scholarly journals Exploring New Zealand Paramedic Attitudes Towards Advance Directives: An Ethical Analysis

2016 ◽  
Vol 13 (4) ◽  
Author(s):  
Paul J Davey ◽  
Amanda B Lees ◽  
Rosemary Godbold
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
End Of Life ◽  
Advance Directives ◽  
Professional Education ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Care Practice ◽  
Free Text ◽  
Advanced Directives

IntroductionAdvance directives are known to present challenging ethical issues in health care practice, however there is a paucity of research paramedic perspectives. When a cardiac arrest occurs in the community, end of life provisions have often not been considered by patients or the patients are unable to communicate their wishes and these are not usually known to the attending paramedic crew. These factors contribute to an ethically complex decision-making environment. Ethical deliberation contributes to practitioners’ critical thinking skills and helps prepare them for decision-making under uncertainty. This research aims to highlight and explore underlying values present within practice-based decisions.MethodsAn exploratory, interpretive study, using the Values Exchange, a web-based ethical decision-making tool, explored eighteen urban-based New Zealand paramedics’ deliberative perspectives on an ethically controversial end of life scenario.ResultsThematic analysis of participants’ free text responses ascertained the breadth of views on advanced directives, with the emergence of three dominant themes; legal tensions, multiple constructs of dignity and seeking solutions that support clinical practice.ConclusionFindings revealed that when considering situations involving advance directives, participants regarded the duty to uphold patient dignity as paramount. There was a desire for greater legal guidance and a call for increased professional education in law and ethics. This study provides insight into New Zealand urban-based paramedics’ views and experiences of this ethically challenging aspect of patient care.

scholarly journals Leadership curricula and assessment in Australian and New Zealand medical schools

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simone Jacquelyn Ross ◽  
Tarun Sen Gupta ◽  
Peter Johnson
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Ethical Decision Making ◽  
Leadership Skills ◽  
Medical Schools ◽  
Leadership Competencies ◽  
Leadership Education ◽  
Free Text ◽  
Medical Council ◽  
Medical Leadership

Abstract Background The Australian Medical Council, which accredits Australian medical schools, recommends medical leadership graduate outcomes be taught, assessed and accredited. In Australia and New Zealand (Australasia) there is a significant research gap and no national consensus on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. This study aims to investigate the current curricula, assessment and evaluation of medical leadership in Australasian medical degrees, with particular focus on the roles and responsibilities of medical leadership teachers, frameworks used and competencies taught, methods of delivery, and barriers to teaching leadership. Methods A self-administered cross-sectional survey was distributed to senior academics and/or heads or Deans of Australasian medical schools. Data for closed questions and ordinal data of each Likert scale response were described via frequency analysis. Content analysis was undertaken on free text responses and coded manually. Results Sixteen of the 22 eligible (73%) medical degrees completed the full survey and 100% of those indicate that leadership is taught in their degree. In most degrees (11, 69%) leadership is taught as a common theme integrated throughout the curricula across several subjects. There is a variety of leadership competencies taught, with strengths being communication (100%), evidence based practice (100%), critical reflective practice (94%), self-management (81%), ethical decision making (81%), critical thinking and decision making (81%). Major gaps in teaching were financial management (20%), strategic planning (31%) and workforce planning (31%). The teaching methods used to deliver medical leadership within the curricula are diverse, with many degrees providing opportunities for leadership teaching for students outside the curricula. Most degrees (10, 59%) assess the leadership education, with one-third (6, 35%) evaluating it. Conclusions Medical leadership competencies are taught in most degrees, but key leadership competencies are not being taught and there appears to be no continuous quality improvement process for leadership education. There is much more we can do as medical educators, academics and leaders to shape professional development of academics to teach medical leadership, and to agree on required leadership skills set for our students so they can proactively shape the future of the health care system.

scholarly journals “What Would You Do?”: How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1114
Author(s):  
Katherine Littlewood ◽  
Ngaio Beausoleil ◽  
Kevin Stafford ◽  
Christine Stephens
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
End Of Life ◽  
Companion Animals ◽  
Chronically Ill ◽  
Future Research ◽  
End Of Life Decisions ◽  
Life Decisions ◽  
End Of Life Decision ◽  
Life Decision

Cats are the most common companion animals in New Zealand. Advances in veterinary care means that cats are living longer and there are many older cats. End-of-life decisions about cats are complicated by owner–cat relationships and other psychosocial factors. Our study explored the ways in which end-of-life decisions were being made by owners of older and chronically ill cats in New Zealand and the role of their veterinarian in the process. Qualitative data were gathered via retrospective semi-structured interviews with 14 cat owners using open-ended questions. Transcripts of these interviews were explored for themes using template analysis and nine themes were identified. Four were animal-centered themes: cat behavior change, pain was a bad sign, signs of ageing are not good, and the benefits of having other people see what owners often could not. Five were human-centered themes: veterinarians understanding owners’ relationships with their cat, normalizing death, the need for a good veterinarian to manage end of life, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat. End-of-life decision making is complex, and the veterinarian’s role is often poorly defined. Our owners appreciated the expertise and validation that their veterinarian provided but continuity of care was important. Future research aimed at exploring the veterinarian’s perspective during end-of-life decision making for cats would be a valuable addition to the topic.

