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【Objective:】 To understand the true experience and feelings of nurses in the intensive care unit on the clinical experience of moral dilemmas, and to provide strategies for reducing the impact of moral dilemmas. 【Methods:】 Thirteen nurses in the intensive care unit were interviewed face to face by descriptive nature research method. The traditional content analysis method were used to compute the data, and the coding, categorization and topic extraction were carried out cyclically until the data were saturated and the interview was stopped. 【Results:】 The moral dilemma experience of nurses in the intensive care unit had the following three themes: negative psychological experience, negative behavior experience, and life and death cognitive experience. 【Conclusion:】 Nurses in the intensive care unit will have complex negative experiences after experiencing moral dilemmas. This negative experience threatens nurses’ mental health. Nursing managers should pay attention to the impact of moral dilemmas on nurses and formulate effective measures, thereby ensure nursing safety and maintain the healthy development of the nursing team.
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【Objective:】 To understand the moral dilemma, coping style of frontline nurses and their correlation during the COVID -19. 【Methods:】 From March to April, 2021, 651 nurses working in designated hospitals for COVID -19 were selected by convenient sampling, and the Chinese version of Moral Distress Scale-Revised (MDS-R) and Chinese version of Coping Style Questionnaire (CSQ) were used for investigation. 【Results:】 Frontline nurses’ MDS-R score was 91.0, "value conflicts" was the moral dilemma with the highest frequency and intensity, more than half (51.0%) of the respondents had considered leaving their position because of moral dilemma. "Problem solving" and "seeking for help" were the major coping strategies adopted by the nurses. Nurses who directly provide medical services for COVID -19 patients, dissatisfied with hospital-related training and adopted negative coping strategies had higher moral dilemmas than other nurses. 【Conclusion:】 The moral dilemma of frontline nurses is at a high level during the period of epidemic prevention and control. Nursing managers should pay attention to guiding and helping nurses to establish positive coping styles and improve their ability to respond to major public health emergencies.
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In view of the current norms and demands of human gene editing technology at home and abroad, the paper explained that the regulatory difficulties faced by human gene editing technology were due to the conflict between economic interests and moral bottom line by constructing a game model in a hypothetical way. On this basis, the ideas of the supervision mode of human gene editing technology were put forward: establish unified international standards based on the country as the main body, enact more stringent and effective laws, to jointly deal with the behavior of genetic manipulation of human gametes, zygotes and embryos for the purpose of reproductive, and ensure the normalization and legalization of gene editing technology to avoid technology abuse.
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Medical internship is a yearlong experience that is physically, mentally, and emotionally exhausting. After five years as students, the interns finally get close to achieving what they have always dreamt of. Most of the fundamental clinical knowledge and skills that a student learns are acquired during their internship. For the first time, students gain financial freedom, recognise the importance of a white coat, and are recognised as doctors. Internship helps a student to realise the mechanics of how a hospital operates, how patients are treated, how crises are managed, and most crucially, how to think and work productively in a chaotic yet effective atmosphere. Each obstacle encountered serves as a training ground. The key dilemmas are whether to prioritise learning clinical skills or study for the post-graduation entrance examinations, and which specialty to opt for. Conscientious mentors are vital to this whole process.
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The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.
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Objective:To explore the correlation between nurses′ workplace adaptability, moral dilemma and resilience after suffering workplace violence in emergency department, in order to provide reference about improving the workplace adaptability and formulating intervention.Methods:A cross-section survey was conducted, we selected 248 nurses who had suffered workplace violence in the emergency department of five tertiary hospitals in Qingdao from January 2022 to January 2023 by convenient sampling method, and used self-designed general information questionnaire, moral dilemma scale, resilience evaluation scale for medical staff and nurses′ workplace adaptability scale to conduct a questionnaire survey on nurses who had suffered workplace violence, and found out the factors affecting their workplace adaptability.Results:The score of workplace adaptability of 248 nurses who had suffered workplace violence was (39.37 ± 12.77) points. Univariate analysis showed that education, length of emergency service, department or social part-time job, professional title, number of night shifts and sleep condition were the influencing factors of workplace fitness for emergency nurses ( t/ F values were -12.72 to 132.15, all P<0.05). The correlation analysis showed that the nurses′ workplace adaptability after workplace violence was negatively correlated with the scores and total scores of all dimensions of moral dilemma ( r values were -0.725 to -0.194, P<0.05), and positively correlated with the scores and total scores of all dimensions of resilience ( r values were 0.135 to 0.732, P<0.05). Multi-factor results showed that education background, department/social part-time job, working years, professional title, sleep status, moral dilemma and resilience were the influencing factors of nurses′ workplace adaptability after workplace violence ( t values were -9.25 to 15.25, P<0.05). Conclusions:Nurses with specialized education, emergency service for 1-3 years, no department/social part-time job, primary professional title, sleep disorder, higher degree of moral dilemma and low level of resilience have low occupational adaptability. Nursing managers should focus on such nurses and improve their occupational adaptability.
