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Reducing health disparities in providing care services in the intensive care unit: a critical ethnographic study. 在重症监护室提供护理服务时减少健康差异:一项重要的人种学研究。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-23 DOI: 10.1186/s12910-024-01118-9
Sajad Yarahmadi, Mohsen Soleimani, Mohammad Gholami, Ali Fakhr-Movahedi, Seyed Mohsen Saeidi Madani

Objective: The intensive care unit, with its structural complexity and the exposure of critically ill patients to various disparities, presents a significant setting for health disparities. This critical ethnographic study sought to uncover cultural knowledge and ethical practices for reducing health disparities in providing care services within the intensive care unit. The focus was on understanding how ethical considerations and cultural competence can address and mitigate these disparities effectively.

Methods: This critical ethnographic study was conducted in 2022-2023 at intensive care units in western Iran. Three interrelated phases were used to collect and analyze the data. More than 300 h of observation were done during the first phase. A horizon analysis was carried out in the next phase. To further enhance the dataset, 18 informants participated in semi-structured interviews and informal conversations. Following that, the analysis procedure was conducted to identify a culture of health disparities and factors that reduce it, as it had been in the prior stage. Trustworthiness data collection methods were implemented to ensure the validity and reliability of the study.

Findings: Two key themes emerged from the study: (A) Improved cultural competence, which encompassed empathy towards patients and their families, effective communication, prioritization of continuous learning, appropriate knowledge and awareness, sensitivity to cultural and religious beliefs, staff attitude and personality, and the delivery of customized care tailored to each patient's needs. (B) Supporting role and compensating for disparities involved recommendations for upholding ethical standards, compensatory actions, maintaining professional behavior despite external factors, addressing gaps and deficiencies, and actively defending and supporting patients.

Conclusion: The findings indicate that staff with high cultural competence can ethically mitigate health disparities through their supportive roles. Managers and health policymakers should create barriers to health disparity by improving staff cultural competence and knowledge about health disparities.

目的:重症监护室结构复杂,重症患者面临各种差异,是造成健康差异的重要场所。这项重要的人种学研究旨在揭示在重症监护病房提供护理服务时,如何通过文化知识和伦理实践来减少健康差异。重点是了解伦理考虑因素和文化能力如何有效地解决和减少这些差异:这项重要的人种学研究于 2022-2023 年在伊朗西部的重症监护病房进行。收集和分析数据分为三个相互关联的阶段。第一阶段进行了 300 多小时的观察。下一阶段进行了视野分析。为了进一步完善数据集,18 名信息提供者参加了半结构化访谈和非正式谈话。随后,与前一阶段一样,进行了分析程序,以确定健康差异文化和减少差异的因素。为确保研究的有效性和可靠性,采用了可信数据收集方法:研究提出了两个关键主题:(A)提高文化能力,包括对病人及其家属的同理心、有效沟通、优先考虑持续学习、适当的知识和意识、对文化和宗教信仰的敏感性、员工的态度和个性,以及根据每个病人的需求提供定制护理。(B) 支持角色和补偿差异涉及以下方面的建议:坚持道德标准、补偿行动、在外部因素影响下保持专业行为、解决差距和不足、积极维护和支持患者:研究结果表明,具有较高文化素养的医务人员可以通过其支持性角色在道德上减少健康差异。管理者和卫生政策制定者应通过提高员工的文化素养和对健康差异的了解,为消除健康差异设置障碍。
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引用次数: 0
Negative performance feedback from algorithms or humans? effect of medical researchers' algorithm aversion on scientific misconduct. 医学研究人员对算法的厌恶对科学不端行为的影响?
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-23 DOI: 10.1186/s12910-024-01121-0
Ganli Liao, Feiwen Wang, Wenhui Zhu, Qichao Zhang

