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1.
J Nurs Care Qual ; 37(1): 28-34, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34538814

RESUMO

BACKGROUND: Complexity in nursing practice creates an intense and stressful environment that may lead to moral distress (MD) and registered nurses (RNs) seeking other employment. LOCAL PROBLEM: In 2020, the RN turnover rate was 8%, with postpandemic turnover projected to reach 13%. METHODS: The Measure of Moral Distress for Health Care Professionals (MMD-HP) was used to measure the frequency and level of RNs' MD. RESULTS: t tests showed significant differences for 16 of 27 MMD-HP items in RN intent to leave. RNs had 2.9 times the odds of intent to leave (P = .019) due to perceived issues with patient quality and safety and 9.1 times the odds of intent to leave (P < .001) due to perceived issues with the work environment. Results explained 40.3% of outcome variance. CONCLUSIONS: MD related to work environment or patient quality and safety were significant factors in RN intent to leave their position.


Assuntos
COVID-19 , Recursos Humanos de Enfermagem no Hospital , Emprego , Humanos , Satisfação no Emprego , Princípios Morais , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
2.
Front Public Health ; 9: 756281, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34796161

RESUMO

Despite the possible social implications of the coronavirus disease 2019 (COVID-19), previous studies of the extended parallel processing model (EPPM) in the context of COVID-19 overlooked the emotional aspects when processing fear-inducing COVID-19-related messages. Drawing upon the moral foundation theory (MFT), this study aimed to (a) apply EPPM in the Korean COVID-19 context, (b) introduce MFT and explain why moral intuitions can be related to the processing of COVID-19 messages, and (c) examine the moderating role of moral intuitions in the EPPM model. Based on the theoretical backgrounds, this study tested EPPM hypotheses and also tested whether moral intuition can moderate the relationship between perceived self-efficacy, perceived threat, fear of COVID-19, and health compliance behavioral intention. This study conducted an online survey using measurements of perceived self-efficacy, perceived threat, MFQ-20, fear of COVID, and health compliance. Our study showed three main findings. First, our study found the main effects of (a) self-efficacy on health compliance behavioral intention and (b) perceived threat on health compliance behavioral intention. Second, our study found that morality moderated the main effects of self-efficacy or perceived threat and also moderated EPPM interaction on fear of COVID. Third, the moderation of morality in the relationship between self-efficacy and health compliance behavioral intention showed that health compliance intention decreased as morality increased. Our findings suggest that people can consider COVID-19 as a social and moral issue that involves protecting others.


Assuntos
COVID-19 , Intuição , Humanos , Princípios Morais , República da Coreia , SARS-CoV-2
3.
Healthc Q ; 24(3): 18-22, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34792443

RESUMO

This article weighs three important moral and ethical considerations for leaders in healthcare: their obligations to society, their privilege as leaders and how value goes beyond a simple cost analysis. Leaders highly motivated by the bottom line have avoided the long overdue action on moral and ethical considerations critical to a more just and fairer society. Leaders are now being tasked to develop strategies for health equity, anti-oppression, anti-racism, social justice, diversity, equity and inclusiveness, community engagement, the social determinants of health and environmental accountability, and to demonstrate that their disruptive work adds more value to society than what can be measured in spreadsheet metrics.


Assuntos
Equidade em Saúde , Liderança , Humanos , Princípios Morais , Justiça Social , Responsabilidade Social
4.
Perspect Biol Med ; 64(4): 494-510, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840153

RESUMO

Bioethics has largely neglected the Anthropocene and its ethical challenges. This essay asks which ethical norms will serve us well in the face of the coming climate catastrophe. It sketches the climate changes likely for the year 2031 and offers six adaptive maxims, drawn from bioethics work in ICUs and hospices, to guide us through the devastation and transition following environmental and social collapse. These six maxims are: work hard to grasp the immensity of the change; cultivate radical hope; have a line in the sand; appreciate the astonishing opportunity of life at this time; train your body and mind; and act for the future generations of all species. Because we are already in an environmental collapse and the beginnings of social collapse, these maxims are relevant today as well as for the future.


