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<p> Nurses may share a commonality of issues which can affect their willingness and ability to respond as post-disaster emergency care providers. Guided by expectancy, locus of control, and chaos theory, a systematic literature review was conducted to identify the barriers which affect nurses&rsquo; willingness and ability to report to their unit after a disaster occurs. Briggs methodology guided this systematic review, and Fineout-Overholt&rsquo;s and Melnyk levels of evidence were used to evaluate the reliability of information and effectiveness of their interventions. Fifteen articles meeting the inclusion criteria (addressed nurses&rsquo; willingness to report to their unit or to contact the incident command center for mobilization, published in 2005 or after, and written in English) were reviewed. Twelve were systemic reviews of descriptive and qualitative studies (Level 5), one was a cohort study (Level 4), one was a report of expert committees (Level 7), and one reported findings from a pilot study. Five articles reported personal barriers related to the nurses&rsquo; home caregiver responsibilities and four articles reported personal barriers related to nurses&rsquo; concern for personal and family safety. Three articles reported institutional barriers related to unsure availability of necessary safety equipment and two articles reported lack of disaster preparedness. Developing a disaster plan that includes emergency phone numbers, a prepared backpack of basic survival gear, and a plan for emergency child and elder care arrangements, as well as providing disaster training for nurses was recommended. Understanding health provider needs and willingness to respond to emergency situations contributes to positive social change by contributing to disaster risk reduction and ensuring safer and more resilient communities.</p>

MSc (Med), Bioethics and Health Law, Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Disclosure of HIV status has been considered an important public health issue for some 20 years. Yet the ethical issues surrounding the disclosure of positive HIV status have not been examined comprehensively. This report examines the ethics behind the disclosure of HIV-positive status primarily or individuals to their sex partners, and for health care practitioners to a patient’s sex partner when the patient is unwilling to disclose. Relevant rights and ethical principles are analysed, including the rights to: self-preservation; privacy and confidentiality; and the bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice. Historic and contemporary individual rights that people living with HIV (PLHIV) have regarding disclosure are emphasised, especially in adverse circumstances, where ethics can support non-disclosure based on the right to selfpreservation. Rights declarations and current disclosure guidelines for health care practitioners from several international and South Africa medical organisations also are reviewed. Of key importance to disclosure decisions are the specific situations of individuals in climates rife with stigma toward, and discrimination against, PLHIV, existing more or less worldwide. The potential negative impacts of disclosure are the basis for disclosure decisions of PLHIV. Research study results show that the negative impacts of disclosure can be severe for individuals, ranging from divorce or abandonment to community ostracism and even to murder. Relevant current theories of social justice related to HIV disclosure also are discussed. A conclusion is reached that, by decreasing stigma and discrimination against PLHIV and protecting individual rights related to HIV disclosure, prevention behaviours will be practised more widely, including ‘positive prevention’ by PLHIV and higher rates of disclosure. The eventual result will be the longterm public health goal of decreased spread of HIV.

The opioid epidemic is a public health crisis. How the crisis developed, how to mitigate its effects, and how to prevent it from spreading is less transparent. The practice of pain management poses a myriad of ethical challenges. The following essay will examine ethical dilemmas that arise during the decision-making process with regards to pain management in the context of addiction after a brief history of pain management and discussion of the corresponding legal and medical regulations.

Thesis (Ed. D)--College of Saint Mary -- Omaha, 2009. / A dissertation submitted by Molly M. Fitzke MSN, RN to College of Saint Mary in partial fulfillment of the requirement for the degree of Doctor of Education with an emphasis on Health Professions Education. This dissertation has been accepted for the faculty of College of Saint Mary by: Peggy L. Hawkins, PhD, RN, BC, CNE, chair ; Patricia Morin, RN, PhD, committee member ; Lois Linden, EdD, RN, committee member. Includes bibliographical references.

