Empirical investigation of the ethical reasoning of physicians and molecular biologists – the importance of the four principles of biomedical ethics

<p>Abstract</p> <p>Background</p> <p>This study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups.</p> <p>Method</p> <p>This study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.</p> <p>Results</p> <p>In this sample, the authors found that oncology physicians and molecular biologists employed in a private biopharmaceutical company have the specific principle of beneficence in mind in their daily work. Both groups are motivated to help sick patients. According to the study, molecular biologists explicitly consider nonmaleficence in relation to the environment, the researchers' own health, and animal models; and only implicitly in relation to patients or human subjects. In contrast, considerations of nonmaleficence by oncology physicians relate to patients or human subjects. Physicians and molecular biologists both consider the principle of respect for autonomy as a negative obligation in the sense that informed consent of patients should be respected. However, in contrast to molecular biologists, physicians experience the principle of respect for autonomy as a positive obligation as the physician, in dialogue with the patient, offers a medical prognosis based upon the patients wishes and ideas, mutual understanding, and respect. Finally, this study discloses utilitarian characteristics in the overall conception of justice as conceived by oncology physicians and molecular biologists from the private biopharmaceutical company. Molecular biologists employed at a public university are, in this study, concerned with allocation, however, they do not propose a specific theory of justice.</p> <p>Conclusion</p> <p>This study demonstrates that each of the four bioethical principles of the American bioethicists Tom L. Beauchamp & James F. Childress – respect for autonomy, beneficence, nonmaleficence and justice – are reflected in the daily work of physicians and molecular biologists in Denmark. Consequently, these principles are applicable in the Danish biomedical setting.</p

Empowered to gain a new foothold in life:A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients’ particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients’ total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and further involvement of relatives must be considered

Utilizing a New Graphical Elicitation Technique to Collect Emotional Narratives Describing Disease Trajectories

Elicitation techniques in connection with semi-structured interviews are scantily used, but reported to be beneficial to research. We developed and tested a new visual technique to be utilized in the latter part of semi-structured interviews. It has proved to be feasible and beneficial to use, and it could possibly be used by others. This way of extending the interviews generates more data in a visual form, as well as in a verbal form, by supporting the participants in remembering nearly forgotten parts of their experiences and in expressing emotions associated with those significant experiences. As a contribution to qualitative research, our study showed that the visual data, created by the participants, also contributed to getting the elaborated narratives

High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

Background and purpose — Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding length of stay (LOS) and patient satisfaction. Patients and methods — In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient satisfaction was measured using a numerical rating scale (NRS; 0–10). Results — For THR, the median satisfaction score was 9–10 and for TKR it was 8.5–10 in all parameters. Older THR patients had higher overall satisfaction. No association was found between overall satisfaction following THR or TKR and sex comorbidity, or LOS. THR patients had shorter mean LOS than TKR patients, even though the median LOS was 2 days for both groups. THR patients were more satisfied than TKR patients in the first weeks after discharge. Interpretation — Patient satisfaction is high following fast-track THR and TKR, with scores ranging from 8.5 to 10 on the NRS. A qualitative investigation of the first weeks after discharge is required to learn more about how to improve the experience of recovery

Benefits and challenges perceived by patients with cancer when offered a nurse navigator

<p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Introduction: </span></strong><span style="font-family: " lang="EN-US">Lack of communication, care and respect from healthcare professionals can be challenges for patients in trajectories of cancer, possibly accompanied by experienced fragmentation of the care, anxiety and worries. One way to try to improve delivery of care is additional help from Nurse Navigators (NN) offered in a predefined shorter or longer period, but patients´ experiences with this have seldom been investigated.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Aims: </span></strong><span style="font-family: " lang="EN-US">To explore patients´ experiences of an NN offered in a short period of a longer trajectory of cancer. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Methods: </span></strong><span style="font-family: " lang="EN-US">NN worked from the hospital side in the transition between primary care and a university hospital before admission. A phenomenological-hermeneutical longitudinal study was performed from referral and until two months after discharge from the hospital. Semi-structured interviews provided data for the analysis, which started open-minded.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Results: </span></strong><span style="font-family: " lang="EN-US"><span style="mso-spacerun: yes;"> </span>Affectional bonds were made to NN and patients felt that they benefited from her presence and her help,<strong style="mso-bidi-font-weight: normal;"> </strong>which they requested until one month after discharge. They were deeply disappointed and felt rejected when the contact to the NN stopped. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Conclusion:</span></strong><span style="font-family: " lang="EN-US"> In efforts to increase quality of care for patients with cancer we recommend paying special attention to critical periods in their trajectories, as well as to the theory of attachment to supplement thoughts of continuity of care and coordination in the care for women. In short, it is fine to offer additional help to those who can use it, but in practice as well as in research we call attention to awareness on how and when to stop the help, to prevent patients from feeling hurt.</span></span></p

Reflection and learning in clinical nursing education mediated by ePortfolio

This paper reports on an investigation into learning mediated by the elective elements of an electronic portfolio (ePortfolio) designed to facilitate four learning styles. The design takes a phenomenological-hermeneutic approach. The setting was Course 4, a ten-week clinical course in Basic Nursing. The participants were eleven first-year students on Course 4 randomly selected. Data was generated by participant observations, interviews and portfolio documents. The entire material was interpreted according to Ricoeur’s theory of interpretation. The study showed that the elective elements of ePortfolio were mostly used by students with theorist style and used the least by students with pragmatist style. Some students can reflect without a learning tool, other students need supervision. The themes a fellow player and an opponent were deduced. The conclusion was that the elective elements work like fellow players and opponents, as they facilitate reflections on nursing practice and one’s own learning processes, and they mediate learning of important nursing competency elements. The tools can promote differentiation of supervision, and allow more time to supervise students who need more support. There is potential to enable students to select among the learning tools