Showing papers in "Journal of medical ethics and history of medicine in 2013"

Medication errors of nurses in the emergency department.

Abstract: Patient safety is one of the main concepts in the field of healthcare provision and a major component of health services quality. One of the important stages in promotion of the safety level of patients is identification of medication errors and their causes. Medical errors such as medication errors are the most prevalent errors that threaten health and are a global problem. Execution of medication orders is an important part of the treatment and care process and is regarded as the main part of the nurses' performance. The purpose of this study was to explore the medication error reporting rate, error types and their causes among nurses in the emergency department. In this descriptive study, 94 nurses of the emergency department of Imam Khomeini Hospital Complex were selected based on census in 2010-2011. Data collection tool was a researcher-made questionnaire consisting of two parts: demographic information, and types and causes of medication errors. After confirming content-face validity, reliability of the questionnaire was determined to be 0.91 using Cronbach's alpha test. Data analyses were performed by descriptive statistics and inferential statistics. SPSS-16 software was used in this study and P values less than 0.05 were considered significant. The mean age of the nurses was 27.7 ± 3.4 years, and their working experience was 7.3 ± 3.4 years. Of participants 46.8% had committed medication errors in the past year, and the majority (69.04%) had committed the errors only once. Thirty two nurses (72.7%) had not reported medication errors to head nurses or the nursing office. The most prevalent types of medication errors were related to infusion rates (33.3%) and administering two doses of medicine instead of one (23.8%). The most important causes of medication errors were shortage of nurses (47.6%) and lack of sufficient pharmacological information (30.9%). This study showed that the risk of medication errors among nurses is high and medication errors are a major problem of nursing in the emergency department. We recommend increasing the number of nurses, adjusting the workload of the nursing staff in the emergency department, retraining courses to improve the staff's pharmacological information, modification of the education process, encouraging nurses to report medical errors and encouraging hospital managers to respond to errors in a constructive manner in order to enhance patient safety.

Effect of education based on the "4A Model" on the Iranian nurses' moral distress in CCU wards.

Abstract: Complexity of health care has caused ethical dilemmas and moral distress to be quite unavoidable for nurses. Moral distress is a major, highly prevalent problem in the nursing profession. The study aims to investigate the effect of education based on the “4A model” on the rate of moral distress among the nurses working in Cardiac Care Units (CCU). The participants consisted of 60 nurses working in Cardiac Care Units (CCU), 30 in the control and 30 in the intervention group. Those in the intervention group took part in the educational workshop about “moral distress” and “4A model”. The moral distress questionnaire was completed by both study groups 1 and 2 months after the intervention. After the intervention, the results of repeated measures analysis of variance revealed a significant difference in the moral distress mean scores between the intervention and the control groups (P<0.001) and within the two groups (P<0.001). Moreover, a significant difference was found between the two study groups regarding the mean score of moral distress 1 and 2 months after the intervention. The findings of the current study revealed a decreasing trend in the moral distress mean score in the intervention group, while there was an increasing trend in the control group after the intervention. It can be concluded that the “4A model” can be used for reducing moral distress and educational interventions can reduce the rate of moral distress among nurses. Authors of this study recommend that more studies with larger sample sizes be conducted in different hospital wards as well.

Perception of Iranian nurses regarding ethics-based palliative care in cancer patients.

Abstract: Palliative care is still a topic under discussion in the Iranian healthcare system, and cancer patients require palliative care. Moreover, nursing ethics has an important role in caring for these patients. The purpose of this study was to identify the perception of Iranian nurses regarding ethics-based palliative care in cancer patients. This study was done with a qualitative approach and by using content analysis. In this study, 14 nurses were selected through purposive sampling, and a face-to-face semi structured interview was conducted with each of them. After data collection, all interviews were transcribed and reviewed, and categories were extracted. At first, similarities in meaning were reviewed and based on centralization arranged in sub-categories. Then, relevant sub-categories were arranged in a category after a second review. In general, original categories in the ethics-based palliative care in cancer patients encompass the following: “human dignity”, “professional truthfulness” and “altruism”. Human dignity has 3 sub-categories consisting of ‘respecting patients’, ‘paying attention to patient values’ and ‘empathizing’. Professional truthfulness has 2 sub-categories consisting of ‘truthful speech’ and ‘truthful action’. Lastly, altruism has 3 sub-categories consisting of ‘complete and multi-dimensional patient acceptance’, ‘supportive behavior’ and ‘responsibility’. Content analysis of ethics-based palliative care in cancer patients revealed the required conditions for this type of care based on the perception of nurses. The results of this study suggest that in nurses’ point of view, human dignity, professional truthfulness and altruism all have important roles in ethics-based palliative care in cancer. The findings of this study will give nurses a greater knowledge about ethics-based palliative care in cancer patients, leading to a better understanding of the ethical needs of these patients, and may ultimately help improve the nursing practice.