Institutions are increasingly employing algorithms to provide performance feedback to individuals by tracking productivity, conducting performance appraisals, and developing improvement plans, compared to traditional human managers. However, this shift has provoked considerable debate over the effectiveness and fairness of algorithmic feedback. This study investigates the effects of negative performance feedback (NPF) on the attitudes, cognition and behavior of medical researchers, comparing NPF from algorithms versus humans. Two scenario-based experimental studies were conducted with a total sample of 660 medical researchers (algorithm group: N1 = 411; human group: N2 = 249). Study 1 analyzes the differences in scientific misconduct, moral disengagement, and algorithmic attitudes between the two sources of NPF. The findings reveal that NPF from algorithms shows higher levels of moral disengagement, scientific misconduct, and negative attitudes towards algorithms compared to NPF from humans. Study 2, grounded in trait activation theory, investigates how NPF from algorithms triggers individual's egoism and algorithm aversion, potentially leading to moral disengagement and scientific misconduct. Results indicate that algorithm aversion triggers individuals' egoism, and their interaction enhances moral disengagement, which in turn leads to increased scientific misconduct among researchers. This relationship is also moderated by algorithmic transparency. The study concludes that while algorithms can streamline performance evaluations, they pose significant risks to scientific misconduct of researchers if not properly designed. These findings extend our understanding of NPF by highlighting the emotional and cognitive challenges algorithms face in decision-making processes, while also underscoring the importance of balancing technological efficiency with moral considerations to promote a healthy research environment. Moreover, managerial implications include integrating human oversight in algorithmic NPF processes and enhancing transparency and fairness to mitigate negative impacts on medical researchers' attitudes and behaviors.

与传统的人力管理相比,各机构正越来越多地采用算法向个人提供绩效反馈,包括跟踪生产率、进行绩效评估和制定改进计划。然而,这种转变引发了关于算法反馈的有效性和公平性的大量争论。本研究通过比较算法和人类的负面绩效反馈(NPF),调查了负面绩效反馈对医学研究人员的态度、认知和行为的影响。研究人员对总共 660 名医学研究人员(算法组:N1 = 411;人类组:N2 = 249)进行了两项基于场景的实验研究。研究 1 分析了两种 NPF 来源在科学不端行为、道德脱离和算法态度方面的差异。研究结果显示,与来自人类的 NPF 相比,来自算法的 NPF 表现出更高水平的道德脱离、科学不端行为和对算法的负面态度。研究 2 以特质激活理论为基础,调查了来自算法的 NPF 如何引发个人的利己主义和算法厌恶,从而可能导致道德脱离和科学不端行为。结果表明,算法厌恶会引发个人的利己主义,两者相互作用会加强道德脱离,进而导致研究人员的科学不端行为增加。这种关系还受到算法透明度的调节。研究得出结论,虽然算法可以简化绩效评估,但如果设计不当,会给研究人员的科学不端行为带来巨大风险。这些发现扩展了我们对 NPF 的理解,突出了算法在决策过程中面临的情感和认知挑战,同时也强调了平衡技术效率与道德考量的重要性,以促进健康的研究环境。此外,其管理意义还包括在算法 NPF 过程中纳入人工监督,提高透明度和公平性,以减轻对医学研究人员态度和行为的负面影响。
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引用次数: 0
Perioperative medication therapy for Muslim patients in Germany undergoing oncological surgery: a retrospective study. 德国接受肿瘤手术的穆斯林患者的围手术期药物治疗:一项回顾性研究。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-18 DOI: 10.1186/s12910-024-01114-z
Aysun Tekbaş, M von Lilienfeld-Toal, F Sayrafi, U Settmacher

Purpose: Engagement of healthcare professionals with patients from diverse cultural and religious backgrounds is crucial in our multicultural society, where miscommunication and errors in medical history taking can lead to incorrect treatment. In particular, Muslim patients may present unique considerations due to their specific cultural and religious beliefs, which can significantly impact treatment outcomes. This study focuses on perioperative medication therapy for patients undergoing upper and lower gastrointestinal tract and pancreatic tumor surgery, specifically examining whether Islamic beliefs were duly considered in medication selection compared to a matching patient cohort.

Materials and methods: Data from January 2004 to July 2023 were analyzed. Muslim patients were identified using the onomastic method and matched with non-Muslim patients at a 1:3 ratio based on age, gender, and procedure. Analysis included examination of subcutaneous, oral, and intravenous medications, with attention to ingredients and compatibility with Islamic principles.

Results: Among 5272 patients, only 5 met the study's inclusion criteria as Muslim patients, undergoing procedures such as anterior rectum resection, gastrectomy, and pancreatic head resection. Their religious affiliations were not documented in the admission records. According to the matched-pair analysis, consistent treatment was performed regardless of religious beliefs. All patients received subcutaneous medication, primarily enoxaparin, instead of fondaparinux, an Islam-compliant alternative. Intravenous heparin was used once for short period. Contrary to Islamic dietary restrictions and the availability of alternatives, capsules containing animal-derived gelatin and other non-compliant medications were administered orally.