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Objective:To systematically evaluate the qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus, so as to provide reference for the subsequent formulation of intervention strategies.Methods:The qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus in the Cochrane Library, CINAHL, EMbase, PubMed, PsycINFO, ProQuest, Web of Science, China National Knowledge Internet, Wanfang, VIP and Chinese Biomedical Database were searched from inception to May 2022. The JBI Critical Appraisal Tool for qualitative studies in Australia (2016) was used to evaluate the literature quality, and research results were summarized and integrated by integrating methods.Results:A total of 13 studies were included, 56 themes were extracted, and they were summarized into 9 categories, forming 3 integrated results as following, lack of personalized and professional information on blood glucose management, worring about the influence of blood glucose management on the health of mothers and children, conflict between daily life and blood glucose management plan.Conclusions:Health care workers should provide gestational diabetes mellitus patients with adequate personalized professional information support on blood glucose management to facilitate scientific decision-making during pregnancy, and also analyze the benefits and risks of different decisions for patients to help them make the best decision and strengthen their external support system to help them implement blood glucose management decisions.
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Public health emergencies not only bring great challenges to the conventional public health system, but also face some ethical dilemmas in the governance process. For example, the compulsory isolation measures affect the normal lives of some citizens, the normal medical treatment of non-epidemic patients may be constrained by complex governance environments, and the relationship between patient privacy protection and the public’s right to know needs to be deeply considered and balanced. To respond the ethical dilemmas in public health emergencies, it is necessary to explore more effective new ideas and methods under ethical concepts, combine with ethical needs in the governance of public health emergencies, comprehensively improve governance capabilities starting from the basic principles and behavioral standards of governance, with a view to providing more effective ethical support for the governance of public health emergencies.
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As one of the important contents and links of doctor-patient communication, the quality of breaking bad news will affect the development of doctor-patient relationship. Bad news informed not only involves the feedback of clinical medical diagnosis results, but also involves special knowledge training and clinical experience accumulation, as well as ethical, legal, social custom and other factors. At present, it is still a difficult problem troubling physicians in the medical environment. From the different perspectives of doctors, patients and family members, this paper sorted out the domestic and international status of breaking bad news, revealed its internal dilemmas, and summarized the informing strategies to cope with these dilemmas, with a view to providing references for hospital managers and medical staff to earlier identify and properly inform, helping both doctors and patients to get rid of the dilemma of notification and improve the doctor-patient relationship.
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【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.
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The retention of emergency patients is a common problem faced by hospitals worldwide. In addition to medical problems, social, family, economic and other problems will also cause patients to stay in the emergency department. It not only brings challenges to patients’ own disease treatment and hospital operation and management, but also brings ethical dilemmas. Taking the service cases of medical social workers who involved in stranded patients in Shanghai E Hospital as an example, this paper analyzed 20 service records and interviews with social workers receiving cases, and combed the ethical dilemmas faced by medical social workers in the process of involving in emergency stranded patients. It was found that medical social workers faced many ethical dilemmas in the process of involving in emergency stranded patients, such as interpersonal relations and relevant legal regulations, the right to life and health and the right to informed consent, the self-determination of case owners and the allocation of medical resources. In this regard, it is suggested to solve the problem of patient retention by advocating the improvement of relevant systems and policies, building cooperative teams to smooth referral channels, strengthening education, and promoting family shared decision-making.
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The positive role of hospice social work in responding to the needs of terminal cancer patients and their families has been highlighted, and has also triggered discussions on localized ethical issues. Taking the casework of terminal cancer patients as an example, this paper analyzed the specific manifestations and causes of ethical dilemmas in the practice of hospice social work, and then provided ideas for coping with them. It was found that hospice care casework workers face four ethical dilemmas, including quality of life dilemmas, emotional boundaries dilemmas, power relationship dilemmas, and cultural respect dilemmas. Service managers can enhance the ethical issue response ability of front-line workers by improving the collaborative service mechanism between medical and social institutions, constructing a whole-process professional supervision system, conducting skills training for caring social workers, and expanding patient and family life education services. The ethical dilemmas in hospice social work service are localized, and will affect the service effect. The response to these issues requires the joint participation of the government, society, universities, hospitals, and front-line social workers.
