Nursing schools are required to ensure that the clinical and academic milieu prepares nurses not only to recognize but also to act on various ethical issues. As a result of our years teaching nursing ...ethics to undergraduate nursing students we have come to believe there is a disconnect between classroom teaching and students' experiences in practice. How then can nurse educators help nursing students not only to see the ethical components of their work but also to take the necessary steps to solve ethical dilemmas and challenge unethical practice? One such strategy is the use of preceptorship. In this paper, we set out to learn about nursing students' ethical encounters in the clinical area, specifically those within the preceptor/student relationship. To this end we conducted an integrative review and are weaving in Gesler's (1992) concepts who argued that ethical issues play out in our physical and social environments. We identified nine articles that describe students' perceptions of ethical problems in their relationships with preceptors. However, it was rare for the authors of these articles to label these as ‘ethical’ issues. The integrative review revealed first, that students describe ethical issues in their narratives, and second, their most common response to these issues is silence. We continue to be concerned that nursing students' classroom learning of ethics is disconnected from their everyday nursing practice. Further research and education implications are discussed and explored in this paper.
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for cancer. Due to the mechanism of action of ICIs, inflammatory reactions against normal tissue were an anticipated side ...effect of these agents; these immune‐related adverse events have been documented and are typically low grade and manageable. Myocarditis has emerged as an uncommon but potentially life‐threatening adverse reaction in patients treated with ICIs. Assessment and characterization of ICI‐associated myocarditis is challenging because of its low incidence and protean manifestations. Nevertheless, the seriousness of ICI‐associated myocarditis justifies a coordinated effort to increase awareness of this syndrome, identify patients who may be at risk, and enable early diagnosis and appropriate treatment. The “Checkpoint Inhibitor Safety Working Group,” a multidisciplinary committee of academic, industry, and regulatory partners, convened at a workshop hosted by Project Data Sphere, LLC, on December 15, 2017. This meeting aimed to evaluate the current information on ICI‐associated myocarditis, determine methods to collect and share data on this adverse reaction, and establish task forces to close the identified knowledge gaps. In this report, we summarize the workshop findings and proposed steps to address the impact of ICI‐associated myocarditis in patients with cancer.
Immune checkpoint inhibitors are a class of drugs that trigger the immune system to recognize and fight cancer cells; however, related immune‐related adverse events are a challenge. This commentary describes a workshop convened by Project Data Sphere to determine best approaches in the treatment of myocarditis, with the goal of minimizing the risk of this adverse reaction in patients with cancer who are treated with immune checkpoint inhibitors.
To be effective, criminal justice policies should affect the underlying social norms for which the policies were enacted. This study sought to determine whether public perceptions of criminal justice ...policies on domestic violence affected social norms. Two waves of data were collected via a telephone survey where a random probability sample of 973 residents was drawn from 4 communities. A structural equation model was tested and confirmed. Results provided strong support for the hypothesis that perceptions of criminal justice policies have direct effects on attitudes toward criminal justice response, and indirect effects on victim-blaming attitudes, both underlying social norms related to domestic violence. The enactment of criminal justice policies, therefore, may have an impact beyond victims and perpetrators and lead to a transformation of the community through the emergence of new social norms. Public awareness campaigns designed to disseminate criminal justice policies may be instrumental in provoking social change.
The focus of much of modern bioethics literature is on the concept of autonomy. Yet, there is little written from the perspective of people with illness who are faced with making decisions about ...their own health care. The purpose of this study is to probe how people with chronic illness, specifically multiple sclerosis, make decisions about their health care. It explores how participants' relationships with their physicians and their families affect their decision-making. Their perceptions of these relationships are then examined in light of the concept of autonomy as it is commonly used in the bioethics literature. The study uses qualitative and a small quantitative methodology. The data derive from semi-structured interviews with twenty two people who have multiple sclerosis. The participants are asked to discuss a health care decision that was important to them. The results indicate that participants take a broad view of what decisions are important in their health care, often choosing to talk about decisions that were not specifically ‘treatment’ decisions. They generally want to make their own decisions. However, they see a role for both their physicians and their families in that decision making. They want a partnership with their physicians with the physicians providing information and advice, and respecting clients' experiences and decisions. The family situation is more complex. Participants want to have a role within the family. They are willing to consider their family's input and the effect of their decisions on the family. However, participants still want to have the final word, and the decision is very dependent on the context at the time. With both physicians and families, participants expected support once they had made a decision. In making decisions they attempted to avoid direct confrontation. These results also indicate that the theoretical concept of autonomy used in bioethics literature does not capture the sense in which these people with multiple sclerosis make their health care decisions. They do not make their decisions in isolation; their relationships with physicians and families are an important component of their health care decision making.
This study has followed up clients who were referred to the Baycrest Competency Clinic for competency assessment. It has elicited the perceptions of clients and their close associates, mainly family ...members, about how decisions are now made, their satisfaction with this and the process of the assessment itself. The findings indicate that substitute decision making has expanded to include clients who were not judged incompetent, and in those judged incompetent, beyond the specific incapacity assessed. Participants generally were satisfied with how decisions are now made, and with the protection of their rights. They also were satisfied with the process of the assessment itself. Some implications for the balance between the ethical principles of autonomy and beneficence, and the relationship between the client and family are discussed.
To report on the perceptions of assessment of competency and its consequences on a group of clients and significant others at follow-up.
Ninety-five interviews were conducted using a carefully ...developed semistructured telephone interview of 24 clients and 71 family/caregivers, representing the perceptions of about 80 clients.
There was general satisfaction in the competency assessment process. There was a perception that interests and rights were protected. Clients were seen to be less involved in all spheres of decision making regardless of capacity outcome. Clients and families were satisfied with how decisions were made.
Follow-up study of competency assessment does not support the conclusions previously drawn based on court record studies that assessments are deleterious and frequently result in violations of rights.
Little research has been undertaken to determine why healthy people agree to enroll in randomized controlled trials of cancer prevention. This study describes the beliefs of Canadian women ...participating in a trial designed to determine the effect of reducing dietary fat on the development of breast cancer. Healthier eating, nutritional counseling, contributing to science, and helping others were the most frequently cited advantages of participation. Weight control and general better health were specifically associated with the dietary regimens. Attending appointments and difficulties when eating out were the main disadvantages of participation. Suggestions that would promote adherence to the trial protocol also were elicited. Responses cited most often included opportunities to meet other participants, more nutritional counseling (particularly psychological tips), updates about the trial, and more recipes. Attention should be paid to these suggestions as they characterize some of the major determinants of adherence behavior.
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