Patient restrictions: Are there ethical alternatives to seclusion and restraint?

2010 ◽  
Vol 17 (1) ◽  
pp. 65-76 ◽  
Author(s):  
Raija Kontio ◽  
Maritta Välimäki ◽  
Hanna Putkonen ◽  
Lauri Kuosmanen ◽  
Anne Scott ◽  
...  
Keyword(s):  
Decision Making ◽  
Aggressive Behaviour ◽  
Psychiatric Care ◽  
Ethical Dilemmas ◽  
Decision Making Process ◽  
Involuntary Admission ◽  
Focus Group Interviews ◽  
Group Interviews ◽  
Acute Psychiatric Care ◽  
Normal Standard

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent.

scholarly journals A Deliberate Choice? Exploring the Decision to Switch from Cigarettes to E-Cigarettes

2019 ◽  
Vol 16 (4) ◽  
pp. 624 ◽  
Author(s):  
Kim Romijnders ◽  
Liesbeth van Osch ◽  
Hein de Vries ◽  
Reinskje Talhout
Keyword(s):  
Decision Making ◽  
Health Benefits ◽  
Relevant Information ◽  
Decision Making Process ◽  
Cigarette Use ◽  
Focus Group Interviews ◽  
Cigarette Smokers ◽  
Risks And Benefits ◽  
Conscious Decision ◽  
Group Interviews

E-cigarettes are increasingly popular among both cigarette smokers and non-users. Although smoking cessation yields the most individual and population health benefits, switching to exclusive e-cigarette use offers some individual health benefits for cigarette smokers. However, e-cigarette use is not harmless, and its use among non-cigarette smokers should be prevented. Our study aims to explore the decision-making process about e-cigarettes among an e-cigarette users, cigarette smokers, and non-users. We conducted 12 semi-structured focus group interviews with e-cigarette users, cigarette smokers, and non-users. We performed a thematic analysis of the interview transcripts. First, knowledge reported by e-cigarette users was mainly based on other users’ experiences. Second, cigarette smokers and non-users were more negative towards e-cigarettes than e-cigarette users. Third, e-cigarette users considered switching from cigarette smoking to e-cigarette use by deliberating relevant information, and weighing up the benefits and disadvantages of e-cigarette use versus smoking. Additionally, important factors in the decision-making process were a perception of risks and benefits of e-cigarettes compared to cigarettes, a supportive social environment about e-cigarette use, and trust in information offered about the risks and benefits of e-cigarettes. Our findings provide insight into what we can learn from the conscious decision-making process of e-cigarette users who switched from cigarettes to e-cigarettes. This information can be considered to develop targeted communications strategies to stimulate a conscious decision-making process, these may highlight benefits of switching to e-cigarettes for cigarette smokers, discussing the risks of smoking, and correcting misperceptions about the perceived risks and benefits of e-cigarette use.

Innovation in Surgery: Qualitative Analysis of the Decision-Making Process and Ethical Concerns

2018 ◽  
Vol 25 (6) ◽  
pp. 586-593 ◽  
Author(s):  
Alban Zarzavadjian Le Bian ◽  
David Fuks ◽  
Renato Costi ◽  
Manuela Cesaretti ◽  
Audrey Bruderer ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Analysis ◽  
Ethical Dilemmas ◽  
Organ Transplant ◽  
Interaction Model ◽  
Decision Making Process ◽  
Surgical Innovation ◽  
Ethical Conflicts ◽  
Long Term Follow Up ◽  
The Ideal

Background. Surgical innovation from surgeon’s standpoint has never been scrutinized as it may lead to understand and improve surgical innovation, potentially to refine the IDEAL (Idea, Development, Exploration, Assessment, Long-term Follow-up) recommendations. Methods. A qualitative analysis was designed. A purposive expert sampling was then performed in organ transplant as it was chosen as the ideal model of surgical innovation. Interviews were designed, and main themes included the following: definition of surgical innovation, the decision-making process of surgical innovation, and ethical dilemmas. A semistructured design was designed to analyze the decision-making process, using the Forces Interaction Model. An in-depth design with open-ended questions was chosen to define surgical innovation and ethical dilemmas. Results. Interviews were performed in 2014. Participants were 7 professors of surgery: 3 in liver transplant, 2 in heart transplant, and 2 in face transplant. Saturation was reached. They demonstrated an intuitive understanding of surgical innovation. Using the Forces Interaction Model, decision leading to contemporary innovation results mainly from collegiality, when the surgeon was previously the main factor. The patient is seemingly lesser in the decision. A perfect innovative surgeon was described (with resiliency, legitimacy, and no technical restriction). Ethical conflicts were related to risk assessment and doubts regarding methodology when most participants (4/7) described ethical dilemma as being irrelevant. Conclusions. Innovation in surgery is teamwork. Therefore, it should be performed in specific specialized centers. Those centers should include Ethics and Laws department in order to integrate these concepts to innovative process. This study enables to improve the IDEAL recommendations and is a major asset in surgery.