Teaching medical ethics: problem-based learning or small group discussion?

Abstract: Lecture is the most common teaching method used in ethics education, while problem-based learning (PBL) and small group discussion (SGD) have been introduced as more useful methods. This study compared these methods in teaching medical ethics. Twenty students (12 female and 8 male) were randomly assigned into two groups. The PBL method was used in one group, and the other group was taught using the SGD method. Twenty-five open-ended questions were used for assessment and at the end of the course, a course evaluation sheet was used to obtain the students’ views about the advantages and disadvantages of each teaching method, their level of satisfaction with the course, their interest in attending the sessions, and their opinions regarding the effect of teaching ethics on students’ behaviors. The mean score in the PBL group (16.04 ± 1.84) was higher than the SGD group (15.48 ± 2.01). The satisfaction rates in the two groups were 3.00 ± 0.47 and 2.78 ± 0.83 respectively. These differences were not statistically significant. Since the mean score and satisfaction rate in the PBL group were higher than the SGD group, the PBL method is recommended for ethics education whenever possible.

Balloon dilators for labor induction: a historical review.

Abstract: A number of recent articles attribute the origin of the use of cervical balloon dilation in the induction of labor to either Barnes in the 1860s or Embrey and Mollison in the 1960s. This review examines the historical record and reveals that, based on current practice attribution should rather be made to two contemporaries of Barnes: the Storer and Mattei. More importantly, Storer’s warning about the rubber used in dilators was ignored, leading to decades of possibly unnecessary deaths following childbirth. To conduct this study key search terms for PubMed, Google Scholar and the website of the University of Ryerson were utilized as “Barnes”, “Woodman”, “balloon dilation”, “balloon catheter”, “foley”, “colpeurynter”, “cervix uteri” and “induction.” Subsequent analysis was done on downloaded articles using BibDesk.

Medical ethics course for undergraduate medical students: a needs assessment study

Abstract: Education needs assessment is one of the essential components of curriculum development. In this study, we aimed to assess the educational needs of general physicians for medical ethics. We conducted a three-stage Delphi study of general physicians' views on important ethical issues in their practice. In the item generation stage we retrieved 45 important educational items from a survey of general physicians, patients, well known ethical clinicians, and a review of other universities' curricula and international literature. The questionnaire was designed to ask the importance of each generated item. We then sent the questionnaire to general physicians. Items scored as highly important by more than 80% of the respondents in the first or second consensus development surveys were considered as educational priorities. Four academic medical ethics teachers reviewed and commented on the findings. The response rate to the first consensus development survey was 38%, of whom 77% also responded to the second survey. We developed consensus on 24 medical ethics items for inclusion in medical ethics curriculum. All items were also considered important by medical ethics teachers, and they added four further items to the list. Despite the attention given to ethical issues originating from technological advances, the most important educational needs of general physicians in medical ethics are still the traditional issues concerning the doctor-patient relationship and professionalism.

Dental and oral diseases in Medieval Persia, lessons from Hedayat Akhawayni.

Abstract: Persian physicians had a great role in assimilation and expansion of medical sciences during the medieval period and Islamic golden age. In fact the dominant medical figures of that period were of Persian origin such as Avicenna and Razes, but their works have been written in Arabic that was the lingua franca of the period. Undoubtedly the most substantial medical book of that period that has been written in Persian belongs to Abubakr Rabi ibn Ahmad al-Akhawayni al-Bokhari and his book, Hidayat al-Mutallimin fi-al-Tibb (Learner's Guide to Medicine).There are two chapters related to oral and dental diseases in the Hidayat, a chapter on dental pain and a chapter on bouccal pain. Akhawayni's views on dental diseases and treatments are mainly based on anatomical principles and less influenced by humeral theory and no mention about the charms, magic and amulets. False idea of dental worm cannot be seen among his writings. Cutting of the dental nerve for relieving the pain, using the anesthetizing fume, using the natural antiseptic and keeping the tooth extraction as the last recourse deserves high praise.

Attitude and practice of dental surgeons towards pharmaceutical companies' marketing gifts.

