Confidentiality, anonymity and amnesty for midwives in distress seeking online support – Ethical?

BACKGROUND: Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support. RESEARCH DESIGN: Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach. FINDINGS: Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified. DISCUSSION: Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery. CONCLUSION: In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people

Long-Term Declines in Nest Success of Prairie Ducks

Increased predation on nests of ducks in prairie uplands, as a result of habitat alteration, has been hypothesized to cause decreased nest success and population sizes. We tested whether, and by how much, nest success declined using data compiled from 37 studies conducted between 1935 and 1992 at 67 sites in the Prairie Pothole Region of Canada and the United States. Nest success declined (P = 0.0002) over time, but time explained only 10% of the variation; precipitation (P = 0.79) did not account for additional variation in nest success. Nest success declined at similar (P = 0.13) rates among 5 species, but late nesters (gadwall [Anas strepera], blue-winged teal [A. discors], and northern shoveler [A. clypeata]) had higher success (P = 0.004) than early nesters (mallard [A. platyrhynchos], and northern pintail [A. acuta]). Populations of gadwalls and northern shovelers, however, have not declined, indicating that declines in nest success may not be related causally to population change. Long-term population declines in blue-winged teal, northern pintails, and mallards coincide with large-scale temporal declines in nest success. Declines in nest success were parallel in parkland and grassland regions, suggesting a causal agent (or agents) that act(s) at a broad scale, despite inherent differences in the composition of the predator communities and habitats between regions