Conclusion: This study underscores the importance of acknowledging Muslim patients' cultural and religious backgrounds in the perioperative setting, as failure to do so may lead healthcare professionals to overlook their potential alternative medication needs, which are essential for providing tailored medical care in modern societies. Integration of diversity-related topics into medical curricula is essential for better preparing physicians for clinical practice and ensuring patient-centered care.

目的:在我们这个多元文化的社会中,医护人员与来自不同文化和宗教背景的患者接触至关重要,因为沟通不畅和病史采集错误可能会导致错误的治疗。尤其是穆斯林患者,由于其特殊的文化和宗教信仰,可能会有独特的考虑因素,这可能会对治疗效果产生重大影响。本研究重点关注接受上下消化道和胰腺肿瘤手术患者的围手术期药物治疗,特别是与匹配的患者队列相比,研究伊斯兰教信仰是否在药物选择中得到了适当考虑:对 2004 年 1 月至 2023 年 7 月的数据进行了分析。根据年龄、性别和手术方式,采用拟态法确定穆斯林患者,并与非穆斯林患者按 1:3 的比例进行配对。分析包括对皮下注射、口服和静脉注射药物的检查,并关注药物成分和与伊斯兰原则的兼容性:在 5272 名患者中,只有 5 人符合研究的穆斯林患者纳入标准,他们接受了直肠前部切除术、胃切除术和胰头切除术等手术。他们的宗教信仰未在入院记录中记录。根据配对分析,无论宗教信仰如何,治疗方法都是一致的。所有患者都接受了皮下注射药物治疗,主要是依诺肝素,而不是符合伊斯兰教教规的磺达肝癸。静脉注射肝素一次,时间较短。与伊斯兰教的饮食限制和替代品的可用性相反,患者口服了含有动物源明胶的胶囊和其他不符合规定的药物:本研究强调了在围手术期了解穆斯林患者的文化和宗教背景的重要性,否则可能会导致医护人员忽视他们潜在的替代用药需求,而这对于在现代社会提供量身定制的医疗服务至关重要。将与多样性相关的主题纳入医学课程对于更好地培养医生的临床实践能力和确保以患者为中心的医疗服务至关重要。
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引用次数: 0
Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States. 不一致的价值观和算法公平性:美国器官分配优先权制度回顾。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01116-x
Reid Dale, Maggie Cheng, Katharine Casselman Pines, Maria Elizabeth Currie

Background: The Organ Procurement and Transplant Network (OPTN) Final Rule guides national organ transplantation policies, mandating equitable organ allocation and organ-specific priority stratification systems. Current allocation scores rely on mortality predictions.

Methods: We examined the alignment between the ethical priorities across organ prioritization systems and the statistical design of the risk models in question. We searched PubMed for literature on organ allocation history, policy, and ethics in the United States.

Results: We identified 127 relevant articles, covering kidney (19), liver (60), lung (24), and heart transplants (23), and transplant accessibility (1). Current risk scores emphasize model performance and overlook ethical concerns in variable selection. The inclusion of race, sex, and geographical limits as categorical variables lacks biological basis; therefore, blurring the line between evidence-based models and discrimination. Comprehensive ethical and equity evaluation of risk scores is lacking, with only limited discussion of the algorithmic fairness of the Model for End-Stage Liver Disease (MELD) and the Kidney Donor Risk Index (KDRI) in some literature. We uncovered the inconsistent ethical standards underlying organ allocation scores in the United States. Specifically, we highlighted the exception points in MELD, the inclusion of race in KDRI, the geographical limit in the Lung Allocation Score, and the inadequacy of risk stratification in the Heart Tier system, creating obstacles for medically underserved populations.

Conclusions: We encourage efforts to address statistical and ethical concerns in organ allocation models and urge standardization and transparency in policy development to ensure fairness, equitability, and evidence-based risk predictions.

