Post Mid-Staffordshire Inquiries Reaction, in and about the National Health Service (NHS), England. The Missing Pieces: Organizational, Care and Virtue Ethics Perspectives

The release of the Mid Staffordshire hospital report otherwise called the Francis report once again ignited the debate about the issue of abuse of especially vulnerable patients, while navigating the care pathway as inpatients in hospitals;within the National health service (NHS), England. Once more the official reaction from the NHS directorate is more “standards” to monitor failed standards in patient care. Of interest in the official responses so far, are the unheard voices addressing the issue of healthcare and organizational ethics concerns that need revisiting. This article seeks to revisit practice, systems and care issues leading to incidents of the type of the Staffordshire abuses, and the important but yet unheralded place of organizational and care ethics in helping to curb such abuses from re-occurring.

Examination of a Benchmark for Ethical Care Competence in Basic Nursing Education

Objectives: With rapid advancements in medical care, nurses are confronted with ethical issues on a daily basis. If new nurses are introduced to the clinical setting without having acquired sufficient ethical judgment skills in basic nursing education, they are unable to respond to the ethical dilemmas they face. This results in learned helplessness, which can lead to burnout and turnover. Therefore, it is imperative to develop educational programs where there is a natural progression from basic to continuing nursing. Therefore, in this study, we conducted a nationwide survey using the Nursing Student Care Ethical Competence Scale to present a benchmark for the assessment of this skill and facilitate continuity in nursing education. Methods: From February to March 2019, we conducted a questionnaire survey of 4930 final-year nursing students enrolled in nursing colleges, junior colleges, and technical schools nationwide. The survey consisted of 29 items on ethical behavior, 26 items on ethics knowledge, and seven items on personal attributes. For the analysis, we calculated percentiles for the five standards of nursing students’ ethical care competence: safe care provision, respecting self-determination, protecting personal information, providing the best care, and upholding patients’ dignity. Results: Responses were obtained from 1505 nursing students (collection rate 30.5%, valid response rate 30.5%). The 80th percentile (minimum value-maximum value) was 128 (38 - 145) points for the ethical competence of nursing students, 37 (11 - 40) points for safe care provision, 28 (4 - 31) points for respect for self-determination, 23 (5 - 25) points for protection of personal information, 23 (5 - 25) points for best care provision, and 13 (3 - 15) points for respect for personal dignity. Discussion: The 80th percentile was established as the benchmark for ethical care competence. Conclusion: Based on these criteria, nursing students can objectively assess their ethical behavior, allowing them to understand their strengths and weaknesses, articulate their challenges, and learn autonomously.

An Analysis of Ophelia in Hamlet from the Perspective of Feminist Care Ethic

Through the ages, Ophelia in Hamlet has long been regarded as a childish maid. This thesis will give an analysis of Ophelia's growth from the perspective of feminist care ethic developmental stages theory, trying to illustrate that in the play Ophelia has experienced ethical development and has arrived at ethical maturity in the end.

Who decides in withdrawal of treatment in a critical care setting? A case study on ethical dilemma

Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.

Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders

With the nursing profession continuing to face an array of ethical issues, the article reports the findings of a survey of members of the American Organization of Nurse Executives conducted in 2012 to determine the extent to which nurse leaders at different organization levels perceive various factors in their personal, professional and organizational environments to be helpful in resolving ethical dilemmas. After their personal values, nurse leaders perceive factors related to their organization to be more helpful than those related to their profession, including, among others, the American Nurses Association Code of Ethics. The two highest rated business-related factors deal with the absence of pressure to compromise one’s own ethical standards which suggests that one way healthcare organizations can assist nurses and their leaders is by neither explicitly nor implicitly pressuring them to go against their own ethical values. Other key factors related to the organization include formal organizational factors such as the existence of an ethics committee or a person to whom unethical activity can be reported as well as more informal factors related to organizational climate such as the actions and responsiveness of one’s immediate boss, the ability to go beyond one’s boss if necessary, the organizational culture, management philosophy, and management’s communication of appropriate ethical behavior. Comparison of the findings of the 2012 survey with those of a similar study conducted in 2000 indicated the four factors perceived as most helpful in both studies were identical with the same rank order and the top-10 factors were identical with some differences in ranking. Further analysis indicated the relative degree of helpfulness of the 17 help factors common to both studies was perceived by responding nurse leaders as quite similar overall. The authors also discuss the implications for the profession and the healthcare industry today and in the future.

