Digital ethical reflection in home nursing care: Nurse leaders' and nurses' experiences.

BACKGROUND: Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. AIM: The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care. RESEARCH DESIGN: The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. PARTICIPANTS AND RESEARCH CONTEXT: The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. ETHICAL CONSIDERATIONS: The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. FINDINGS: Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. CONCLUSION: Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses' understanding of the tool's purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work.

[What place for ethics in psychiatry?] / Quelle place pour l'éthique en psychiatrie ?

At a time when healthcare establishments are facing sensitive financial and institutional challenges, how can ethics be given a place in psychiatry? In society, ethical debates focus on surrogate motherhood, active euthanasia or assisted suicide, and embryo research. In psychiatry, the question often crystallizes around violent incidents that are hardly representative of the daily lives of professionals and patients. Militant discourse prevails over listening to the people concerned. The law requires establishments to reflect on the ethical issues raised by the reception and medical care of patients, without specifying the boundaries. Ethics in healthcare facilities focuses on care situations - what is possible or desirable - with no single theoretical model to serve as an example to follow.

Digital ethical reflection in long-term care: Leaders' expectations.

BACKGROUND: Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals' handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. RESEARCH AIM: This study aimed to explore healthcare leaders' expectations of using a digital tool for ethical reflection among their home nursing care staff. RESEARCH DESIGN: A qualitative research design with vignettes and focus group interviews was used. The data were analyzed using reflexive thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT: The sample comprised ten healthcare leaders from municipal long-term care in Norway. ETHICAL CONSIDERATIONS: Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. FINDINGS: The analysis resulted in the development of three themes representing leaders' expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. DISCUSSION: Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees' activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool's potential to ensure continuity in ethics work requires considerable organizational and leader involvement. CONCLUSIONS: This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified.

AI-assisted ethics? considerations of AI simulation for the ethical assessment and design of assistive technologies.

Current ethical debates on the use of artificial intelligence (AI) in healthcare treat AI as a product of technology in three ways. First, by assessing risks and potential benefits of currently developed AI-enabled products with ethical checklists; second, by proposing ex ante lists of ethical values seen as relevant for the design and development of assistive technology, and third, by promoting AI technology to use moral reasoning as part of the automation process. The dominance of these three perspectives in the discourse is demonstrated by a brief summary of the literature. Subsequently, we propose a fourth approach to AI, namely, as a methodological tool to assist ethical reflection. We provide a concept of an AI-simulation informed by three separate elements: 1) stochastic human behavior models based on behavioral data for simulating realistic settings, 2) qualitative empirical data on value statements regarding internal policy, and 3) visualization components that aid in understanding the impact of changes in these variables. The potential of this approach is to inform an interdisciplinary field about anticipated ethical challenges or ethical trade-offs in concrete settings and, hence, to spark a re-evaluation of design and implementation plans. This may be particularly useful for applications that deal with extremely complex values and behavior or with limitations on the communication resources of affected persons (e.g., persons with dementia care or for care of persons with cognitive impairment). Simulation does not replace ethical reflection but does allow for detailed, context-sensitive analysis during the design process and prior to implementation. Finally, we discuss the inherently quantitative methods of analysis afforded by stochastic simulations as well as the potential for ethical discussions and how simulations with AI can improve traditional forms of thought experiments and future-oriented technology assessment.

Contours of a research ethics and integrity perspective on open science.

This article argues that adopting a research ethics and integrity perspective could support researchers in operationalizing the open science guiding principle "as open as possible, as closed as necessary" in a responsible and context-sensitive manner. To that end, the article points out why the guiding principle as such provides only a limited extent of action-guidance and outlines the practical value of ethical reflection when it comes to translating open science into responsible research practice. The article illustrates how research ethics and integrity considerations may help researchers understand the ethical rationale underpinning open science as well as recognize that limiting openness is necessary or at least normatively permissible in some situations. Finally, the article briefly discusses possible consequences of integrating open science into a responsibility-centered framework and implications on research assessment.

Can a structured model of ethical reflection be used to teach ethics to nursing students? An approach to teaching nursing students a tool for systematic ethical reflection.

BACKGROUND: Nurses encounter many ethical dilemmas in their practice. The ability to make good ethical decisions is a necessary competence in healthcare professions. International studies call for development and research on various methods to teach healthcare professionals ethics. This article describes an approach for learning how to be aware of and discover ethical dilemmas. By applying experienced narratives from healthcare practice and using question guidelines from a structured ethical model, nursing students learn to discover and find possible solutions for ethical problem in their practice. AIM: The aim of this study was to describe second- and third-year nursing students' experiences by using structured ethical reflection as an approach to increase ethical awareness and deal with ethical decisions. DESIGN: This study has a descriptive exploratory design. A three-day ethics seminar was carried out to help students learn how to recognize and explore ethical dilemmas in their practice. MATERIALS AND METHODS: The data are collected from questionnaires used to evaluate the ethics seminar where 52 nursing students participated. The questionnaire contained open-ended and closed questions and was analysed using Braun and Clarke's reflexive thematic analysis. The empirical data were collected by 52 nursing students answering an evaluation questionnaire after the ethics seminar. FINDINGS: Four themes were developed: Becoming aware of ethical dilemmas, Learning ethics by discussing knowledge and experiences with other students, Increased curiosity about ethics as a subject and Understanding the importance of critical ethical reflection work in clinical practice. DISCUSSION: The process of learning how to understand the ethical principles in real-life nursing context continues progressing through the bachelor's program. Using group discussions and discussing examples of ethical dilemmas from practice help the students to a more comprehensive reflection process. CONCLUSION: The nursing students experienced video lessons, group discussions and the use of a structured reflection model as a valuable approach in learning to recognize ethical dilemmas and how to deal with real-life ethical dilemmas.

