Moving It Along: A study of healthcare professionals' experience with ethics consultations.

BACKGROUND: Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them. OBJECTIVES: The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals. DESIGN AND METHOD: The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States. RESULTS: The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.

From the inside out: a new approach to teaching professional identity formation and professional ethics.

Professional identity formation is a dynamic process that begins in undergraduate nursing education and continues to develop throughout one's professional career. In recent decades, nursing educators emphasized the social dimension of professional identity formation in which professionalization is achieved through following rules, codes, and standards set by the profession. Character or psychological development and the proper use of virtues like integrity, compassion, or courage are often part of the hidden curriculum. The purpose of this article is to introduce a recently developed conception of professionalism that is grounded in virtue ethics and integrates both social and character development into a professional identity that is dynamic, situated, and lifelong. The conception is operationalized through the Framework for Nurse Professionals (FrNP) and the Stair-Step Model of Professional Transformation. The FrNP and the Stair-Step Model promote a robust and morally resilient professional nursing identity that will foster professional growth throughout one's career.

Of courage and leaving safe harbors.

If the health care system in the United States is to be sustainable, dramatic changes that result in better outcomes, lower costs, and improved quality are needed. As the largest group of health care providers, successful change will depend, in part, upon nursing practitioners, leaders, visionaries, advocates, and educators who are courageous enough to make difficult decisions and to follow through with actions. This philosophical inquiry addresses the nature of courage, types and motivations for courageous actions, and the complex psychological manifestations of thinking courageously. The inquiry concludes with educational and practical goals to promote proper use of courage in clinical practice.

The importance of being humble.

Scholarly work in philosophy, positive psychology, and other applied disciplines reconceptualize humility as an important element of reflection, change, and growth, but the change has not been mirrored in the nursing literature. Humility has a rich heritage and may be an implicit but fundamental construct in nursing. The value of humility for nursing education and practice rests in its conceptual basis for strategies that are currently being used. It is on the ground of humility that self-reflection, response to weaknesses and accomplishments, and our orientation to relationships should rest.

Towards understanding the nature of conflict of interest and its application to the discipline of nursing.

Most incidences of dishonesty in research, financial investments that promote personal financial gain, and kickback scandals begin as conflicts of interest (COI). Research indicates that healthcare professionals who maintain COI relationships make less optimal and more expensive patient care choices. The discovery of COI relationships also negatively impact patient and public trust. Many disciplines are addressing this professional issue, but little work has been done towards understanding and applying this moral category within a nursing context. Do COIs occur in nursing and are they problematic? What are the morally appropriate responses to COI for our discipline and for individual practicing nurses? In this paper I examine the nature of 'conflict of interest' as a general ethical category, its characteristics and its application to our discipline. Conflict of interest is an odd moral category that may actually or potentially result in immoral decisions. The moral justification for COI is grounded prime facie by the moral value of respect for persons and principle of fidelity from which trust is developed and maintained. In review of the historical development, there appears to be consensus on some qualities of COI that are presented. I conclude that making judgements about COI are challenging and often difficult to determine from a nursing perspective. Improving nurses' and professional organizations' awareness of COI and sharpening our ability to respond appropriately when COI arise can reduce potential harm and promote trust in those whom we serve.

Public perceptions of health care professionals' participation in pharmaceutical marketing.

Trust in the nurse-patient relationship is maintained not by how professionals perceive their actions but rather by how the public perceives them. However, little is known about the public's view of nurses and other health care professionals who participate in pharmaceutical marketing. Our study describes public perceptions of health care providers' role in pharmaceutical marketing and compares their responses with those of a random sample of licensed family nurse practitioners. The family nurse practitioners perceived their participation in marketing activities as significantly more ethically appropriate than did the public responders. Further research is warranted before conclusions can be drawn, but these early findings suggest that nurse practitioners should consider a conservative approach to participating in pharmaceutical marketing.

Nurse practitioners' perceptions and participation in pharmaceutical marketing.

AIM: This paper reports on a study conducted to describe family nurse practitioners' perceptions towards and participation in pharmaceutical marketing and to explore the relationships among related variables. BACKGROUND: The pharmaceutical industry's intense global marketing strategies have resulted in widespread concern in healthcare professionals and professional groups, sectors of the public in many countries, and in the World Health Organization. Research on healthcare providers' participation in pharmaceutical marketing indicates that these relationships are conflicts of interests and compromise healthcare providers' prescribing practices and trust. Nursing, as a discipline, appears to be slow to address the impact of pharmaceutical marketing on nursing practice. METHOD: Questionnaires about perceptions and participation in pharmaceutical marketing were completed by a random sample of 84 licensed family nurse practitioners in the United States of America in 2007. FINDINGS: Family nurse practitioners viewed pharmaceutical company marketing uncritically as educational and beneficial. They also perceived other providers but not themselves as influenced by pharmaceutical marketing. The findings supported those found in previous research with nurses and physicians. CONCLUSION: Lack of education, participation in marketing and psychological and social responses may impede family nurse practitioners' ability to respond critically and appropriately to marketing strategies and the conflict of interest it creates.

Hypericum and nurses: a comprehensive literature review on the efficacy of St. John's Wort in the treatment of depression.

PURPOSE: Many patients look to complementary and alternative medicine for a herbal solution to depression. This literature review summarizes recently published research on the treatment of depression using St. John's wort (Hypericum perforatum). CONCLUSIONS: The compounds in St. John's wort herbal preparations are more effective than placebo and, in several studies, more effective than common antidepressant medications in treating minor depression. However, the efficacy of St. John's wort for treating major depression, cyclothymia, or bipolar disorder is less evident. Although some studies are promising in the treatment of these major disorders, research support is lacking, and it is a controversial aspect of Hypericum therapy. PRACTICE IMPLICATIONS: As with any herbal treatment, risks from adverse reactions and drug interactions exist. Providers have an ethical and legal obligation to stay current in knowledge and to provide useful, accurate information to patients.