The Impact of Health Care Reform Initiatives on Ethical Conflict and Opportunities for Nurses to Improve Quality of Care While Enhancing Their Work Environments

Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.

The effects of ethical dilemmas regarding the use of physical restraints in eldercare on female nurses who care for their relatives in Japan

Purpose: This study sought to clarify the relationship between a nurse’s exposure to elderly relatives and their perspective in using restraints on the elderly in health care situations. Methods: We approached nursing staff supervisors at 17 general hospital wards and explained the objectives of the study. Supervisors at 14 hospitals agreed to participate, giving us a sampling pool of 1929 nurses. We used a chi square test to compare nurses who had spent time with elderly relatives and those who had not on several variables related to using restraints on elderly patients. Results and Conclusion: This study found that nurses who live with elderly family members were significantly more likely to believe that restraints cause diseases (including chronic diseases) based on a chi square test (p < 0.05). Therefore it would be important that essential was the experiences of individuals with elderly family members when making programs of decreasing nurse’s dilemma to restraining the elderly.

Ethically Inspired Care Information Technology Can Enable Freedom of Choice of Older Users

The goal of this paper is to present the ethical issues that are relevant at the concept development stage and inspiring its development during the CONFIDENCE （Ubiquitous Care System to Support Independent Living） project. We propose that the technology must support principles such as human rights, privacy, safety, and dignity. The voluntary contribution of people as participants in research must undergo the scrutiny of research plans by ethical review boards. Informed consent processes and procedures must be observed in this realm. Ethical issues arising in heterogeneous fields involving technology, end-users, service providers, and formal and informal caregivers pose important challenges. Attempting to maximize the ethical compliance of the results of this ICT （information and communication technology） project, we explore and suggest preventive measures for possible scenarios of misuse of this or related technology. Concluding, the observation of ethical principles throughout the development process can empower users to make informed decisions on the acceptance of ICT systems and services when these reach the market.

Revolutionizing Healthcare—The Integration of Virtual Worlds, AR, and Metaverse Technology

This paper explores the transformative impact of virtual worlds, augmented reality (AR), and the metaverse in the healthcare sector. It delves into the ways these technologies are reshaping patient care, medical education, and research, while also addressing the challenges and opportunities they present. The paper highlights the potential benefits of these technologies and emphasizes the need for comprehensive regulatory frameworks and ethical guidelines to ensure responsible integration. Finally it outlines their transformative impact and discusses the challenges and opportunities they present for the future of healthcare provision.

Physical restraints:An ethical dilemma in mental health services in China

Given that physical restraints cause adverse effects to patients and nurses,their wide and frequent use has resulted in various clinical and ethical controversies in mental health services.The rate of physical restraints is significantly higher in China than in other countries.Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients.Therefore,this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China.This study synthesized the ethical issue according to the ethical principle of autonomy,justice,beneficence,and nonmaleficence.Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China,applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial.In regard to respect the basic rights of psychiatric patients,it is recommended to protect the their autonomy,and eliminate the adverse effects of physical restraint.This goal would be achieved by ensuring the informed consent,providing humane care,and regulating the implementation of physical restraints.

An Ethical Practice Intervention Program for Pediatric Nurses with Varied Nursing Experience

Aim: This study aimed to elucidate experience-related differences in the impact of an intervention program promoting ethical nursing practices among pediatric nurses with 0 - 5 years’ experience in varying settings. Methods: The pediatric nursing care model, defining 24 elements of pediatric nursing practice, was developed to educate nurses with pediatric nursing experience only, as well as those with experience in other settings, on ethical nursing practices toward pediatric patients and their families. Participants’ level of knowledge and frequency of application of these practices were assessed before, directly after and two months after the intervention, with a final follow-up three months post-intervention. Results: Results showed that among those who have experience in nursing areas other than pediatrics, the frequency of practicing items related to children’s rights and dignity significantly increased (p Conclusions: Participants showed an increased awareness of issues related to ethical pediatric nursing practice for patients’ and their parents.