Assuntos
Bioética , Planetas , Humanos , Princípios Morais
5.
Perspect Biol Med ; 64(4): 511-540, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840154

RESUMO

The Ethics of Environmentally Responsible Health Care (2004) argued that the obligation to protect nature must be a core principle of bioethics and that the environmental harm of health-care practices should be taken seriously. In the two decades since, the accelerating pace of climate change and environmental decline has strengthened the moral case for reducing the environmental costs of health care. Nevertheless, mainstream bioethics has until recently neglected these vital issues. In response, a field of clinical environmental bioethics is emerging that applies concepts and measures of sustainability to such key clinical ethical issues as humanizing technology, setting limits, caring for the dying, respecting patient wishes, and allocating resources justly. Bioethical analysis of these and other issues can support just and humane health-care adaptation to climate change. Health-care adaptation in turn plays an important role in helping communities and nations adapt to the inevitable forward march of climate change. This essay offers two recommendations: (1) establish a climate transition commission for health-care adaptation to climate change with bioethics participation, and (2) strengthen advocacy for health-care reform by uniting it with climate activism.


Assuntos
Bioética , Ética Clínica , Temas Bioéticos , Mudança Climática , Ética , Humanos , Princípios Morais
6.
Perspect Biol Med ; 64(4): 541-556, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840155

RESUMO

In her book The Lost Art of Dying: Reviving Forgotten Wisdom (2020), Lydia Dugdale claims that a deep cultural forgetting process underlies contemporary society's impoverished views of, and practices surrounding, death and dying. Her thesis, and the cultural developments that trace this story of widespread forgetting, offer insight into how medical trainees come to participate in such impoverished views and practices, to the detriment of themselves and the patients they serve. Through better understanding the tacit metaphysical and ethical forces that contribute to this process, trainees might better appreciate the insidious power of such forces on their moral development. Moreover, by turning to traditioned communities outside of medicine and to patients themselves, medical trainees may find the moral resources to reimagine their roles both in providing care and attending to their own mortality.


Assuntos
Princípios Morais , Feminino , Humanos
7.
Laeknabladid ; 107(12): 590-596, 2021 Dec.
Artigo em Islandês | MEDLINE | ID: mdl-34821575

RESUMO

INTRODUCTION: A survey of the experience of Icelandic medical candidates, general physicians, and specialty physicians of clinical work, aimed to show how the working environment affects doctors' moral character and experience of support, well-being and expectations. For comparison, results of a British survey with the same questions for specialty physicians were used. MATERIAL AND METHODS: A total of 89 physicians answered 15 questions. Statistical comparison was made between results from topical clusters of questions. RESULTS: The results show a significant problem in work conditions of Icelandic doctors. Their experience is rated low in the second quarter (2,1 - 3,0) on a numerical scale of how the environment thwarts professional character and of lack of support. In comparison with British specialists, their experience is similar but slighly better regarding supportiveness. Icelandic candidates and general physicians experience significantly more stress, less support and autonomy in their work than specialists. Compared to the British, the experience of Icelandic specialists was more positive about professional autonomy and emotional attachment to the work. Our survey shows for the first time the effect of the working environment on professional virtues of Icelandic doctors. DISCUSSION: These findings resonate with the literature that the moral character of doctors contributes to satisfaction, flourishing and experience of meaningfulness. They substantiate views raised by Icelandic physicians about tremendous work stress and scarcity of staff. The survey demonstrates the doctors' experience of work-related challenges and provides reasons for society to improve their working conditions to enable them to live up to their ideals.


Assuntos
Clínicos Gerais , Princípios Morais , Atitude do Pessoal de Saúde , Humanos , Islândia , Inquéritos e Questionários
8.
Hist Philos Life Sci ; 43(4): 119, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34787736

RESUMO

This article is the first one to offer an investigation, from a biological perspective, of "natural philia" or "kin-based" philia (commonly translated as "friendship") in Aristotle's practical philosophy. After some preliminary considerations about its place in Aristotle's ethical treatises, the discussion focuses on Aristotle's biology. Here we learn that natural philia, couched in terms of a biological praxis rather than a trait of character, is widespread in the animal kingdom, although in different ways and to varying degrees. To account for such differences, Aristotle establishes a Scala Philiae in two different biological texts-Historia Animalium and Generation of Animals-where natural bonds in animals are classified in view of their strength and duration. Each level of Aristotle's Scala is examined. Finally, the argument returns to Aristotle's ethical and political texts, drawing greater attention to the biological mechanisms that underlie natural philia in human beings. I conclude that natural philia provides one fundamental biological building-block of Aristotle's ethics and politics.