Towards a viable and just global nursing ethics.

Globalization, an outgrowth of technology, while informing us about people throughout the world, also raises our awareness of the extreme economic and social disparities that exist among nations. As part of a global discipline, nurses are vitally interested in reducing and eliminating disparities so that better health is achieved for all people. Recent literature in nursing encourages our discipline to engage more actively with social justice issues. Justice in health care is a major commitment of nursing; thus questions in the larger sphere of globalization, justice and ethics, are our discipline's questions also. Global justice, or fairness, is not an issue for some groups or institutions, but a deeper human rights issue that is a responsibility for everyone. What can we do to help reduce or eliminate the social and economic disparities that are so evident? What kind of ethical milieu is needed to address the threat that globalization imposes on justice and fairness? This article enriches the conceptualization of globalization by investigating recent work by Schweiker and Twiss. In addition, I discuss five qualities or characteristics that will facilitate the development of a viable and just global ethic. A global ethic guides all people in their response to human rights and poverty. Technology and business, two major forces in globalization that are generally considered beneficial, are critiqued as barriers to social justice and the common good.

Toward a theory of self-reconciliation following mistakes in nursing practice.

PURPOSE: To explore nurses' responses to making mistakes in hospital-based practice in the US. METHODS: A grounded theory approach was used to explore the process that occurs after nurses perceive that they have made mistakes in practice. Theoretical sampling was used and data were collected until saturation occurred. Ten participants, who were registered nurses, described 17 personal mistakes. The mistakes they described occurred in hospitals. All participants were practicing nursing either in hospitals or in other work settings. FINDINGS: A process of "Self-Reconciliation After Making Mistakes in Hospital Practice" was identified, with four distinct categories: reality hitting, weighing in, acting, and reconciling. The core category was reconciliation of the self, personally and professionally. CONCLUSIONS: This research was a first step toward the development of a theory of mistake making in nursing practice. This response to making mistakes is consistent with previous research and is related to cognitive dissonance theory. The responses to mistakes varied from less healthy responses of blaming and silence to healthier responses that included disclosure, apologizing, and making amends. Further research to develop the theory and to determine helpful interventions is suggested.

Practical strategies for providing culturally sensitive, ethical care in developing nations.

Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

Lessons learned from Hurricane Mitch: a guide for holistic practice.

Hurricanes are often devastating for the victims. Although millions of dollars and hours are invested, relief efforts could be more effective. The purpose of this article is to utilize the lessons learned from Hurricane Mitch as a guide for holistic practice in both hurricane preparation and response planning.

Compassionate nursing professionals as good citizens of the world.

Globalization is reshaping the world and its people. Nursing, likewise, is in the process of expanding its worldview to one that accommodates global care. The authors further articulate a global ethic for nursing by distinguishing 2 concepts: world citizenship, as described by Martha Nussbaum, which calls nurses to critically evaluate personal and culture-based beliefs, and compassionate professional, which calls nurses to nurture partnerships of mutual respect. It is also important that nursing participate and support professional and international organizations that address social injustices related to healthcare, poverty, and public health.

Pharmaceutical promotions and conflict of interest in nurse practitioner's decision making: the undiscovered country.

PURPOSE: To increase nurse practitioners' (NPs) awareness of the conflict of interest that exists between the NPs' primary goal of making the best medication choices for patients and the potentially negative impact that the pharmaceutical industry's marketing strategies have on these choices. DATA SOURCES: Selected healthcare professional, philosophical, and bioethical literature was reviewed. CONCLUSIONS: Healthcare professionals are given gifts, dinners, and other inducements in the drug industry's effort to increase consumerism and drug sales. The current method of drug promotion increases sales but also increases healthcare expenses. Research also indicates that the pharmaceutical marketing strategies influence the judgments that NPs and other healthcare professionals make about patient care and drug prescriptions. IMPLICATIONS: Guidelines are presented that can reduce the likelihood that any conflict of interest that exists will influence NPs' decisions about patient care.

The ethics of administrative credentialing.

A vascular surgeon has practiced in the same community for more than 20 years, holding privileges at the two largest local general hospitals. She is widely respected and admired by patients and fellow physicians in all specialties, and her results are consistently good. Recently, the board of directors at the hospital that has been the source of 80% of her case referrals hired a notorious slash-and-burn management firm to improve the balance sheet. The new chief executive officer (CEO) installed an information technology system that can provide management with physician-specific figures on costs and reimbursements. The management consultants identified the 10% of physicians with the worst cost/reimbursement ratios over the preceding 5 years and persuaded the board of directors to order their clinical privileges withdrawn. Our seasoned surgeon learns that she is among the targeted group. Is there an ethical issue here, and, if so, how should she respond?

Two models of mistake-making in professional practice: moving out of the closet.

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients.

Always having to say you're sorry: an ethical response to making mistakes in professional practice.

Efforts to decrease errors in health care are directed at prevention rather than at managing a situation when a mistake has occurred. Consequently, nurses and other health care providers may not know how to respond properly and may lack sufficient support to make a healthy recovery from the mental anguish and emotional suffering that often accompany making mistakes. This article explores the conceptualization of mistakes and the ethical response to making a mistake. There are three parts to an ethical response to error: disclosure, apology and amends. Honesty and humility are discussed as important virtues that facilitate coping and personal growth for the health care provider who is involved in mistakes. In conclusion, a healthy view of nursing practice and mistake making is one that prevents error but, when prevention is not possible, accepts fallibility as part of the human condition and achieves the best possible outcome for all.