Simply Academic: Linking Reporting Environments

2008 ◽  
Vol 23 (3) ◽  
pp. 455-466 ◽  
Author(s):  
Martin T. Stuebs
Keyword(s):  
Decision Making ◽  
Financial Reporting ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Decision Making Process ◽  
Academic Environment ◽  
Reporting Environment

This instructional case attempts to connect the environmental incentives and ethical issues from two different reporting environments. It provides two different scenarios that allow students to identify and grapple with multiple incentives and resultant ethical dilemmas present in the academic reporting environment. A summary then requires students to link stakeholders, activities, incentives, and dilemmas in the academic environment to corresponding situations in the financial reporting environment. The purpose of the case is threefold: (1) It makes students aware of the incentives and ethical issues present in various reporting environments. (2) By explicitly linking the academic and financial reporting environments, students see the relevance of ethics in their current lives and are motivated to develop ethical habits now in order to prepare for the challenges that will occur later in their careers. (3) The case forces students to practice making decisions in situations with conflicting incentives and ambiguous or nonexistent legal guidance. Strong conflicting incentives can cloud and compromise even the purest of intentions. Dealing with these conflicts early and often can mature one's judgments and improve the decision-making process.

Perspectives of prostate cancer patients about active surveillance.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 82-82
Author(s):  
Fred Saad ◽  
Margaret Fitch ◽  
Kittie Pang ◽  
Veronique Ouellet ◽  
Carmen Loiselle ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Active Surveillance ◽  
Health Care Professionals ◽  
Treatment Options ◽  
Low Risk ◽  
Close Monitoring ◽  
Focus Group Interviews ◽  
Group Interviews

82 Background: In prostate cancer (PC), men diagnosed with low risk disease may be monitored through an active surveillance (AS) approach that runs counter to the traditional message of undergoing treatment as soon as possible following a cancer diagnosis. This research explored the perspectives of men with PC regarding their decision-making process for AS to identify the factors that influenced their decision and assisted health care professionals in discussing AS as an option. Methods: Focus group interviews (n = 7) were held in several Canadian cities with men (n = 52) diagnosed with PC and eligible for AS. The men’s viewpoints were captured regarding their understanding of AS, the factors that influenced their decision to engage in AS, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the interviews. Results: All patients described the perception that their disease was not “large enough” to require treatment. They understood that the waiting process avoided the side effects associated with treatments, and they were comfortable about postponing treatment while undergoing close monitoring. Conversations with their doctor and how AS was described were cited as key influences in their decision. Other influences included availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions: AS is a relatively new approach for the care of men with low risk PC. Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.

The Impact of Task Information Feedback on Ethical Reasoning

2006 ◽  
Vol 18 (1) ◽  
pp. 103-116 ◽  
Author(s):  
Dawn W. Massey ◽  
Linda Thorne
Keyword(s):  
Decision Making ◽  
Public Interest ◽  
Ethical Dilemmas ◽  
Ethical Reasoning ◽  
Accounting Students ◽  
Decision Making Process ◽  
Information Feedback ◽  
The Public ◽  
Cognitive Decision ◽  
The Impact

This study investigates whether task information feedback (TIF) promotes 84 auditors' and accounting students' use of higher ethical reasoning, thereby increasing their tendency to consider the public interest in the resolution of ethical dilemmas. TIF is a type of feedback in which subjects are provided with guidance about the cognitive decision-making process they should use. In our experiment, subjects used higher ethical reasoning to resolve audit dilemmas after receiving TIF than they did before receiving TIF. Accordingly, our findings suggest that TIF is effective in promoting higher ethical reasoning and thus increasing the tendency of practicing and aspiring auditors to consider the public interest when resolving ethical dilemmas.

Neonatal Ethical Decision Making: Where Does the NNP Fit In?

1999 ◽  
Vol 18 (8) ◽  
pp. 27-32 ◽  
Author(s):  
Patricia Waltman ◽  
Laura Schenk
Keyword(s):  
Decision Making ◽  
Nurse Practitioners ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Dilemmas ◽  
Decision Making Process ◽  
Educational Strategies ◽  
Neonatal Nurse Practitioners ◽  
Historical Basis

Neonatal nurse practitioners are frequently confronted with ethical dilemmas in the NICU. This article reflects on the historical basis of ethical decision making and the issues some novice NNPs face today regarding their participation in the decision-making process. It examines various educational strategies that can be used to help NNPs to develop the skills they need to participate collaboratively in ethical decision making in the NICU. It concludes with recommendations for further research.

Manoeuvring challenging demands: care managers, the Free Choice System and older users of home care services with reduced decision-making capacity

2020 ◽  
Vol 4 (4) ◽  
pp. 479-495
Author(s):  
Anna Dunér ◽  
Gerd Gustafsson
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Free Choice ◽  
Home Care Services ◽  
Focus Group Interviews ◽  
Care Services ◽  
Care Managers ◽  
Decision Making Capacity ◽  
Older Users ◽  
Group Interviews

The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care.

Ethical Dilemmas and the Nurse Practitioner in the NICU

2001 ◽  
Vol 20 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Linda Juretschke
Keyword(s):  
Decision Making ◽  
Nurse Practitioner ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Dilemmas ◽  
Decision Making Process ◽  
Advanced Practice ◽  
Emergency Situations

With the emergence of advanced practice roles for nurses, including the role of the neonatal nurse practitioner (NNP), nurses are increasingly being placed in the position of making difficult decisions, especially in acute or emergency situations. NNPs, therefore, must have a working knowledge of the ethical decision-making process in order to make appropriate decisions at the bedside.

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