Assuntos
Princípios Morais , Filosofia , Animais , Humanos
9.
Tijdschr Psychiatr ; 63(10): 703-706, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757607

RESUMO

BACKGROUND: New technological possibilities for early identification of (risk) of later antisocial behavior. AIM: To raise the question whether, or under what conditions, early identification is in the best interest of the (young) child. METHOD: Ethical analysis in which fetal alcohol spectrum disorder (FASD) is central. RESULTS: The bioethical debate on 'moral bio enhancement' investigates the ethical desirability of practical applications of neurobiological and behavioral genetic knowledge of moral and immoral human behavior. One of those applications is the early detection of (risk) of behavioral disorders based on biomarkers. It seems plausible that early detection makes it possible to organize appropriate help. However, if effective interventions are not available, it is even more important to consider the disadvantages of focusing on future risk and any stigmatizing effects. CONCLUSION: We conclude that in the absence of effective interventions, broad social prevention is preferable to prevention based on screening for individual risk factors.


Assuntos
Transtorno da Personalidade Antissocial , Princípios Morais , Transtorno da Personalidade Antissocial/diagnóstico , Criança , Humanos
10.
Tijdschr Psychiatr ; 63(10): 699-702, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757606

RESUMO

BACKGROUND: Due to rapid digitalization, an increasing amount of data is available in healthcare settings; big data and artificial intelligence (AI) have also made their appearance. AIM: To provide insight into various ethical dilemmas that need to be considered when applying big data in clinical practice. METHOD: Description and analyses of the ethical aspects associated with the use of clinical data in the context of psychiatric care. RESULTS: Various ethical aspects play a role in four phases; data collection, analysis, dissemination and application of results. In order to use clinical data and AI in a responsible manner, these aspects must be taken into account. CONCLUSION: The use of big data and AI in healthcare should aim to stimulate learning and improving care together with patients and professionals. Big data and AI should not be seen as the holy grail, but as a supporting tool in healthcare - a field in which many of the aspects that play a role in clinical care cannot be converted into measurable data.


Assuntos
Inteligência Artificial , Atenção à Saúde , Humanos , Princípios Morais , Psicoterapia
11.
Tijdschr Psychiatr ; 63(10): 717-722, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757610

RESUMO

BACKGROUND: In the new Compulsory Mental Health Care Act (Wvggz), patient competence has a more central position. AIM: To describe the new position of patient competence in the Wvggz and to reflect on related moral questions. METHOD: Discussion of relevant legal texts and publications. RESULTS: In case of incompetency of a patient, a surrogate decision-maker has to attempt what decision the patient would make if he or she were competent. A new element in the Wvggz is that grandparents and grandchildren can also act as surrogate decision-makers. A competency judgment is mandatory in every decision on involuntary treatment, with the exception of involuntarily commitment. Competent refusal of care has to be respected, unless the patient is in a life threatening situation or there is a risk of other people getting harmed. CONCLUSION: The question is whether the changed position of patient competence in the new law will contribute to the aim of maintaining and enhancing patients' autonomy. Due care in competency judgments is complex and remains important.


Assuntos
Tratamento Involuntário , Psiquiatria , Feminino , Humanos , Princípios Morais
12.
Tijdschr Psychiatr ; 63(10): 723-726, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757611

RESUMO

BACKGROUND: Professionals in forensic psychiatry regularly face moral issues. For example, they have to make trade-offs between the treatment of a patient and society's security. AIM: To provide insight into some difficult, specifically forensic, dilemmas and show that forensic professionals benefit from structural ethics support. METHOD: Describing that ethics support, such as moral case deliberation, can provide support in making moral choices in forensic psychiatry. RESULTS: By participating in moral case deliberation, considerations are better substantiated and employees learn from and with each other. CONCLUSION: Moral case deliberation supports staff in jointly reflecting on moral dilemmas of the (forensic) workplace.


Assuntos
Psiquiatria Legal , Princípios Morais , Humanos
13.
Tijdschr Psychiatr ; 63(10): 731-736, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757613

RESUMO

BACKGROUND: Subgroups of patients with severe mental illness are underrepresented in scientific research. One of the possible causes is the fact that in these patient groups barriers may exist to the giving of competent informed consent. AIM: Describing the ethical dilemmas that may occur when conducting research with these patient groups. METHOD: We present an overview of the Dutch legislation and regulation concerning participation in scientific research, and discuss the ethical dilemmas that arise in the mentioned patient groups. We present four directions for solutions. RESULTS: In research with these patient groups more attention is needed for the explicit assessment and enhancement of competence. For the subgroup that is persistently incompetent, the possibilities of doing research with existing patient data without informed consent, need further exploration. CONCLUSION: Further legislative development is needed for research with patients with severe mental illness who are persistently incompetent. Herein, it is crucial to involve ethicists and organizations representing patients' and relatives' perspectives.


