Caregivers' perceptions of compulsory treatment of physical illness in involuntarily psychiatric hospitalization.

BACKGROUND: Physical morbidity is rife among patients with serious mental illness. When they are involuntarily hospitalized and even treated, they may still refuse treatment for physical illness leading clinicians to wonder about the ethics of coercing such treatments. RESEARCH AIM: This survey study explored psychiatric caregivers' perceptions on whether compulsory treatment of physical illness is legal and whether it is justifiable in patients with serious mental illness and under what circumstances. RESEARCH DESIGN: A questionnaire that included two case vignettes of an involuntarily hospitalized psychiatric patient with diabetes refusing treatment with insulin for various reasons. The cases differed in terms of diabetes severity. Participants answered questions regarding the appropriateness of involuntary treatment. PARTICIPANTS AND RESEARCH CONTEXT: Psychiatric medical doctors and nurses working in a mental health center. (N = 89, 50 female, ages 26-66). ETHICAL CONSIDERATIONS: The study was approved by the Medical Centre Institutional Review Board (IRB) and the University Ethics Committee. The respondents' anonymity was kept. Participation was voluntary and consent was obtained. RESULTS: The severity of the patient's medical condition and their reason for refusing treatment were associated with participants' willingness to give insulin despite patient objection [(F(1, 87) = 49.41, p < .01; (F(1, 87) = 33.44, p < .01), respectively]. Participants were more inclined to support compulsory treatment if the patient's refusal was "illness-oriented" (i.e. directly related to psychiatric illness). Participants presented diverse views regarding the perceived legality of compulsory treatment of physical illness in such situations (illegal 63.09%; legal 23.8%; 13% unsure). The majority (53.5%-55.3%) of those who thought it was illegal supported compulsory treatment in high-severity, illness-oriented refusal situations. CONCLUSIONS: The severity of the medical condition and the reason for treatment refusal influence psychiatric caregivers' willingness to provide compulsory treatment for physical illness in involuntary hospitalized psychiatric patients. Beyond the legal framework, ethical guidelines for these situations are warranted, while decisions should be made on a case-by-case basis.

Nursing students' experiences and perceptions of an anatomy laboratory session: Mixed methods study.

Many nursing curricula do not offer anatomy laboratories and exposure to cadaveric material. In this mixed methods study, nursing students' perceptions and experiences from an anatomy laboratory session were examined. Students from two academic nursing programs (a four-year general baccalaureate nursing program and a two-year accelerated nursing program for non-nursing baccalaureate graduates) took part in an anatomy laboratory session (N = 223). Participants' learning experiences, emotional experiences, and satisfaction with the anatomy laboratory session were assessed by their responses to closed-ended questionnaires. Participants' reasons for participation and suggestions for improvement were examined by open-ended questions. A mixed methods analysis of the data revealed a high level of satisfaction with the anatomy laboratory experience. Positive attitudes and learning experiences correlated with a sense of identification with the nursing profession. Satisfaction was positively associated with a perceived quality of learning and negatively associated with a negative emotional experience. Curiosity and self-challenge, as well as the quest for tangible, in-depth learning, were major motivators involved in the students' desire to participate in the session. Both qualitative and quantitative analyses indicated that the educational experience was significant. Therefore, it is recommended to integrate anatomy laboratory sessions into anatomy courses for nursing students. This will help to illustrate and assimilate classroom material and strengthen nursing students' sense of identification with their profession.

Effect of ethnicity, country of origin and workplace on health behaviors and health perception among nurses: Cross-sectional study.

PURPOSE: The study aimed to (1) examine health behaviors and perceived health among nurses; (2) analyze the effect of nurses' personal and work characteristics on these variables; and (3) explore the relationship between health behaviors and nurses' health perception. DESIGN AND METHODS: A cross-sectional study was conducted among nurses working in health care organizations (HCOs) across Israel. An email with the online questionnaire was sent to nurses working in 19 HCOs across Israel during September-December 2018. FINDINGS: Of 18,120 nurses employed, 3542 completed the survey. Mean age was 44.8 years, 91% were female), 64.6% were hospital nurses and 52.8% were clinical staff nurses. Two-thirds of nurses did not achieve the physical activity (PA) target; the majority reported unfavorable eating habits; 66% slept less than 7 h at night and 15% smoke. Hospital nurses working night shifts reported the least favorable health behaviors. Non-Jewish nurses had less eating habits compared with Jewish nurses. Nurses born in the Former Soviet Union perceived their health as significantly worse than that of the other respondents. Binomial logistic regression demonstrated that, age, Israeli origin, achieving the PA target, having food breaks during work, consuming a Mediterranean diet, sleeping at least 7 h, undergoing screening tests as recommended, and not smoking predicted better health perception among nurses. CONCLUSIONS: Nurses, particularly hospital-based, non-Jewish and immigrants from the Soviet Union, demonstrated unfavorable health behaviors that may negatively affect their wellbeing and health perception. CLINICAL RELEVANCE: Interventions aimed at improving the health promoting mindset of nurses have the potential to improve their health and wellbeing and to enable them to become role models and health educators for patients and their families.