背景:器官获取与移植网络(OPTN)最终规则指导着国家器官移植政策,规定了公平的器官分配和特定器官优先分层系统。目前的分配评分依赖于死亡率预测:我们研究了器官优先级系统的伦理优先级与相关风险模型的统计设计之间的一致性。我们在 PubMed 上检索了有关美国器官分配历史、政策和伦理的文献:我们发现了 127 篇相关文章,涉及肾移植(19 篇)、肝移植(60 篇)、肺移植(24 篇)、心脏移植(23 篇)以及移植的可及性(1 篇)。目前的风险评分强调模型性能,忽视了变量选择中的伦理问题。将种族、性别和地域限制纳入分类变量缺乏生物学依据,因此模糊了循证模型与歧视之间的界限。对风险评分缺乏全面的伦理和公平评估,一些文献仅对终末期肝病模型(MELD)和肾脏捐献者风险指数(KDRI)的算法公平性进行了有限的讨论。我们揭示了美国器官分配评分所依据的不一致的伦理标准。具体而言,我们强调了 MELD 中的例外点、KDRI 中的种族纳入、肺分配评分中的地域限制以及心脏分级系统中风险分层的不足,这些都为医疗服务不足的人群造成了障碍:我们鼓励努力解决器官分配模型中的统计和伦理问题,并敦促在制定政策时实现标准化和透明化,以确保公平、公正和基于证据的风险预测。
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引用次数: 0
Disclosure of true medical information: the case of Bangladesh. 披露真实医疗信息:孟加拉国的案例。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01115-y
Sanwar Siraj, Kristien Hens, Yousuf Ali

Background: Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh.

Methods: This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets.

Results: This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family's wishes and preferences.

Conclusions: While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient's active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.

背景:医疗保健中的实话实说是指为患者提供有关其诊断和预后的准确信息,使他们能够做出有利于其整体健康的决定。全世界的医生,尤其是英国和美国的医生,都公开分享此类医疗信息。然而,孟加拉国是一个穆斯林占多数的社会,其社会规范与西方社会不同。因此,我们研究了穆斯林文化是否支持向患者披露真相,特别是在孟加拉国,如何以及在多大程度上向患者提供有关危及生命的疾病的医疗信息:这是一项现象学定性研究。我们对孟加拉国达卡 Shaheed Suhrawardy 医学院医院的临床医生、护士、患者及其亲属进行了 30 次深入访谈。我们还通过观察探讨了患者、家属和医护人员之间在参与医疗决策和披露真相问题上的互动。我们使用 NVivo 软件确定共同主题,并采用主题分析方法对数据集进行分析:本研究发现了与披露真相的伦理和实践相关的三个重复出现的主题:最佳利益而非自主权、欺骗的矛盾价值以及谁能理解什么。参与者发现,医生经常对临终病人隐瞒致命的医疗预后,以确保最佳的医疗效果。研究结果表明,作为减轻负担和提供安慰的一种手段,对病人的欺骗被普遍接受。与会者认为,应该对某些病人隐瞒真实的医疗信息,因为披露这些信息可能会给他们造成严重的负担。是否披露医疗信息或披露的程度主要取决于家属的意愿和偏好:虽然在许多文化中,如在英国和美国,向病人披露真相被认为是一种道德规范,但在孟加拉社会,向病人隐瞒或部分披露严重医疗预后的做法却是一种实际的医疗行为。本研究强调了承认病人积极参与和尊重形成家庭参与医疗决策的文化价值观的重要性。这些发现可能对在孟加拉国家庭动态和基于宗教的文化价值观中促进患者自主权具有重要的政策和实践意义。
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引用次数: 0
Ethical constraints and dilemmas in the provision of in-vitro fertilization treatment in Ghana: from the perspectives of experts. 加纳在提供体外受精治疗方面的伦理限制和困境:从专家的角度。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01113-0
David Appiah, John K Ganle

Background: Infertility presents both medical and public health challenges, with in vitro fertilization (IVF) emerging as a prominent solution, particularly when other alternatives are exhausted. However, IVF treatment raises significant ethical questions that have been under explored in the Ghanaian context. This study aimed to explore ethical constraints and dilemmas in the provision of in vitro fertilization (IVF) treatment in Ghana.

Methods: A descriptive phenomenological qualitative design was employed. Purposive sampling techniques were used to recruit 12 participants including ART experts from three in vitro fertilization (IVF) centres, ethicists and a legal practitioner. In-depth face-to-face interviews guided by an open-ended interview guide were conducted. Thematic analysis of the interviews was performed to identify major themes.

Results: Providing IVF treatment in Ghana raises several ethical issues, including inequitable access due to high costs and limited availability, which favour wealthier individuals and leave marginalized populations with fewer options. There are significant ethical considerations in balancing the potential benefits of successful IVF treatment outcomes against the health risks and emotional tolls on patients. Decisions about the fate of surplus embryos present moral dilemmas, including whether to preserve, donate, or discard them. Differing personal beliefs about the moral status of the embryo further complicate the ethical landscape. Ensuring informed consent is challenging due to the complex medical, ethical, and emotional implications of IVF treatment, potentially leading to compromised consent. Additionally, there are ongoing risks of breaches in confidentiality, given the sensitive nature of reproductive health data and the importance of protecting patient privacy.