Assuntos
Consentimento Livre e Esclarecido , Transtornos Mentais , Humanos , Princípios Morais
14.
Tijdschr Psychiatr ; 63(10): 737-740, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757614

RESUMO

BACKGROUND: Scarcity and limitations determine the context of care and have an impact on our general experience of good care. This appears in a continuous experience of deficit in, for example, lack of time, shortage of people, long waiting lists, lack of money, possibilities, breathing space, evolution and improvement. It is a major cause of moral distress in health professionals, clients and their families and friends, which leads to fundamental questions and doubts regarding the meaningfulness of the care process as a whole. AIM: To inquire into the phenomenon of limited care and describe it from an ethical perspective. METHOD: Consideration of ethical aspects of good care within the context of scarcity and limitations. RESULTS: When looked at from the two-fold dynamics of scarcity and the three stages of the 'Doing the Best I Can Do'-model, we can come to a meaningful approach to ethical efficiency within care practices. CONCLUSION: Giving room to experiences of moral distress as a result of scarcity and limitations, entering the dialogue about this, making them negotiable, within a context of authentic reflection and intervision, carefully choosing the most important priorities from a care ethics point of view, are all important and essential dimensions of a constructive way of dealing with scarcity and limitations within daily care practices as well as in the long run.


Assuntos
Pessoal de Saúde , Princípios Morais , Emoções , Humanos
15.
Acta Biomed ; 92(S6): e2021461, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34739455

RESUMO

Background and aim of the work .The fluctuation from day to day within a working week of moral distress, coping, and general health of frontline healthcare workers (HCWs) in facing the challenges of the COVID-19 pandemic has been poorly studied. This study described the weekly fluctuation from day to day of moral distress, coping, and general health in frontline HCWs who worked during the first epidemic wave (May-June 2020) of the COVID-19 pandemic in Italy. METHODS: This study has an intensive longitudinal design, and a convenience sampling procedure was employed to enroll physicians, nurses, allied health professions, and healthcare assistants. Data collection was performed using diary encompassed four sections: a socio-demographic form (required only at the baseline data collection) and three scales to assess moral distress, coping, and general health. RESULTS: Results confirmed poor perceived health and mild moral distress in frontline HCWs, especially in HCWs with offspring, during the initial phases of the COVID-19 pandemic and the stability of their daily perception over a working week regarding moral distress, general health, and avoidant coping strategy, while approach coping strategy reported a slight fluctuation over time. CONCLUSIONS: Accordingly, on the one hand, these results confirm that outcomes regarding mental health and moral distress are pretty stable and provide insights, on the other hand, regarding the possible organizational interventions to support approach coping strategy as it seems more susceptible to variation over time.


Assuntos
COVID-19 , Pandemias , Adaptação Psicológica , Surtos de Doenças , Pessoal de Saúde , Humanos , Princípios Morais , SARS-CoV-2
16.
Nursing ; 51(12): 39-43, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34807861

RESUMO

ABSTRACT: ED nurses are at high risk for developing moral distress during the COVID-19 pandemic. Predisposing factors include limited resources, inadequate staffing, PPE shortages, and caring for vulnerable populations. This article explores personal and organizational strategies to help nurses cope with moral distress.


Assuntos
COVID-19 , Adaptação Psicológica , Humanos , Princípios Morais , Pandemias , SARS-CoV-2
17.
Harefuah ; 160(11): 710-716, 2021 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-34817134

RESUMO

INTRODUCTION: As the coronavirus pandemic emerged in late 2019, a task force was founded in the Sheba Medical Center and began preparing for the arrival of the pandemic to Israel. Several wards were put in charge of isolated COVID-19 patients. A new intensive care unit was formed for the most critical COVID-19 patients, requiring mechanical ventilation and multi-organ treatment. The Corona ICU began operating in March 2020, with a multi-disciplinary team, gathered from ICU units, an internal medicine ward, an anesthesiology department, social workers and psychologists. Simultaneously, the routine medical center functions in non-corona sections were maintained, as much as possible. The coronavirus pandemic entails challenges of many aspects: an unfamiliar pathogen causing an unknown illness, a necessity for social distancing, ambiguity regarding the risk factors for contamination and illness severity, and medical crews put at risk. Consequently, the pandemic involves ethical, social, economic and moral aspects, affecting the medical crew members and system, the patients and their families, and our society as a whole. In this article we review our joint experience in the Sheba Medical Center Corona ICU, of the medical, ethical and moral dilemmas that emerged from the first COVID-19 wave.