When do caregivers ignore the veil of ignorance? An empirical study on medical triage decision-making.

In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations ("worst-first"). This study empirically examined the influence of value-oriented considerations on medical triage decision-making. Participants were asked to prioritize medical treatment relating to four case scenarios of an emergency situation resulting from a car collision. The cases differ by situational characteristics pertaining to the at-fault driver, which were related to culpability attribution.In three case scenarios most participants gave priority to the most severely injured individual, unless the less severely injured individual was their brother. Nevertheless, in the aftermath of a vehicle-ramming terror attack most participants prioritized the less severely injured individual ("victim-first").Our findings indicate that when caregivers are presented with concrete highly conflictual triage situations their choices may be based on value-oriented considerations related to contextual characteristics of the emergency situation. Philosophical and practical ramifications of our findings are discussed.

Nurses' perceptions of pain management adequacy in mechanically ventilated patients.

AIMS AND OBJECTIVES: To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. BACKGROUND: Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. DESIGN: The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. METHODS: A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February-May 2015. The "STROBE" EQUATOR checklist was used. RESULTS: Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. CONCLUSION: Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. RELEVANCE TO CLINICAL PRACTICE: Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.

Experiences, behaviors, and perceptions of registered nurses regarding research ethics and misconduct.

BACKGROUND: Nurses engaging in research are held to research ethics standards. RESEARCH AIM: Examine experiences, behaviors, and perceptions of nurses in Israel regarding research ethics and explore possible related factors. RESEARCH DESIGN: An original investigator-designed self-administered questionnaire measured five variables: (a) ethics in research, (b) encountered research misconduct during the course of one's studies, (c) the inclination to fabricate data, (d) the inclination to select or omit data, and (e) knowledge of research misconduct in the workplace. Additionally, demographic data were collected. PARTICIPANTS AND RESEARCH CONTEXT: The questionnaire was completed by 151 Israeli registered nurses. 10.2% hold a PhD, 34 % hold an MA, 42.2% hold a BA, and 13.6% with no academic degree. ETHICAL CONSIDERATIONS: The study was approved by the University's ethics committee; anonymity and consent of the respondents were respected. FINDINGS: Registered nurses' level of studies achieved was significantly associated with a lower inclination to fabricate data, with one exception-PhD nurses were more inclined to fabricate data than nurses with a Master's degree. A trend was found in which a higher level of studies is associated with higher knowledge of research misconduct in the workplace. DISCUSSION: Results indicate that nurses' perceptions of research ethics change throughout their academic studies, indicating a positive influence of level of studies, research experience, and work experience on ethics perceptions. Nevertheless, PhD nurses showed a greater inclination to actually select, omit, or even fabricate data than MA nurses. This may be related to pressure to publish. CONCLUSION: PhD nursing programs should include ethics training. Academic faculty members should serve as role models regarding research integrity. Research ethics deserves further emphasis on all levels of nurse education in Israel, as well as in the nurses' code of ethics and related documents. This may positively impact ethical research practices.

Psychiatrists' Media Involvement: A Survey of Attitudes.

BACKGROUND: Psychiatrists may face challenging core medical ethics questions since the media encourages their assistance and participation at various levels. This paper examines attitudes of psychiatrists regarding their involvement with the media and their view of their professional association in such incidents. METHODS: A survey was completed by a convenience sample of 81 Israeli psychiatrists. The specially designed questionnaire was compiled by the research team focusing on potential involvement of the psychiatrist regarding reality shows; discussing criminality and responsibility in the media; media involvement of the national psychiatric association and appearing in the media in matters of public education and mental health literacy. RESULTS: Psychiatrists are largely reluctant to engage with the mass media. At the same time, they support a strong media presence by their professional psychiatric association. CONCLUSION: Professional psychiatry associations should consider deliberating the issue of media involvement further and contemplate further development of ethical recommendations on the issue.