Studying the Reinforcement Effect of a Seminar on Ethical Practices among Pediatric Nurses

Aim: This study aimed to examine the effect of a seminar to continuously reinforce ethical nursing practices among pediatric nurses. Methods: This seminar was based on a 24-point pediatric nursing care model (PNCM) that provided specific examples of basic ethical nursing practices for children undergoing medical procedures and their families. Participants’ knowledge level and application frequencies, regarding these practices, were assessed face-to-face in the first session and via email 2 and 5 months later, using the PNCM checklist and qualitative data about ethical practices. Results: Results revealed that 8 PNCM items about frequency remained the same as the first session after 5 months;however, 16 items reported increased application. The qualitative data collected 2 months later suggested that the nurses could have adapted better to implement ethical pediatric nursing;however, the one collected 5 months later confirmed the effect of the seminar on ethical nursing practices with children and their families. The continuous effect of the seminar became more evident from the responses received 5 months later than those received 2 months later. Conclusions: The findings confirmed a reinforced effect on ethical pediatric nursing practice with child patients and their parents after 5 months.

Preliminary Study of the Organizational Ethical Climate and its Enhance-ment Methods for Taiwan and Shanghai

This paper investigates the types of the organizationalethical climate for both Taiwan and Shanghai,and thedifference between their enhancement methods in orderto provide both parties with a reference for effectivelyforming an ethical climate,and thus help establish busi-ness ethics.This survey was based on an empiricalstudy,utilizing questionnaires which were a combinationof past literatures with ready-made questionnaires con-ducted on eight hundred and seventeen valid samplesfrom both parties.The results showed that"law andcode"and"caring"are main ethical climate types forboth parties,which also indicates the norms of"caring"and"law and code"on enhancement methods of an ethi-cal climate.Both parties emphasize"changing organiza-tional culture"to enhance ethical climate,yet Shanghaiexclusively places stresses on"executives’supervisingsubordinates’behaviors",revealing its organizations’strong tendency to avoiding transgression.It was alsofound that diverse organizations represent different ethi-cal

Patient-oriented CaremHistory, Progress and Current State according to Literature and in Practice in the Czech Republic

This work is focused on ＂patient-oriented care＂, which belongs to modem style of health care including nursing. Such health care emphasises holistic approach with focus on communication, partnership, ethic aspects of human interactions and which supports active collaboration between the patient and also his/her family and the nursing staff. In Czech scientific literature the term ＂patient-oriented care＂ is rarely encountered. Single given definition found for this topic was present in legal norm bulletin The Concept of Czech Nursing [1] which was however defined as care focused on patient problems not on care connected treatments. International literature had therefore to be addressed. Question remains whether patient-oriented care is even possible in practice when it is basically omitted from Czech scientific literature. The aim of this research was to define the term ＂patient-oriented care＂ based on historical point of view, its characteristics and sources from Czech and international literature and try and apply such care in new nursing methods of approach. This research was conducted on theoretical level. Method of analysing review documents and analytically comparative approach were applied. The total 83 scientific publications were analysed with 55 reviews, 22 articles and 6 virtual sources. The area of interest was defined to include forms of application of patient-oriented care in nursing history, the characteristics of patient-oriented care in Czech and international literature, necessary conditions for successful use of patient-oriented care and novel methods of approaching patient-oriented care. We found that contrary to the Czech Republic US has established patient-oriented care as one of the pivotal research subjects onto which much interest is focused and which is frequently being published. There is an established project in Austria focused on implementation of the concept of patient-oriented care into public health care. In the Czech Republic this term is only mentioned in the legislative decree, together with the method of nursing process but not used in practice. Due to absence or broader application of patient-oriented care approach in the Czech Republic and in order to make this approach more effective, further education on this approach has been introduced in the form of life-long education. The way the newly acquired knowledge is implemented in practice must be the subject of further research. The trend of the new approach toward the patient-oriented care should inspire further focus on education and care provision including nursing. The necessity for a change is felt particularly in the current intense argument on the insufficient numbers of general nurses and the levels of their qualification education in this country. Better agreement should be reached regarding evaluation of patient-oriented care to ensure it really is conducted in order to benefit the patient.