When is lack of scientific integrity a reason for retracting a paper? A case study.

OBJECTIVE: The journal received a request to retract a paper reporting the results of a triple-blind randomized placebo-controlled trial. The present and immmediate past editors expand on the journal's decision not to retract this paper in spite of undisputable evidence of scientific misconduct on behalf of one of the investigators. METHODS: The editors present an ethical reflection on the request to retract this randomized clinical trial with consideration of relevant guidelines from the Committee on Publication Ethics (COPE) and the International Committee of Medical Journal Editors (ICMJE) applied to the unique contextual issues of this case. RESULTS: In this case, scientific misconduct by a blinded provider of a homeopathy intervention attempted to undermine the study blind. As part of the study, the integrity of the study blind was assessed. Neither participants nor homeopaths were able to identify whether the participant was assigned to homeopathic medicine or placebo. Central to the decision not to retract the paper was the fact that the rigorous scientific design provided evidence that the outcome of the study was not affected by the misconduct. The misconduct itself was thought to be insufficient reason to retract the paper. CONCLUSION: Retracting a paper of which the outcome is still valid was in itself considered unethical, as it takes away the opportunity to benefit from its results, rendering the whole study useless. In such cases, scientific misconduct is better handled through other professional channels.

Literature and cinema in the training of doctors and medical humanities / La literatura y el cine en la formación del médico y las humanidades médicas

Abstract The use of literature and cinema to teach human values to medical students creates very important conceptual elements in the academic framework of medical humanities. Literary and film narratives allow students to generate an ethical, historical and epistemological reflection on the perspectives of medical practice and the doctor-patient relationship. In addition, it fosters in the students manifestations of solidarity, empathy and recognition of the human suffering of the sick. This article shows different thematic orientations and specific works that can help create and develop undergraduate courses in medical curricula. (Acta Med Colomb 2019; 44. DOI: https://doi.org/10.36104/amc.2019.1274).

Resumen La utilización de la literatura y el cine para la enseñanza de valores humanistas a los estudiantes de medicina crea elementos conceptuales de gran importancia en el marco académico de las humanidades médicas. Las narrativas literarias y cinematográficas permiten generar en los alumnos una reflexión ética, histórica y epistemológica ante las perspectivas de la práctica médica y la relación médico-paciente. Además, estimula en ellos las manifestaciones de solidaridad, empatía y reconocimiento del sufrimiento humano de los enfermos. En este artículo se muestran distintas orientaciones temáticas y obras específicas que pueden servir a la creación y desarrollo de cursos de pregrado en los currículos de medicina. (Acta Med Colomb 2019; 44. DOI: https://doi.org/10.36104/amc.2019.1274).

Ethical competence: An integrative review.

BACKGROUND: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence. OBJECTIVE: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. METHOD: An integrative review was carried out, for the 2009-2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of "ethical competence" in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. RESULTS: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing. CONCLUSION: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.

Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review.

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a "bottom-up" perspective might give healthcare personnel opportunities to think and reflect more than a "top-down" perspective. A "bottom-up" approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a "top-down" approach risks removing such moral responsibility.

[Ethics and medical simulation]. / Éthique et simulation médicale.

Simulation in health care helps to raise health professionals' awareness of medical ethics and to understand the mechanisms involved in a difficult situation. They can thereby adopt a suitable form of behaviour and communication.

Global Health Ethical Reflection on Antibiotics Abuse / 中国医学伦理学

The ambiguous diagnosis,the public's insufficient understanding of AMR and improper use of antibiotics in agriculture are the main reasons for accelerating antibiotic resistamce(AMR).At present,the main coping strategies are limited to technical means while lacking ethical consideration.The related ethical issues are,mainly,tensions of personal health interests and public health interests,the conflicts between agricultural development and human health benefits,the distributive justice,inter-generational justice.Understandings and addressing these issues rely on value judgments based on the moral theories.And then it will form an effective and reasonable antibiotic management solution which will help to deal with AMR fundamentally.

Ethical Reflections on Medical Dispute in the Department of Otorhinolaryngology / 中国医学伦理学

In recent years, there were several extreme conflicts between doctors and patients in Otorhinolaryn-gology department. Medical field always contributes the disputes to medical system and patients′quality, however, the public blames the doctors′morality. This article analyzes these incidents in the perspective of ethics and social medicine, trying to find the causes. And it puts forward the countermeasures in terms of medical education, hospi-tal, and the medical personnel.