Abstract: Interaction of pharmaceutical companies (PC) with healthcare services has been a reason for concern. In medicine, awareness of the ethical implications of these interactions have been emphasized upon, while this issue has not been highlighted in dentistry. This study undertook a cross-sectional rapid assessment procedure to gather views of dentists in various institutions towards unethical practices in health care and pharmaceutical industry. The purpose of this study was to assess the need for the formulation and implementation of guidelines for the interaction of dentists with the pharmaceutical and device industry in the best interest of patients. A group of 209 dentists of Lahore including faculty members, demonstrators, private practitioners and fresh graduates responded to a questionnaire to assess their attitudes and practices towards pharmaceutical companies’ marketing gifts. The study was conducted during 2011 and provided interesting data that showed the pharmaceutical industry is approaching private practitioners more frequently than academicians and fresh graduates. Private practioners accepted the gifts but mostly recognized them as unethical (over 65%). Both groups considered sponsoring of on-campus lectures as acceptable (over 70%). Respondents are not fully aware of the ethical demands which are imperative for all health care industries, and there is a dire need of strict guidelines and code of ethics for the dentist’s interaction with the pharmaceutical and device industry so that patient interest is protected.

Occupational therapists and patients’ rights: their level of Clinical knowledge

Abstract: Addressing patients’ rights issues brings occupational therapists ethical and political responsibilities that involve patients’ privileges and new facilitating factors which influence their needs The goal of this study was to determine the level of occupational therapists’ knowledge about patients’ rights The present research was a cross-sectional study which involved 125 occupational therapists chosen by a convenience sampling strategy in Tehran during the year of 2012 A four-part questionnaire was used for data collection, and the degree of the subjects’ self-assessment of their knowledge was measured based on the obtained numbers of correct answers in the third part The validity and reliability of this questionnaire were assessed prior to its being distributed among participants The results demonstrated no significant association between the level of occupational therapists’ knowledge about patients’ rights and their existing experiences within their areas of occupational therapy (P>005) Based on the result, 536% of the respondents had high level of knowledge about patients’ rights Facilitating factors which influence the attainment of patients’ rights were classified into three groups: organizations, therapists and clients The results of the present research demonstrated that the level of occupational therapists’ knowledge about patients’ rights were high Furthermore, this study showed that for optimal result, there is a need to provide milieu for observing the patients’ rights in clinical occupational therapy services

The absent discourse of communication: understanding ethics of provider-patient relationship in six hospitals in urban India

Abstract: Understanding the complexities of a provider-patient relationship is considered to be of critical importance especially in medical ethics. It is important to understand this relation from the perspectives of all stakeholders. This article derives from a qualitative study conducted across six obstetric care providing institutions in the cities of Mumbai and Navi Mumbai, India, over a period of 10 months. Thirty obstetricians were interviewed in-depth to understand what they perceived as the most important aspect in developing a good provider-patient relationship. The study found that while most providers highlighted the point of communication as the most critical part of the provider-patient relationship, they admitted that they could not engage in communication with the patients for various reasons. Obstetric consultants and residents said that they were too overburdened to spend time communicating with patients; providers working in public hospitals added that the lack of education of their patients posed a hindrance in effective communication. However, providers practicing in private institutions explained that they faced a challenge in communicating with patients because their patients came from educated families who tended to trust the provider less and were generally more critical of the provider's clinical judgement. The article shows how provider-patient communication exists as an idea among medical providers but is absent in daily clinical practice. This gives rise to a discourse shaped around an absence. The authors conclude by decoding the term ‘communication' - they read the word against the context of its use in the interviews, and argue that for the providers ‘communication' was not intended to be a trope towards setting up a dialogue-based, egalitarian provider-patient relationship. Providers used the word in lieu of ‘counselling', ‘guiding', ‘talking to'. It concludes that, despite the providers' insisting on the significance of communication and complaining about its absence, what they desired in reality was not the possibility of a dialogue with the patient or a chance to be able to share decision-making power with the patient, but to be able to provide better instructions and chart out what was best for them in a more detailed way.

Continuing review of ethics in clinical trials: a surveillance study in Iran.