Assuntos
COVID-19 , Pandemias , Humanos , Unidades de Terapia Intensiva , Princípios Morais , SARS-CoV-2
18.
Am J Crit Care ; 30(6): 461-465, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34719711

RESUMO

BACKGROUND: Nurses experience moral distress when they feel disempowered or impeded in taking the ethically right course of action. Research suggests an inverse relationship between moral distress and empowerment. In the intensive care unit, providing palliative care services may reduce moral distress because palliative care is often provided in situations that give rise to moral distress. OBJECTIVE: To evaluate the effect of nurses' use of a palliative care screening tool on their moral distress and perceptions of empowerment. METHODS: A pretest-posttest pilot study was conducted involving day-shift medical intensive care unit nurses. The nurses administered a palliative care screening tool to their assigned patients daily for 8 weeks and communicated the results to an attending physician or fellow. Demographic information was collected, along with data on nurses' moral distress and perceptions of structural and workplace empowerment before and after the intervention. Moral distress was evaluated using the Moral Distress Scale-Revised. Perceptions of structural and workplace empowerment were quantified using the Conditions for Work Effectiveness Questionnaire-II and the Global Empowerment Scale, respectively. RESULTS: Preintervention and postintervention surveys were completed by 17 nurses. Paired-sample t tests revealed a significant decrease in the frequency of moral distress (t16 = -2.22, P = .04) and a significant increase in workplace empowerment (t16 = -2.75, P = .01). No significant changes in moral distress intensity or structural empowerment were found. CONCLUSION: Nurses' sense of empowerment and the frequency of moral distress are favorably affected by active participation in assessing and communicating patients' palliative care needs.


Assuntos
Princípios Morais , Enfermeiras e Enfermeiros , Atitude do Pessoal de Saúde , Humanos , Percepção , Projetos Piloto , Estresse Psicológico , Inquéritos e Questionários
19.
Am Psychol ; 76(5): 812-814, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34780222

RESUMO

This award recognizes a distinguished career and enduring contribution to the practice of psychology. Samuel Knapp's long, distinguished career has resulted in demonstrable effects and significant contributions to best practices in professionalism, ethics education, positive ethics, and legislative advocacy as Director of Professional Affairs for the Pennsylvania Psychological Association and as an ethics educator extraordinaire. Dr. Knapp's work has modified the way psychologists think about professional ethics through education, from avoiding disciplinary consequences to promoting overarching ethical principles to achieve the highest standards of ethical behavior. His focus on respectful collaboration among psychologists promotes honesty through nonjudgmental conversations. His Ethics Educators Workshop and other continuing education programs have brought together psychology practitioners and faculty to focus deeply on ethics and resulted in the development of the APA Ethics Educators Award. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Distinções e Prêmios , Comunicação , Ética Profissional , História do Século XX , História do Século XXI , Princípios Morais , Pennsylvania , Psicologia
20.
Eur J Psychotraumatol ; 12(1): 1984667, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34777712

RESUMO

Background: Research is urgently needed to understand health care workers' (HCWs') experiences of moral-ethical dilemmas encountered throughout the COVID-19 pandemic, and their associations with organizational perceptions and personal well-being. This research is important to prevent long-term moral and psychological distress and to ensure that workers can optimally provide health services. Objective: Evaluate associations between workplace experiences during COVID-19, moral distress, and the psychological well-being of Canadian HCWs. Method: A total of 1362 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in an online survey. Participants completed measures reflecting moral distress, perceptions of organizational response to the pandemic, burnout, and symptoms of psychological disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Results: Structural equation modelling showed that when organizational predictors were considered together, resource adequacy, positive work life impact, and ethical work environment negatively predicted severity of moral distress, whereas COVID-19 risk perception positively predicted severity of moral distress. Moral distress also significantly and positively predicted symptoms of depression, anxiety, PTSD, and burnout. Conclusions: Our findings highlight an urgent need for HCW organizations to implement strategies designed to prevent long-term moral and psychological distress within the workplace. Ensuring availability of adequate resources, reducing HCW risk of contracting COVID-19, providing organizational support regarding individual priorities, and upholding ethical considerations are crucial to reducing severity of moral distress in HCWs.


Assuntos
COVID-19 , Pessoal de Saúde , Saúde Mental/tendências , Princípios Morais , Angústia Psicológica , Local de Trabalho/psicologia , Adulto , Ansiedade/psicologia , Esgotamento Profissional/psicologia , Canadá , Depressão/psicologia , Feminino , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Inquéritos e Questionários
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