[Withdrawal of artificial nutrition and hydration in severe stroke: medical, legal and ethical considerations]. / Aspects médicaux, législatifs et éthiques de l'arrêt de la nutrition et de l'hydratation artificielles dans l'accident vasculaire cérébral grave.

In the majority of cases, severe stroke is accompanied by difficulty in swallowing and an altered state of consciousness requiring artificial nutrition and hydration. Because of their artificial nature, nutrition and hydration are considered by law as treatment rather basic care. Withdrawal of these treatments is dictated by the refusal of unreasonable obstinacy enshrined in law and is justified by the risk of severe disability and very poor quality of life. It is usually the last among other withholding and withdrawal decisions which have already been made during the long course of the disease. Reaching a collegial consensus on a controversial decision such as artificial nutrition and hydration withdrawal is a difficult and complex process. The reluctance for such decisions is mainly due to the symbolic value of food and hydration, to the fear of "dying badly" while suffering from hunger and thirst, and to the difficult distinction between this medical act and euthanasia. The only way to overcome such reluctance is to ensure flawless accompaniment, associating sedation and appropriate comfort care with a clear explanation (with relatives but also caregivers) of the rationale and implications of this type of decision. All teams dealing with this type of situation must have thoroughly thought through the medical, legal and ethical considerations involved in making this difficult decision.

Sustainability as an Ethical Principle: Ensuring Its Systematic Place in Professional Nursing Practice.

Alongside the central focus on the persons requiring nursing care in professional nursing practice, the perspective of the sustainability of interventions and the use of materials (for example, nursing aids and hygiene articles) is gaining prominence in nursing decision-making processes. This contribution makes the principle of sustainability concrete and delineates its importance in the context of professional nursing practice and decision-making. It further suggests the development of an ethical policy in order to systematically ensure that sustainability has a place in ethical reflection and decision-making, and describes the elements involved. Finally, a synthesis is made between the importance of the principle of sustainability, suggested ethical policies (system of ethical reflection) as they affect nursing practice and professional reflection, decision-making, and practice.

Differences in the Ethical Value System of Social Work between China and Western Societies and the Medical Social Work / 中国医学伦理学

Different cultural backgrounds between China and western societies determine the differences of their ethical value systems,which are both oriented by group interests and individual health interests.As the society develops,the new type medical service system enrolls various issues including social psychological service,embodying the characteristics and ethical values of medical social work.Therefore,it is necessary to fully make clear and take use of the differences of Chinese and western cultures in the practice of medical social work,apply ethical values in the construction of social welfare system building,and meanwhile guide the development of community social work.

An Ethical Reflection on Fashion / 中国医学伦理学

As an inevitable outcome of industrialization and modernization,fashion has already underlined and comprised our daily life.No matter it is fashion of substances,concepts or behaviors,all of them are crashing against the traditional ethics value system.Its unique characteristic tries to overthrow the traditional behavior mode and cognition mode,reflecting individual's abnormal sense of value.Fashion is a two-blade sword.On the one hand,it brings both society and individuals with positive ethical effect.On the other hand,it also leads to the popularity of consumerism,corroding people's spiritual world.Morality can be used as a guide and model of fashion,and fashion can also be used for decorating morality.To avoid dull preaches is the key to balance the mutual relationship between morality and fashion.

Reflection on Triage of Casualties Aroused by Wenchuan Earthquake / 中国医学伦理学

Researching and discussing the significance,principle,method and ethical conception of triage of casualties during earthquake.In particular,explaining the relationship between triage efficiency and aid impact;Pointing principles in Triage.At last,affirming the exigent importance of education of triage and giving some advie.

The Application Prospect of Genetic Testing and Relevant Social and Ethical Problems / 中国医学伦理学

As a novel testing method in clinic,the technology of genetic testing and its application appear prosperous in many areas,such as genetic diagnosis,therapy,prevention and biological pharmacy,etc.With the application of the genetic testing,some related ethical,legal and social problems also emerged.A preliminary study is conducted on the potential ethical problems that appear in genetic testing,such as individual mental burden,family relationship,public pressures,etc.Relevant ethical principles are also put forward,especially the admission criteria of genetic testing to provide a reference for the application and management of genetic testing in our country.

The Combination of Morality Education and Filial Piety Culture——An Ethical Reflection on Medical Students' Filial Piety Practice during Vacations / 中国医学伦理学

Medical students' practice of filial piety during vacations can help to combine the morality education and filial piety culture for medical students,which is of ethical significance.Firstly,the ethical meanings of filial piety are discussed from three aspects,including "filial piety" and "gratitude",ethical choice of filial piety,and the modern value of filial piety culture.Secondly,ethical reflection on medical students' filial piety education is raised and discussed from three aspects including medical students' well-liking growth and development,cultivating medical ethics and expanding new ways of morality education for medical students.