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Ethical dilemmas commonly exist among nurses during the epidemic prevention and control of major infectious diseases, which can affect their physical and mental health and nursing quality. This paper reviewed the ethical dilemmas of nurses in the epidemic prevention and control of major infectious diseases from four aspects, including concepts, current situation, evaluation tools, and influencing factors, with a view to raising the attention of nurses, nursing administrators, and health management organizations to the ethical dilemmas of nurses in the epidemic prevention and control of major infectious diseases, and providing theoretical references for further formulating strategies. In terms of ethical dilemmas research of nurses during the prevention and control of major infectious diseases, domestic and foreign studies mostly used scales and qualitative interviews to investigate. Research has found that the ethical dilemmas of nurses during the period include the ethical dilemma of visiting restrictions, the ethical dilemma of fair allocation of scarce resources, and the ethical dilemma of nurses’ rights and obligations. The main influencing factors include demographic factors, psychological factors, risk perception, and social support. It is recommended to develop suitable assessment tools from the perspective of ethical in the future, timely grasp the current situation of ethical dilemmas of nurses during the prevention and control of major infectious diseases, and deeply explore influencing factors.
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With the arrival of aging, various industries in society are facing great pressure, especially higher requirements for the medical and nursing industries. The integrated eldercare services with medical care breaks through the traditional endowment pattern and integrates medical treatment, elderly care, rehabilitation, and nursing. However, many factors hinder the development of this model at present, and it requires the cooperation of the country and various departments to improve. From the perspective of a Healthy China, based on the release and implementation of policies such as the "Healthy China 2030" Plan Outline and the "Healthy China Action (2019-2030)" , this paper briefly summarized the current status and existing problems of the development of integrated eldercare services with medical care in China, and put forward rectification suggestions, aiming to provide reference to build a new endowment pattern of integrated eldercare services with medical care with Chinese characteristics.
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Modern medical model advocates holistic medical treatment and holistic care, which transforms the concern about diseases in traditional medicine into the concern about people in modern medicine. Narrative medicine, as a tool for practicing holistic medical treatment and holistic care, runs through the whole process of patients’ entering medical procedures. It not only meets the needs of patients’ disease-related narratives, but also provides a new and more comprehensive way of communication for both doctors and patients, which is helpful to promote the comprehensive recovery of patients and the healthy development of doctor-patient relationship. At present, narrative medicine is facing some difficulties in the process of local practice in China. Social work, as one of the main bodies of multi-disciplinary and inter-professional cooperation in the medical field, can give full play to its professional advantages to help the new exploration of narrative medicine practice in China.
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En Medicina, intereses enfrentados a los valoressuperiores que sustentan su práctica con frecuencia nossumergen en desafíos éticos que debemos afrontar: Entretales intereses destacan los de carácter político, económico ymediático. En el presente ensayo se presentan y discuten trescasos de relevancia histórica y se analizan las cuestiones moralesconcernientes a cada uno(AU)
In medicine, interests opposed to the higher values that support its practice oîen immerse us in ethical challengesthat we must face: Among such interests, those of a political,economic and media nature stand out. In this essay three casesof historical relevance are presented and discussed and the moralquestions concerning each one are analyzed(AU)
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Conflict of Interest , Ethics, Professional , Politics , General Practice , Occupational GroupsABSTRACT
Catecholamine-secreting tumors occur with equal frequency in men and women, primarily in the fourth and fifth decades. The associated hypertension may be sustained or paroxysmal, and patients who are diagnosed in the presymptomatic stage may have normal blood pressure. These tumors can be lethal unless they are diagnosed early and treated appropriately. Numerous disorders can mimic pheochromocytoma, leading to diagnostic dilemma. Described here is a case which was misdiagnosed for 5 years as anxiety, panic attacks, cervical spondylosis, vasomotor symptoms of menopause, arrhythmia and even acute coronary syndrome. Therefore, enhanced adrenal awareness is the need of the hour, to catch this “great masquerade”.
