Institutional Ethics Resources: Creating Moral Spaces

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings

Advancement of the German version of the moral distress scale for acute care nurses : a mixed methods study

Aim: Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German‐speaking contexts. Hence, the aim of this study was to develop and psychometrically test a German‐language version of the Moral Distress Scale. Design: We chose a sequential explanatory mixed methods design, followed by a second quantitative cross‐sectional survey. Methods: An American moral distress scale was chosen, translated, culturally adapted, tested in a pilot study and subsequently used in 2011 to conduct an initial web‐based quantitative cross‐sectional survey of nurses in all inpatient units at five hospitals in Switzerland's German‐speaking region. Data were analysed descriptively and via a Rasch analysis. In 2012, four focus group interviews were conducted with 26 nurses and then evaluated using knowledge maps. The results were used to improve the questionnaire. In 2015, using the revised German‐language instrument, a second survey and Rasch analysis were conducted. Results: The descriptive results of the first survey's participants (n = 2153; response rate: 44%) indicated that moral distress is a salient phenomenon in Switzerland. The data from the focus group interviews and the Rasch analysis produced information valuable for the questionnaire's further development. Alongside the data from the second survey's participants (n = 1965; response rate: 40%), the Rasch analysis confirmed the elimination of previous deficiencies on its psychometrics. A Rasch‐scaled German version of the Moral Distress Scale is now available for use

An Evaluation of School Zone Traffic Control Strategies

Throughout the past six decades, the predominant mode of student transport has shifted from walking to riding in a school bus or personal vehicle which has impacted both the safety and efficiency of school zone traffic control strategies. In order to improve school zone operations in West Virginia, current warrants and laws relevant to school zones within West Virginia and other states are researched. Concerns are characterized with respect to traffic efficiency and safety parameters and are addressed in a survey polling county and district transportation officials throughout West Virginia. In addition, school zone crash data provided by the Highway Safety Information System (HSIS) is analyzed for Ohio and North Carolina to gain a better understanding of the cause and nature of school zone crashes. Through multidisciplinary cooperation, school zone traffic control strategies should implement uniform procedures that target driver awareness and education on their actions and the effect they have on safety and efficiency and how the two issues are interrelated

Development and validation of a questionnaire to measure moral distress in community pharmacists

The Author(s) 2016. . This article is published with open access at Springerlink.com This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Jayne L. Astbury, and Cathal T. Gallagher, 'Development and validation of a questionnaire to measure moral distress in community pharmacists', International Journal of Clinical Pharmacy (2017) Vol 39(1): 156-164, first published online on 22 December 2016, the version of record is available on line via doi: 10.1007/s11096-016-0413-3 Funding for this work was provided by Pharmacy Research UK (PRUK).Background Pharmacists work within a highly-regulated occupational sphere, and are bound by strict legal frameworks and codes of professional conduct. This regulatory environment creates the potential for moral distress to occur due to the limitations it places on acting in congruence with moral judgements. Very little research regarding this phenomenon has been undertaken in pharmacy: thus, prominent research gaps have arisen for the development of a robust tool to measure and quantify moral distress experienced in the profession. Objective The aim of this study was to develop an instrument to measure moral distress in community pharmacists. Setting Community pharmacies in the United Kingdom. Method This study adopted a three-phase exploratory sequential mixed-method design. Three semi-structured focus groups were then conducted to allow pharmacists to identify and explore scenarios that cause moral distress. Each of the identified scenarios were developed into a statement, which was paired with twin seven-point Likert scales to measure the frequency and intensity of the distress, respectively. Content validity, reliability, and construct validity were all tested, and the questionnaire was refined. Main outcome measure The successful development of the valid instrument for use in the United Kingdom. Results This research has led to the development of a valid and reliable instrument to measure moral distress in community pharmacists in the UK. The questionnaire has already been distributed to a large sample of community pharmacists. Conclusion Results from this distribution will be used to inform the formulation of coping strategies for dealing with moral distress.Peer reviewedFinal Published versio

Reducing Congestive Heart Failure Hospital Readmission Through a Practice Guideline

Patients with congestive heart failure (CHF) are at increased risk for hospital readmission within 30 days of discharge. The gap in practice involves the coordination of care for patients with CHF in the transition from hospital to home. Patients with CHF are at increased risk for hospital readmission due to barriers involving self-care, communication, and coordination of care. The purpose of this project was to implement a clinical practice guideline (CPG) that used a predictive tool and clinical pathway for coordination of care for CHF patients at increased risk for hospital readmission within 30 days. The DNP project involved using the chronic care model as a framework and addressed the practice-focused question, which asked whether the CPG would be accepted by an expert panel for full implementation. The CPG was presented to a 9-member expert panel, all members of a larger QI readmission task force. There were 5 cardiac providers, and 4 nursing or administrative leaders with decision-making abilities at the site. Scores on the Agree II instrument from nine experts ranged from 5.5 to 6.81 across 23 items and 6 domains indicating overall agreement on the CPG. Recommendations of the panel included a change to the clinical practice guideline to reflect ischemic workup and criteria for admission when a patient presents to the emergency department. The expert panel agreed to full implementation of the CPG. The impact of this CPG will lead to decreased needs for hospital readmission, improved coordination of care, improved communication between the patient and the healthcare team, and empowerment of patients, leading to positive social change in terms of caring for patients with chronic CHF

A Study of Subject-matter Content and Source of Photographs on Three Small-city and Three Metropolitan Texas Daily Newspapers

This study was concerned with the subject-matter content and source of photographs at three small-city and three metropolitan Texas newspapers. An analysis was conducted over a fourteen-day period at six daily newspapers: The Dallas Morning News, The Fort Worth Star-Telegram, The Houston Chronicle, The Sherman Democrat, The Paris News, and The Midland Reporter-Telegram

Johann Sebastian Bach's Suite No. 6 for Violoncello Solo, BWV 1012 : an analysis for performance

Thesis (M.Mus.)--Michigan State University. Department of Music Theory, 2003Includes bibliographical references (pages 86-87