Conclusion: This study revealed that several ethical dilemmas confront both healthcare providers and couples in the process of IVF. There is an urgent need for the development of clear and uniform regulations to govern the practice of IVF treatment in Ghana, with further attention given to mitigating financial barriers and enhancing support systems for couples considering IVF treatment.

背景:不孕不育症给医疗和公共卫生都带来了挑战,体外受精(IVF)成为一种重要的解决方案,尤其是在用尽其他替代方法的情况下。然而,体外受精治疗引发了重大的伦理问题,而在加纳,对这些问题的探讨还很不够。本研究旨在探讨在加纳提供体外受精(IVF)治疗过程中的伦理限制和困境:采用描述性现象学定性设计。采用有目的的抽样技术招募了 12 名参与者,包括来自三个体外受精(IVF)中心的 ART 专家、伦理学家和一名法律从业人员。在开放式访谈指南的指导下,进行了面对面的深入访谈。对访谈进行了主题分析,以确定主要主题:在加纳提供体外受精治疗会引发一些伦理问题,包括由于费用高昂和可用性有限而造成的不公平,这有利于富裕人群,而使边缘化人群的选择更少。在平衡试管婴儿成功治疗的潜在益处与健康风险和对患者造成的情感伤害之间,存在着重大的伦理考虑。决定剩余胚胎的命运也是一个道德难题,包括是保存、捐赠还是丢弃。对胚胎道德地位的不同个人信仰使伦理问题更加复杂。由于试管婴儿治疗涉及复杂的医学、伦理和情感问题,确保知情同意具有挑战性,可能会导致知情同意受到影响。此外,鉴于生殖健康数据的敏感性和保护患者隐私的重要性,保密性被破坏的风险一直存在:这项研究表明,在试管婴儿过程中,医疗服务提供者和夫妇都面临着一些伦理困境。迫切需要制定明确、统一的法规来规范加纳的体外受精治疗实践,并进一步关注减少财务障碍和加强对考虑接受体外受精治疗的夫妇的支持系统。
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引用次数: 0
Exploring bias risks in artificial intelligence and targeted medicines manufacturing. 探索人工智能和靶向药物制造中的偏差风险。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01112-1
Ngozi Nwebonyi, Francis McKay

Background: Though artificial intelligence holds great value for healthcare, it may also amplify health inequalities through risks of bias. In this paper, we explore bias risks in targeted medicines manufacturing. Targeted medicines manufacturing refers to the act of making medicines targeted to individual patients or to subpopulations of patients within a general group, which can be achieved, for example, by means of cell and gene therapies. These manufacturing processes are increasingly reliant on digitalised systems which can be controlled by artificial intelligence algorithms. Whether and how bias might turn up in the process, however, is uncertain due to the novelty of the development.

Methods: Examining stakeholder views across bioethics, precision medicine, and artificial intelligence, we document a range of opinions from eleven semi-structured interviews about the possibility of bias in AI-driven targeted therapies manufacturing.

Result: Findings show that bias can emerge in upstream (research and development) and downstream (medicine production) processes when manufacturing targeted medicines. However, interviewees emphasized that downstream processes, particularly those not relying on patient or population data, may have lower bias risks. The study also identified a spectrum of bias meanings ranging from negative and ambivalent to positive and productive. Notably, some participants highlighted the potential for certain biases to have productive moral value in correcting health inequalities. This idea of "corrective bias" problematizes the conventional understanding of bias as primarily a negative concept defined by systematic error or unfair outcomes and suggests potential value in capitalizing on biases to help address health inequalities. Our analysis also indicates, however, that the concept of "corrective bias" requires further critical reflection before they can be used to this end.