Specific Ethical Codes for Mental Health Care Professionals: Do We Need to Annotate?

BACKGROUND: In Israel a general code of ethics exists for physicians, drafted by the Israel Medical Association. The question arises whether psychiatrists require a separate set of ethical guidelines. OBJECTIVES: To examine the positions of Israeli psychiatrists with regard to ethics in general and professional ethics in particular, and to explore opinions regarding a code of ethics or ethical guidelines for psychiatry.  Methods: A specially designed questionnaire was compiled and completed by psychiatrists recruited for the study. METHODS: A specially designed questionnaire was compiled and completed by psychiatrists recruited for the study. RESULTS: Most participants reported low levels of perceived knowledge regarding ethics, professional ethics, and the general code of ethics. Older and more experienced professionals reported a higher level of knowledge. Most psychiatrists agreed or strongly agreed with the need for a distinct code of ethics/ethical guidelines for psychiatrists. This support was significantly higher among both psychiatrists under 50 years and residents. CONCLUSIONS: Our findings suggest that the existing code of ethics and position papers may not be sufficient, indicating a potential need to develop and implement a process to create the ethical code itself. In addition, the findings highlight the importance of ethics education, suggesting that the need for a code of ethics is more urgent in the early stages of professional training, as younger professionals may be more exposed to advanced media technology. While some may fear that a distinct code of ethics will distance psychiatry from modern medicine, others assert that the profession combines aspects from the humanities and social sciences that require a unique sort of management and thus this profession requires a distinct code of ethics.

Procedural immunity of the district psychiatrists and members of the district psychiatric committees against civil wrongs claims in Israel.

In the public sector, psychiatrists as well as other physicians and mental health workers are subject to legal claims as a result of their clinical decisions. Until 2006, these professionals had no procedural immunity for such claims. The paper describes the legal change that took place in Israel since February 2006 with regard to some civil servants, including District Psychiatrists and members of District Psychiatric Committees. A clinical case vignette illustrates the possible implications of this statute amendment.

Treatment of sex offenders in Israeli prison settings.

The number of incarcerated sex offenders in the Israeli prison system has steadily increased during the past decade. While treatment of sex offenders is complex, treatment of those in prison seems to be more challenging. This publication presents major considerations and dilemmas, clinical as well as ethics-related, derived from the experience of the psychiatric division in the Israeli prison service in treating sex offenders in this special setting. The psychiatrist treating the incarcerated offender must always maintain a sensitive balance between the needs and wishes of his patient and the potential threat to society stemming from recidivism.

Qur'anic healing for spiritual ailments: between tradition, religious law and contemporary law.

Qur'anic healing [al'ilaj bi-lqur'an] is a traditional spiritual healing method based on the Qur'an. It is practiced in various Muslim communities for the treatment of mental afflictions and other ailments. Through Qur'anic healing, the wider issue of religious and cultural related healing is presented, and the question of possible cooperation between physicians and healers is raised. Using a criminal court case brought before the Israeli Supreme Court in the mid 1950s, the legal and ethical aspects of practicing Qur'anic healing are discussed, including: healers' liability, right to practice healing and legal "risks" involved in various methods of treatment. The legal analysis is based both on Israeli and Muslim law, demonstrating how similar legal results may be achieved through different legal systems and practices.

Abortion in Islamic countries--legal and religious aspects.

The debate over abortion is still controversial as ever. As one of every four people in the world is of the Muslim religion, it is important to learn more about the Islamic point of view toward this dilemma in medical ethics. The first part of this paper gives a general view of the sources of Islamic law and discusses modern developments in Islamic medical ethics regarding abortion. The second part focuses on the legal aspects of abortion in different Islamic states, dealing with the need to supply solutions to women who for different reasons wish to abort and at the same time enact laws that would not contradict Islamic principles. A study of three Muslim states (Egypt, Kuwait and Tunisia) demonstrates three different approaches toward legalizing abortion--a conservative approach, a more lenient approach, and a liberal one--all within Islamic oriented states. This leads to a conclusion that a more liberal attitude regarding abortion is possible in Islamic states, as long as traditional principles are taken into account.