Ethical issues of medical missions: the clinicians' view.

Surgery is an important part of health care worldwide. Without access to surgical treatments, morbidity and mortality increase. Access to surgical treatment is a significant problem in global public health because surgical services are not equally distributed in the world. There is a disproportionate scarcity of surgical access in low-income countries. There are many charitable organizations around the world that sponsor surgical missions to under served nations. One such organization is Operation Smile International, a group with which both authors have volunteered. This paper will describe the purpose and processes involved in Operation Smile and identify some of the key ethical issues that arise in short term medical volunteer work highlighting the importance of sustainability.

Healthcare experiences of women with visual impairment.

PURPOSE: This investigation was a secondary analysis of focus group transcripts to address the question of how women with low vision or blindness have experienced healthcare. DESIGN: Secondary analysis of qualitative data was performed on transcripts from 2 focus groups. SETTING: These focus groups were conducted at an agency serving visually impaired people in Philadelphia. SAMPLE: The 2 focus groups included 7 and 11 women, respectively, having low-vision or who are blind who had been part of an original study of reaching hard-to-reach women with disabilities. METHODS: Content analysis for the identification of thematic clusters was performed on transcriptions of the focus group data. FINDINGS: Findings are consistent with existing research on the health needs of women with disabilities but add specific understanding related to visual impairment. Six thematic categories were identified: health professionals' awareness, information access, healthcare access, isolation, the need for self-advocacy, and perception by others. CONCLUSIONS AND IMPLICATIONS: Secondary analysis of qualitative data affords in-depth understanding of a particular subset of participants within a larger study. Clinical nurse specialists and other health professionals need to increase their sensitivity to the challenges faced by women with visual impairment, and plan and provide care accordingly. Health professions students need to be prepared to interact with people who are visually impaired and healthcare settings need to respond to their needs.

Progress in ethical decision making in the care of the dying.

Practitioners in critical care have made a significant progress in caring for dying patients in critical care by taking advantage of the suggestions from their professional groups. Progress has been made in responding to and controlling patients' pain. Major initiatives from the Joint Commission and the American Pain Society have helped direct this improvement. Palliative care consultations as well as ethics consultations have improved symptom control in the critically ill. Issues of consent have been problematic for dying patients in critical care especially in the area of discontinuing therapies. But, better policies related to advance directives have been developed to ensure good care. Spiritual care has received more attention, and now chaplains are recognized by the Society for Critical Care Medicine as integral to the critical care team. The American Association of Critical-Care Nurses has been a leader in improving end-of-life issues and continues to spearhead many projects to improve end-of-life care.

Views of African American Nursing Home residents about living wills.

Advance directives may be understood differently by various cultural and racial groups. These differences need to be identified so that individualized treatment decisions can be made according to patient preferences and communicated to clinicians. This exploratory, descriptive, qualitative research asked elderly African American nursing home residents why they had not completed a living will. Focus groups were conducted at 3 nursing homes and the participants spoke of: 1) not wanting artificial life-supporting treatments, 2) not being asked about living wills, 3) the importance of their families in the decision-making process, 4) the role of physicians in end-of-life care, and 5) having a living will was probably a good idea. Elderly nursing home residents would benefit from discussions within their family and cultural community about goals of therapy at the end of life that may lead to increased use of advanced directive documents.

Perspectives of women with disabilities on reaching those who are hard to reach.

Healthcare needs of women with disabilities are often neglected, even for women who are well connected to the community and to the healthcare system. So-called "hard-to-reach" women, whose degree of disability impedes use of community resources, have even greater difficulty obtaining health care. The purpose of this study was to gain insight into the perceptions of women with mobility and sensory limitations about several healthcare issues that may affect them: barriers to obtaining care, sources of information about health issues, ways to improve access to care, and ways to help hard-to-reach women overcome barriers to health care and health information. Researchers conducted six focus groups, comprising 43 women with limitations of mobility, hearing, or vision. To validate the women's input, researchers conducted two additional focus groups: the first comprised female physicians with special interest in the health care of women with disabilities, and the second included professional administrative staff of agencies that provide services for people with disabilities. In several cases, members of the physician and agency focus groups were themselves women with disabilities. In addition, 16 women with disabilities participated in an online survey; their responses were used to validate the findings of the face-to-face focus groups. Transcribed data were content analyzed and 10 themes identified. Seven of those themes are discussed in this article: communication barriers; lack of knowledge and awareness among healthcare providers; access issues; working the system; system issues; outreach to healthcare providers; and reaching hard-to-reach women. The findings of this study can provide direction to development of more effective outreach to hard-to-reach women with disabilities, resulting in better integration of healthcare services for this population.