Abstract: In recent years, notable measures have been taken to protect the rights of participants in biomedical research in Iran. The present study examines possible trends in adherence to ethical codes regarding informed consent after the development of the National Code of Ethics in Biomedical Research (NCEBR) and establishment of research ethics committees. In this retrospective study, 126 dissertations from Tehran University of Medical Sciences were evaluated for adherence to ethical codes. These dissertations were all in clinical trial design and had been presented in the years 1999 and 2009, that is, precisely before and after the development of the NCEBR. A checklist was developed to evaluate the ethical issues associated with informed consent. A single investigator retrieved and evaluated the consent forms from the dissertations. Borderline cases were discussed with other investigators to reach a consensus decision. Based on the checklist, the Standardized Ethical Score (SES) was calculated for each consent form. The mean SES and the rate of consent form attachment were compared between the two years. In total, 70 dissertations had reported obtaining informed consent from study participants, whereas consent forms were attached in only 22 dissertations (17.50%). The percentage of dissertations with the consent form attached increased over time from 12.2% in 1999 to 20.8% in 2009 (P > 0.05), but the majority still did not include a consent form. Moreover, the mean SES of consent forms was significantly higher in 1999 (0.746) than in 2009 (0.428), highlighting the need for more training of researchers and improved surveillance by the ethics committees. A great amount of effort is still needed to make the consent process more ethical, especially for dissertations as a less visible part of academic research. As for students, more systematic training focused on research ethics should be implemented prior to thesis submission.

Brief report: The Third Annual Medical Ethics Congress in Iran

Abstract: The Third National Congress on Medical Ethics was held on February 21–23, 2013 in Tehran, Iran by Medical Ethics and History of Medicine Research Center (MEHRC) in cooperation of the Ministry of Health and Medical Education and the Ministry of Science, Research and Technology. This occasion provided an opportunity for medical ethics experts as well as lawyers, philosophers, and jurisprudences to discuss related issues in different fields of medical ethics. The congress attended by more than 100 participants provided an oral presentation and also more than 120 participants who presented their work as posters. The congress covered a wide range of subjects. It is worth mentioning that the secretary of the annual medical ethics congress of Iran was developed in the Medical Ethics and History of Medicine Research Center of Tehran University of Medical Sciences in 2010. This secretary was created by cooperation of Ministry of Health, Treatment and Medical Education in order to organize the annual congresses of medical ethics in different medical universities all over the country. Following the first annual congress in Tehran University of Medical Sciences (TUMS) (Sep 19–21, 2010) and the second congress in Isfahan University of Medical Sciences (Feb 22–24, 2012), recent congress was held in TUMS. In accordance with the approved schedule, the first two days was dedicated to the subject of “Medical Ethics and Reproductive Health” and the third day was on “Ethics in Teaching”. At the first day, the opening ceremony was included the official welcome by the scientific secretary Dr Kiarash Aramesh, and then Professor Bagher Larijani, the congress chairman and the head of MEHRC, opened the 3rd congress by his lecture on “ Ethics in Reproductive Health”. The next key speaker of the congress was Dr Jihan Tawilah, the representative of the World Health Organization (WHO), who delivered the message of this important organization on behalf of Dr Alwan. In addition to mentioning the name of famous Iranian scholars including Avicenna and Razi as the Iranian pioneers in health care services, she appreciated the Iranians efforts in addressing ethical issues in health care. Furthermore she insisted on the role of national ethics committees in providing a proper support in the dialogue between medical, jurisprudence, law, and social sciences in health care services. Then, Dr Ninuk Widyantoro from Indonesia presented ethical issues in family planning and Dr Sarah Jane Hawkes from England gave a presentation on the ethical issues of screening HIV and provided facts about opt in and opt out methods of getting informed consent. The expert panels during two days presented and discussed the most important and critical ethical challenges of the assisted reproductive technologies, surrogacy, embryo donation, abortion, etc. Patients’ autonomy, justice and beneficence in various legal, cultural and religious contexts were discussed too. In the third day, the congress on “Ethics in Teaching” was launched. After opening ceremony and the welcome speech by Dr Pooneh Salari the scientific secretary, the congress chairman Professor Bagher Larijani gave a lecture on the issues by overview of ethics in teaching including ethics education in Iran and the recent advances in the Tehran University of Medical Sciences including establishing PhD degree in medical ethics as well as reforms in teaching medical ethics. In this day, several international guests from all over the world attended the congress. Dr Ninuk Widyantoro from Indonesia gave a speech on teaching ethics in formal education and the ethical issues surrounding teaching in HPV vaccination was reviewed by Dr Sarah Jane Hawkes from England. Dr Kate Moriarty from UNESCO (Paris) described the mission statement of UNESCO about ethics, human rights, and education while other lecturers presented the ethical issues in other different areas of education including medical and clinical education, designing medical examinations, communication skills, internalization of ethical standards and their implications, the role of ethical intelligence in teaching, ethics in virtual teaching, role models, and compiling ethical guidelines for teaching. In all sessions and during coffee breaks, discussions were continued and created a chance for attendees to network. The congress indentified different aspects of ethical challenges regarding the differences in cultural and religious principles and highlighted new areas for cooperation in future.