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. (shrink)

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. (shrink)

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. (shrink)

Editorial peer reviewers play an important role in shaping the direction of knowledge growth of their discipline. Recent concern over reports of peer review misconduct has led some to advocate the establishment of a code of ethics for peer reviewers. Such a code should include guidelines for the discipline and for society at large, but it should also contain guidelines for the authors whose manuscripts are reviewed. Peer reviewers have a special obligation to show beneficence and fairness or impartiality towards (...) the authors for whom they review. The practical application of these two ethical concepts is discussed. (shrink)

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. To turn human nature into humanity and righteousness is like turning the willow into cups and bowls.The book of Mencius. (shrink)

A growing number of nurse researchers travel globally to conduct research in poor and underserved populations in developing nations. These researchers, while well versed in research ethics, often find it difficult to apply traditional ethical standards to populations in developing countries. The problem of applying ethical standards across cultures is explained by a long-standing debate about the nature of ethical principles. Fundamentalism is the philosophical stance that ethical principles are universal, while the anthropologically-based ‘multicultural’ model claims the philosophical position that (...) principles are culturally bound. The authors explicate the two philosophical stances and advocate a morally sensitive but moderate position of ‘ethical multiculturalism’ rather than favouring either of the above philosophical positions. The final section suggests ways to promote ethical multiculturalism while planning and conducting nursing research. (shrink)

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. (shrink)

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. (shrink)

is a review of 5 ethically based healthcare funding models discussed in the literature that are currently used to justify funding choices. If healthcare professionals and managers are better informed about the ethical reasoning behind funding choices, they could better determine which resource allocation alternatives to support. But where should we spend our resources? Although healthcare professionals have a duty to advocate for all healthcare recipients to receive a fair share of resources, the author concludes that our greater duty as (...) a profession is to the good of society as a whole. Balancing allocation decisions by considering all of the competing healthcare funding models and the ethical bases for them is suggested rather than to advocate too strongly for favored models.... (shrink)