Neonatal nurse practitioner ethics knowledge and attitudes

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2247-2258
Author(s):  
Mobolaji Famuyide ◽  
Caroline Compretta ◽  
Melanie Ellis
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Neonatal Nurse Practitioners

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

scholarly journals An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

2018 ◽  
Vol 36 (5) ◽  
pp. 362-369 ◽  
Author(s):  
Amelia Barwise ◽  
Young J. Juhn ◽  
Chung-Il Wi ◽  
Paul Novotny ◽  
Carolina Jaramillo ◽  
...  
Keyword(s):  
Decision Making ◽  
Socioeconomic Status ◽  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Composite Index ◽  
Life Care ◽  
Individual Housing ◽  
Lower Likelihood ◽  
Multiple Variables

Background: Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. Objective: Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. Design/Setting/Participants: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. Measurements: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. Results: Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives −0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home −0.60(95% CI: 1.0.5-0.72). Conclusion: Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.

Data-based ethical decision making, lateral relations, and organizational commitment

2018 ◽  
Vol 40 (6) ◽  
pp. 946-963 ◽  
Author(s):  
Sean Robert Valentine ◽  
David Hollingworth ◽  
Patrick Schultz
Keyword(s):  
Decision Making ◽  
Organizational Commitment ◽  
Information Flow ◽  
Structural Equation ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Self Report ◽  
Equation Modeling ◽  
Content Type

Purpose Focusing on ethical issues when making organizational decisions should encourage a variety of positive outcomes for companies and their employees. The purpose of this paper is to determine the degree to which data-based ethical decision making, lateral relations and organizational commitment are interrelated in organizations. Design/methodology/approach Data were collected from business professionals employed at multiple locations of a financial services firm operating in the USA. Mediation analysis (based on structural equation modeling) was used to test the proposed relationships. Findings Results indicated that employees’ perceptions of data-based ethical decision making were positively related to perceived lateral relations, and that perceived lateral relations were positively related to organizational commitment. Research limitations/implications Given that information was collected using only a self-report questionnaire, common method bias could be an issue. In addition, the study’s cross-sectional design limits conclusions about causality. Another limitation involves the study’s homogenous sample, which decreases the generalizability of the findings. Finally, variable responses could have been impacted by individual frames of reference and other perceptual differences. Practical implications Results suggest that information flow enhancements should support or be consistent with horizontal information flow enhancements, and that together these factors should increase employee commitment. Originality/value Given the dearth of existing research, this interdisciplinary investigation is important because it fills gaps in the management literature. This study is also important because the results could inform decisions regarding the use of data analysis in ethical decisions and lateral forms of organizational structuring to improve work attitudes.

scholarly journals A Framework for Authentic Ethical Decision Making in the Face of Grand Challenges: A Lonerganian Gradation

2021 ◽  
Author(s):  
Patricia Larres ◽  
Martin Kelly
Keyword(s):  
Decision Making ◽  
Business Ethics ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Codes Of Ethics ◽  
Human Beings ◽  
Human Flourishing ◽  
Invariant Structure ◽  
Grand Challenges

AbstractThis paper contributes to the contemporary business ethics narrative by proposing an approach to corporate ethical decision making (EDM) which serves as an alternative to the imposition of codes and standards to address the ethical consequences of grand challenges, like COVID-19, which are impacting today’s society. Our alternative approach to EDM embraces the concept of reflexive thinking and ethical consciousness among the individual agents who collectively are the corporation and who make ethical decisions, often in isolation, removed from the collocated corporate setting. We draw on the teachings of the Canadian philosopher and theologian, Fr. Bernard Lonergan, to conceptualize an approach to EDM which focuses on the ethics of the corporate agent by nurturing the universal and invariant structure that is operational in all human beings. Embracing Lonergan’s dynamic cognitive structure of human knowing, and the structure of the human good, we advance a paradigm of EDM in business which emboldens authentic ethical thought, decision making, and action commensurate with virtuous living and germane to human flourishing. Lonergan’s philosophy guides us away from the imposition of over-arching corporate codes of ethics and inspires us, as individual agents, to attend to the data of our own consciousness in our ethical decision making. Such cognitional endowment leads us out of the ethics of the ‘timeless present’ (Islam and Greenwood in Journal of Business Ethics 170: 1–4, 2021) towards ethical authenticity in business, leaving us better placed to reflect upon and address the ethical issues emanating from grand challenges like COVID-19.

scholarly journals Ethics and Total Worker Health®: Constructs for Ethical Decision-Making and Competencies for Professional Practice

2021 ◽  
Vol 18 (19) ◽  
pp. 10030
Author(s):  
Bonnie Rogers ◽  
Anita L. Schill
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Well Being ◽  
Work Hours ◽  
Worker Safety ◽  
Worker Health ◽  
Total Worker Health

Work has become increasingly technologically driven and fast paced, with long work hours, new/emerging hazards, and rising health care costs. Threats to worker safety, health, and well-being including non-traditional work arrangements and practices, precarious work, uncertain hazardous exposures, and work organization issues, such as heavy workloads, design of work, uneven work hours, and difficult interpersonal relationships among workers and managers are apparent. Furthermore, the relationship between personal health risk factors and workplace risks and exposures has drawn increased attention and concern. As employer economic pressures continue to build, it is anticipated that ethical dilemmas for practitioners will become increasingly complex. A review of relevant Total Worker Health (TWH) literature, related ethical constructs and competencies, an examination of codes of ethics for occupational safety and health and health promotion/education disciplines was conducted. A case study for TWH utilizing an ethical decision-making model for the analysis of key ethical issues and solutions was completed. TWH approaches to protecting safety, promoting health, and advancing well-being are increasingly being adopted. These approaches can reveal ethical dilemmas, and ethical constructs are needed to guide decision-making. A core set of proposed ethical competencies for TWH professionals are identified as a transdisciplinary framework to support workplace ethical culture.

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