For a Pedagogy of Care

Today, philosophy as well as other sciences identifies care as a primary concept to reflect upon, and if we contemplate our own experience, the ontological and existential primacy of caring becomes apparent. Starting from these premises, it is fundamental to reinterpret education from the perspective of the concept of care. To contribute to the development of this pedagogical debate, the aim of this paper is to identify the ways of behaving which qualify the competence of an educator as capable of providing care. This is a central pedagogical question; indeed, since the practice of care occurs in relationships where the educator is the subject responsible for ensuring that the relationship is permeated by care. As such, a core task of pedagogical reflection is identifying the relational postures which shape good care.

Care and Estrangement in Mother-Child Relationship in Sula

Motherhood is one of the unavoidable themes of Toni Morrison’s Sula.However,motherhood manifests itself more as split and disconnection than affection and comfort in this novel.From the perspective of the ethic of care,we will find that motherhood is rather complicated and fraught with conflicts.The onus of parenthood care has traditionally fallen on the mother.The reality is that mother care is not as guaranteed and unconditional as readers used to believe.The performance of mother care is actually subject to many hindrances even though the mother may entertain a profound love towards her child.In this story,we may find that racial oppression,financial hardship,emotional burden,children’s depressing response,etc.,all exemplify these hindrances.Lack of care,thus,can lead to the disconnection and estrangement between mother and child.This novel dispels the myth of unconditional maternal love and presents to us the complicatedness of motherhood.

人工智能养老的伦理困境反思

人工智能养老是人工智能与养老服务相互融合而形成的新兴领域。中国社会正值人口老龄化、高龄化的加速期与上升期,人工智能为满足老年人的健康需求提供前所未有的契机,也面临着严峻的伦理难题和挑战。面向老年人的人工智能伦理治理,应坚持以人为本的价值立场,以增进老年人福祉为价值目标。理念赋能,维护老年人的权利与尊严;关系赋能,倡导多方协作共担责任的伦理治理;技术赋能,弥合老年数字鸿沟;心理赋能,提升老年人内在自我效能。

长期护理保险居家护理项目的伦理基础与制度保障

长期护理保险居家护理项目包括家庭照护类和上门护理类,以孝道文化和尊老敬老文化为伦理基础。各地试点政策均对居家护理项目进行了规定。但家庭照护类项目中参保人家属在确定非正式护理人员和维系家庭照护质量中承受着伦理压力,上门护理类项目中上门护理员在维系护理质量和上门护理市场中承受着伦理压力。制度解决相关伦理问题,应允许参保老年人自由选择现金或服务支付,推进家政行业建设,对家庭照护质量维系提供支持,并建立统一的居家上门护理质量标准和考核制度,建立针对养老服务机构上门护理的惩罚和退出制度。

家庭医生服务制度的健康伦理、现实挑战与机制完善

人文关怀、契约精神与资源分配是家庭医生服务制度健康伦理的核心指向,该制度在实践运作中存在诸多健康伦理的现实挑战。人文关怀理念的培养,必须强化全科医学人文教育的规范化与家庭医生执业中人文教育的制度化;签约服务信任关系的养成,应力求实现家庭医生服务制度的规范化且应充分考虑不同人群的特殊需要,加强家庭医生服务平台的信息化建设;签约服务首诊秩序的形成,除了人文关怀理念与签约服务信任的相关制度完善外,还应采取诱导性的制度设计,合理调整与配置医疗卫生资源,引导居民逐步养成科学的健康理念与有序的就医习惯。

中国基本养老服务制度的伦理向度

基本养老服务制度关乎伦理,蕴含遵循以人民为中心的核心价值、彰显共建共享的顶层设计、聚焦正义和效率的协调统一、秉持公共善和个体善相辅相成的伦理属性;在制度的执行和贯彻中存在保基本与需求多样性的差距、传统代际养老责任意识与普惠性相背离、资源配置的均衡性不足等方面的实然伦理困境;只有聚焦基本养老服务责任的顺序性和协同性相结合、传统孝老爱亲文化的创造性转化和创新性发展、基本养老服务分配形式公平和实质公平相统一等应然伦理路径,基本养老服务制度建设才能在“善”的应然方向彰显更大效能。