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Synchronous malignancies involving acute leukemia and a solid organ are rare. Bleeding per rectum is a common manifestation of acute leukemia during induction chemotherapy and might mask the presence of synchronous colorectal adenocarcinoma (CRC). Here we present two rare cases of acute leukemia with synchronous CRC. We also review previously reported synchronous malignancies to investigate demographics, diagnosis, and treatment modalities. Management of these cases requires a multispecialty approach
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El cuidado del equipo interprofesional de salud es un factor indispensable para que el sistema sanitario funcione de manera estable y resi-liente, especialmente cuando la presión se vuelve extrema. La pandemia, además de poner a prueba los sistemas de salud y sus actores, ha dejado algunas dudas respecto a los alcances del profesionalismo, frente a las demandas y expectativas que la sociedad tiene. Para efectos de la presente revisión, el concepto de profesionalismo en tiempos de crisis incluye controversias y dilemas que surgen en la relación con la sociedad, ética profesional y responsabilidad sobre el autocuidado. El compromiso y la resiliencia para garantizar el cuidado del paciente son evidentes en el actuar de los profesionales de la salud; sin embargo, en ocasiones esto ha ido en detrimento de su propia integridad física y moral. La agenda de salud en México está en deuda con médicos, residentes y profesionales de enfermería, una vía para saldarla es a través del fortalecimiento de las instituciones, la definición de políticas y normativas institucionales que promuevan el autocuidado y, entre otras medidas, el establecimiento de sistemas que no obliguen a aquéllos a convertirse en héroes enfrentados a los riesgos de una crisis.
The care of the interprofessional health team is an indispensable factor for the health system to function in a stable and resilient manner, especially when the pressure becomes extreme. In addition to putting health systems and their actors to the test, the pandemic has left some doubts about the scope of professionalism in the face of society's demands and expectations. For this review, the concept of professionalism in times of crisis includes controversies and dilemmas that arise in the relationship with the community, professional ethics, and responsibility for self-care. Commitment and resilience to ensure patient care are evident in the actions of health professio-nals; however, at times, this has been to the detriment of their own physical and moral integrity. The health system in Mexico is indebted to physicians, residents, and nursing professionals, and a way to settle it is through the strengthening of institutions, the definition of institutional policies and regulations that promote self-care, and, among other measures, the establishment of systems that do not force them to become heroes facing the risks of a crisis.
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Resumo O objetivo do estudo é analisar problemas morais e/ou éticos vivenciados por membros de comitês de ética em pesquisa durante suas atividades e as estratégias utilizadas para solucionar esses problemas. Trata-se de pesquisa de abordagem qualitativa, com participação de 39 membros que atuavam em comitês em Salvador/BA, Brasil. Os dados foram coletados em outubro de 2020 por questionário on-line autoaplicado na plataforma Google Forms. Os resultados evidenciaram: vivências de conflitos de interesses e de valores, bem como dilemas; e utilização de trocas de experiências e compartilhamento de ideias e opiniões como estratégias para solucionar esses problemas. Conclui-se que os membros desses comitês vivenciam problemas morais e/ou éticos e buscam solucioná-los por meio de estratégias que favorecem o desenvolvimento de pesquisas conforme critérios éticos e metodológicos adequados.
Abstract The objective of the study is to analyze moral and/or ethical issues experienced by members of research ethics committees when performing their activities and the strategies used to deal with those issues. This is a qualitative study with 39 individuals that participated in committees in Salvador, Bahia, Brazil. Data were collected in October 2020 using a self-administered online questionnaire developed using Google Forms. Results showed that participants underwent conflicts of interests and values, and also faced dilemmas, and the strategies used to deal with those issues were exchanging of experiences and sharing of ideas and opinions. It is concluded that members of such committees experience moral and/or ethical issues and seek to deal with them via strategies that favor the development of research according to appropriate ethical and methodological criteria.
Resumen El objetivo del estudio es analizar los problemas morales o éticos experimentados por los miembros de los comités de ética de investigación durante sus actividades y las estrategias que utilizan para resolver dichos problemas. Se trata de una investigación de enfoque cualitativo, con la participación de 39 miembros que actuaban en comités en Salvador, Bahía, Brasil. Los datos se recopilaron en octubre del 2020 por medio de un cuestionario en línea autoadministrado en la plataforma Google Forms. Los resultados mostraron experiencias de conflictos de intereses y valores, así como dilemas; y el intercambio de experiencias, ideas y opiniones como estrategias para solucionar dichos problemas. Se concluye que los miembros de estos comités experimentan problemas morales o éticos y tratan de solucionarlos mediante estrategias que favorezcan el desarrollo de investigaciones de acuerdo con criterios éticos y metodológicos adecuados.