines in their daily lives. However, de lege lata remains relatively unspoken as to the legal status of patients whose devices contain self-learning CIS that can interface directly with the peripheral nervous system. As a means to reconcile for this lack of legal foresight, this article approaches the topic of CIS-nervous system interaction and the impacts it may have on the legal definition of “persons” under the law. While other literature of this nature centres upon notions of transhumanism or self-enhancement, the approach herein approached is designed to focus solely upon the legal nature of independent CIS actions when operating alongside human subjects. To this end, it is hoped that further discussion on the topic can be garnered outside of transhumanist discourse to expedite legal consideration for how these emerging relationships ought to be received by law-generating bodies internationally.
      Citation: Clinical Ethics
      PubDate: 2021-02-19T11:16:37Z
      DOI: 10.1177/1477750921994277
       
  • Children’s medical treatment decision-making: Reform or review'

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      Authors: Jo Bridgeman
      First page: 183
      Abstract: Clinical Ethics, Ahead of Print.
      This article considers proposals to reform the law in response to recent high profile cases concerning the medical treatment of children, currently before Parliament in the Access to Palliative Care and Treatment of Children Bill 2019–21. It considers the proposed procedural change, to introduce a requirement for mediation before court proceedings, and argues that dispute resolution processes should be a matter of good practice rather than enshrined in law. It argues that the proposed substantive change to determination of best interests would not result in different outcomes because the best interests analysis co-exist with the legal and professional duties of doctors to children in their care. It argues that if there is to be reform of the law it needs to follow from a comprehensive review of all the issues in which the minimum standards imposed by law fit together with good practice standards and not in response to individual cases.
      Citation: Clinical Ethics
      PubDate: 2021-02-05T05:30:38Z
      DOI: 10.1177/1477750921994280
       
  • A comparison of the ethical climate of operating rooms from the
           perspective of operating room nursing students and staff: An analytical
           study

    • Free pre-print version: Loading...

      Authors: Fatemeh Esmaelzadeh, Monirsadat Nematollahi
      First page: 259
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThe ethical climate is an essential component of organizational climate or culture. The ethical climate is necessary for clinical practice in operating rooms.ObjectiveThis study aimed to compare the ethical climate from the perspective of operating room nursing students and operating room staff of hospitals affiliated with Mashhad University of Medical Sciences, Iran.MethodThis analytical study was performed on 95 operating room nursing students and 169 operating room staff of hospitals in Mashhad, Iran. The students were selected through the census method and the staff were selected by using stratified random sampling. The data were collected via Olson’s Hospital Ethical Climate Survey and analyzed by using BMI SPSS version 21.ResultsThe total mean scores of the ethical climate were 3.44 ± 0.45 and 3.32 ± 0.48 from students and staff’s perspectives, and the independent t-test showed no significant difference between them (p  0.05). Furthermore, the results of the study indicated a significant difference in communication with physicians’ score between operating room staff (2.82 ± 0.49) and students’ views (3.25 ± 0.6) (p 
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:15Z
      DOI: 10.1177/14777509211011435
       
 
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