背景:尽管人工智能在医疗保健领域具有巨大价值,但它也可能因存在偏见风险而扩大健康不平等。本文探讨了靶向药物生产中的偏差风险。靶向药物生产是指针对个体患者或群体中的亚群患者生产药物的行为,例如,可以通过细胞和基因疗法来实现。这些制造过程越来越依赖于可由人工智能算法控制的数字化系统。然而,由于开发的新颖性,这一过程中是否会出现偏差以及如何出现偏差尚不确定:我们研究了利益相关者在生物伦理、精准医疗和人工智能方面的观点,记录了 11 个半结构式访谈中关于人工智能驱动的靶向疗法制造过程中可能存在偏见的一系列观点:结果:研究结果表明,在制造靶向药物时,上游(研发)和下游(药品生产)流程都可能出现偏差。然而,受访者强调,下游流程,尤其是那些不依赖患者或人群数据的流程,可能存在较低的偏差风险。研究还发现了一系列偏差含义,从消极、矛盾到积极、富有成效。值得注意的是,一些参与者强调了某些偏差在纠正健康不平等方面具有生产性道德价值的潜力。这种 "纠正性偏见 "的观点打破了偏见主要是由系统性错误或不公平结果所定义的负面概念的传统理解,并提出了利用偏见来帮助解决健康不平等问题的潜在价值。然而,我们的分析也表明,"纠正偏差 "的概念需要进一步的批判性反思,然后才能用于这一目的。
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引用次数: 0
Nurses' experience of nasogastric tube feeding under restraint for Anorexia Nervosa in a psychiatric hospital. 精神病院护士在束缚下为厌食症患者进行鼻胃管喂食的经验。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-10 DOI: 10.1186/s12910-024-01108-x
Berit Støre Brinchmann, Mette Spliid Ludvigsen, Tove Godskesen

Background: Anorexia nervosa is a complex mental disorder that has severe physical and psychological consequences, often requiring hospitalisation, and in the most severe cases, patients receive coercive treatment. Among the various nursing tasks associated with encountering these patients, the administration of nasogastric tube feeding under restraint stands out. It is crucial to recognise and address the unique practical and ethical challenges nurses face when caring for adults struggling with severe anorexia nervosa. The aim of the study was to gain a deeper understanding of registered nurses' experience of nasogastric tube feeding under restraint in hospitalised patients with severe anorexia nervosa.

Methods: A naturalistic design guided this study. Narrative interview data were analysed using reflexive thematic analysis. The participants were twelve registered nurses recruited from an inpatient ward for adult patients with an eating disorder in a Norwegian psychiatric hospital.

Results: Three main themes were developed: providing good nursing care during coercive treatment; having ethical concerns about nasogastric tube feeding under restraint when the patient reaches a body mass index that is not immediately life-threatening; and having concerns about involving personnel from another ward in the nasogastric tube feeding under restraint procedure.

Conclusions: Nurses find nasogastric tube feeding under restraint to be part of life-saving nursing for patients with severe anorexia nervosa. It raises ethical concerns, especially with patients with a body mass index that is no longer life-threatening. Our results demonstrate the vulnerability of nurses as well as the difficulties and ethical dilemmas of nursing during nasogastric tube feeding under restraint.

背景:神经性厌食症是一种复杂的精神障碍,会对患者的生理和心理造成严重影响,通常需要住院治疗,在最严重的情况下,患者会接受强制治疗。在与这些患者相关的各种护理任务中,在约束下实施鼻胃管喂食的任务尤为突出。认识并解决护士在护理患有严重厌食症的成人时所面临的独特的实际和伦理挑战至关重要。本研究旨在深入了解注册护士在约束下对住院的重度神经性厌食症患者进行鼻胃管喂食的经验:本研究采用自然主义设计。采用反思性主题分析法对叙述性访谈数据进行分析。研究对象是从挪威一家精神病医院的成人饮食失调症住院病房招募的12名注册护士:结果:形成了三大主题:在强制治疗期间提供良好的护理;当患者的体重指数达到不会立即威胁生命的程度时,对在限制条件下进行鼻胃管喂食存在伦理顾虑;对让其他病房的人员参与限制条件下的鼻胃管喂食程序存在顾虑:护士们认为,在限制条件下进行鼻胃管喂食是严重厌食症患者救生护理的一部分。这引起了伦理方面的关注,尤其是对体重指数已不再危及生命的患者。我们的研究结果表明了护士的脆弱性,以及在束缚状态下进行鼻胃管喂食时的护理困难和伦理困境。
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引用次数: 0
Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences. 循环死亡后控制性捐献中临终关怀与器官捐献之间的紧张关系:ICU医护人员的经验。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-09 DOI: 10.1186/s12910-024-01093-1
Matthieu Le Dorze, Romain Barthélémy, Olivier Lesieur, Gérard Audibert, Marie-Ange Azais, Dorothée Carpentier, Charles Cerf, Gaëlle Cheisson, Renaud Chouquer, Vincent Degos, Marion Fresco, Fabien Lambiotte, Emmanuelle Mercier, Jérôme Morel, Laurent Muller, Erika Parmentier-Decrucq, Sébastien Prin, Armine Rouhani, France Roussin, Jean-Christophe Venhard, Mathieu Willig, Catherine Vernay, Benjamin Chousterman, Nancy Kentish-Barnes

Background: The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD.