Bioethics has been central to living donor liver transplantation (LDLT), which mandates a high recipient benefit and an acceptably low donor risk. The double equipoise imposes the contextual features of this already technically complex treatment. This research aimed at looking into key bioethical issues of LDLT in the light of the contemporary practice standards. In adult LDLT, in order to provide a partial graft of adequate size, donor right hepatectomy is often required. This procedure pioneered by The University of Hong Kong is now being performed at many centers and by many surgeons. Through close guidance and gradual granting of surgical privilege, newer surgeons can now perform this operation safely with low blood loss (400 mL) and low complication rates ( 30%). Analysis of our series also showed that right liver donors with a smaller remnant left liver had higher peak bilirubin level and longer peak prothrombin time after the operation. Severe complications were associated with hyperbilirubinemia (p=0.031) while prolonged hospital stay was associated with prolonged prothrombin time (p=0.011) and smaller remnant left liver (p=0.036). Facts need to be known to potential right liver donors before operation. Donor left hepatectomy, which carries a lower donor risk, is more feasible for donors with a larger left liver and recipients with a smaller body size. Lowering the graft size requirement also allows more LDLTs being done using left livers. The percentages of left liver LDLTs feasible with a graft to standard liver volume (G/SLV) ≥ 40%, ≥ 35%, ≥ 30%, and ≥ 25% were 5.8%, 12.5%, 29.1%, and 62.3% respectively. For every 5% decrease in G/SLV ratio, twice as many left liver LDLTs could be performed. The 5-year survival rate was 85.7% for liver transplantation recipients with hepatocellular carcinoma (HCC) within the Up-to-7 criteria, unaffected by the presence of microvascular invasion (88.2% vs. 85.1%, p=0.652). This is comparable with that of liver resection patients with HCC without microvascular invasion (81.2%, p=0.227) but far superior to that of liver resection patients with lesions with microvascular invasion (50.0%, p<0.0001). Primary liver transplantation for HCC with microvascular invasion and within the Up-to-7 criteria in fact doubled the chance of cure as compared with liver resection. LDLT has been criticized of fast-tracking patients with more aggressive HCC for transplant. Waiting does select out patients with better survival to undergo transplantation. With careful selection though without waiting, LDLT nevertheless does not confer poorer survival. Progressive liver failure following a major hepatectomy for HCC is a known and uncommon cause of mortality. Proceeding to LDLT is an ethical challenge because of the possibility of coercion. Tumor status as confirmed by histopathological examination of resected specimens can demonstrate features of more aggressive cancer, which warns against a rescue transplantation for the increase in chance of tumor recurrence. In order to overcome ABO blood group incompatibility, paired donor interchange (between two pairs: A to B and B to A) has been practiced for the liver. The extension to matching with one pair of universal donor (O) and universal recipient (AB) was also performed at our center. The obvious biological advantage of this treatment modality has to be weighed against the potential increase in risks to patients involved. Media coverage of advances and successes in liver transplantation stimulates deceased donor organ donation (DDOD). The relation between widely reported key events and DDOD can be recognized as celebrity hero influence, medical success, or emotional response. An accountable liver transplant service answerable to the public is vital to a region where the DDOD rate is low. Selective disclosure of patient information to the media for public interest in promoting organ donation can be justified. LDLT now has a two-decade history of clinical practice. Basic and clinical research has provided a clearer picture of the efficacy and fallibility of LDLT. We can now be more accurate in defining and interpreting the applicability of LDLT for a wider spectrum of disease indications. / published_or_final_version / Medicine / Master / Doctor of Medicine

<p> The quality of health care in the United States is often measured by the patient&rsquo;s satisfaction. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed by the Center for Medicare and Medicaid Services (CMMS) along with the Agency for Healthcare Research and Quality (AHRQ) in 2002 to standardize the assessments and measures of patient satisfaction (Koch, 2014). Healthcare organizations are mandated to report their HCAHPS results to CMMS and AHRQ. Because of the significant role nurses take in the care and overall experience of hospitalized patients, this project explored RN scores on the Judgments About Nursing Decisions (JAND) instrument by Dr. Shake&rsquo; Ketefian (1984) and patient satisfaction data. The findings from the project suggest that RNs who are functioning in the post-conventional area of Kohlberg's Moral Development Theory as measured by the JAND may have an influencing effect on patient satisfaction outcomes as measured by the HCAHPS.</p>

The great power of the medical profession over the lives of men entails a wealth of moral problems in medical practice and lends particular importance to questions of the responsibility of the physician. We investigate the solutions offered by Galen, the most prolific medical author of classical Antiquity, in his medical and philosophical writings. Issues of ethics and moral psychology are discussed in numerous passages of Galen's works, and he even devoted a number of treatises exclusively to ethics. The main results of our analysis of these treatises and passages can be summarized as follows. Starting with his interpretation of a prominent Hippocratic maxim, we discuss possible motivations for Galen's re-definition of the relationship between physician and patient. For Galen, it was the physician, not the patient, who led the fight against the disease. This prominent position of the Galenic physician entailed particular obligations and responsibilities. But Galen also took the view that certain responsibilities resided with the patient, particularly that of selecting the right physician and keeping the prescribed diets. Moreover Galen thought that everybody ought to pursue the systematic liberation of the soul from passions and errors, guided by his ethical methodology. Galen gave disciplined care for one's health and acquisition of medical knowledge the status of moral duties for every educated person. For physicians, he provided a wealth of additional principles and rules of conduct, covering areas as diverse as experimentation with drugs, surgical risks, promulgation of knowledge on poisons, remuneration and other social impacts of medicine, and medical education, all of them inspired by respect for the health of man, the animal who topped the teleological hierarchy of creation, and medicine, the art whose task it was to preserve and restore man's health. Galen held medicine in exceptionally high esteem, even by the standards of physicians. His view of medicine as the divine art kat 'exochen is considered in the context of his high valuation of human life and health. Health assumed a high rank in the hierarchy of goods, for it provided the basis for all the other goods and virtues. For Galen, preservation and restoration of health could be attained only on the basis of a sound scientific methodology. He was reluctant to apply criteria external to medicine proper to its practice, and mostly judged the morality of medical activities by the adherence to the principles of a well-founded therapy and avoidance of undue harm.

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