Methods: In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation.

Results: Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall.

Conclusions: cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses.

Trial registration: This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).

背景:循环死亡后控制性捐献(cDCD)的发展既重要又具有挑战性。临终关怀与器官捐献之间的矛盾给重症监护室(ICU)的医护人员带来了重大的伦理问题。这项前瞻性、多中心、观察性研究旨在更好地了解重症监护室医生和护士在 cDCD 方面的经验:在法国的 32 个 ICU 中,ICU 的医生和护士受邀在被确定为潜在 cDCD 捐赠者的 ICU 临终患者死亡后填写一份调查问卷,这些患者要么经历了单独的生命维持疗法的撤消,要么经历了有计划的器官捐赠(OD(-) 组和 OD( +) 组)。首要目标是评估潜在 cDCD 捐赠者死亡后他们的焦虑程度(国家焦虑量表 STAI Y-A)。次要目标是探讨临终关怀与器官捐献之间可能存在的紧张关系:共有 26 名 ICU 医护人员(79 名医生和 127 名护士)参与了 79 例潜在 cDCD 捐献者的研究。医生和护士的STAI Y-A在OD(-)组和OD(+)组之间没有差异(医生的STAI Y-A在OD(-)组为34(27-38),在OD(+)组为32(27-40),P = 0.911;护士的STAI Y-A在OD(-)组为32(25-37),在OD(+)组为39(26-37),P = 0.875)。器官捐献的可能性仅是影响护士做出 WLST 决定的一个因素,也是影响护士和医生实施 WLST 的一个因素。ICU 医护人员总体上对 cDCD 体验持积极态度。WLST和cDCD程序可通过支持专业人员明确其在生命末期支持和器官捐献成功之间的意图,以及在必要时通过加强ICU医生和护士之间的沟通来进一步改善:本研究已在ClinicalTrials.gov注册(标识符:NCT05041023,2021年9月10日)。
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引用次数: 0
Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention. 护理痴呆症患者的医护人员的伦理自我效能感:CARE 干预前后的简要报告。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-09 DOI: 10.1186/s12910-024-01106-z
Frederik Schou-Juul, Lucca-Mathilde Thorup Ferm, Simon Kinch, Sofie Smedegaard Skov, Christian Ritz, Sigurd Lauridsen

Background: Interventions targeting healthcare professionals' confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.

Methods: Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.

Results: While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.

Conclusions: The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

背景:尽管有文献记载教育项目对员工的知识和自我效能有积极影响,但针对医护人员在处理痴呆症护理中的伦理问题时的信心的干预措施却很有限。然而,有关教育项目影响的文献并不一致,这凸显了有针对性干预的必要性。CARE 干预方案专门用于增强道德决策的信心,旨在弥补这一不足。本研究评估了 CARE 干预在提高医护人员护理痴呆症患者(尤其是最初自我效能水平较低者)的伦理自我效能方面的有效性:采用非实验性的前后评估设计,对医护专业人员(n = 86)实施 CARE 干预,测量干预前后的伦理自我效能。我们假设所有参与者在干预前和干预后的道德自我效能感平均得分存在显著差异,尤其是那些干预前得分较低的参与者,我们预计他们将从干预中获益最多。统计分析包括配对 t 检验和 Wilcoxon 检验,用于对测量前得分低的亚组进行分析:结果:虽然在整个样本中没有观察到明显的变化,但初始自我效能感低的参与者在干预后有了统计学意义上的明显改善:CARE干预有望提高最初自信水平较低的医护人员的道德自我效能感。有针对性的干预措施对于解决在应对痴呆症护理中的伦理挑战方面存在的信心差距至关重要,这将对专业人员的福祉和护理质量产生影响。进一步的研究应探讨长期效果并扩大样本量,以提高研究结果的普遍性和可持续性。
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引用次数: 0
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BMC Medical Ethics
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