Thesis (Ph. D.)--University of Chicago, Divinity School, December 2000. / Includes bibliographical references. Also available on the Internet.

Bakgrund: Att vara närvarande vid ett hjärtstopp kan vara psykiskt påfrestande för vilken sjuksköterska som helst. Genom att kontinuerligt få träning och uppdatera sin kunskap gällande HLR ger det sjuksköterskan möjlighet att vid senare tillfälle reflektera över händelsen och därmed kunna släppa situationen. Syfte: Var att belysa allmänsjuksköterskans chans till reflektion efter att aktivt deltagit vid ett hjärtstopp. Metod: Var en kvalitativ intervjustudie med semistrukturerade intervjufrågor. Fem stycken sjuksköterskor intervjuades under november 2017. Intervjuerna transkriberades och efter en manifest analysmetod delades innehållet upp i fyra kategorier med två underliggande kategorier tillhörande varje kategori. Resultat: Det visade att chansen till reflektion var bristande. Vissa informanter upplevde att de fick chans till reflektion, medan andra ansåg att det var en brist. Resultatet visade även skillnaden på hur snabbt reflektionen skedde efter ett hjärtstopp mellan avdelningar. Informanterna uttryckte även detta som en brist, då de ibland inte fick utlopp för sina egna känslor och tankar. Slutsats: Efter avslutad studie syns bristen vara för stor då alla borde få samma chans till reflektion efter avslutad HLR.

Heart failure is a disease that affects millions of Americans, but has a disproportionate impact on underserved, minority communities. Over the coming decade, heart failure will become a chronic disease for more Americans as treatments improve, but the disease cannot be cured. Minority populations are, and will continue to be, disproportionately impacted by heart failure due in large part to their increased risk factors, which stem from social and structural determinants of health. Palliative care services offer incredible benefits for patients and caregivers covering a variety of areas, such as goals of care discussions, shared decision-making, and psychosocial support. Providing early palliative care services to underserved heart failure patients offers extra resources to effectively manage their disease and lifestyle in a personalized fashion, and aligns with the urban bioethical principles of agency, social justice, and solidarity. / Urban Bioethics

Residency training marks a period of rapid learning in the career of a physician. As new physicians are swiftly acquiring medical knowledge and practicing new clinical skills, they are also undergoing intense professionalization and socialization, which influences their understanding of the healthcare system and their role within it. The working conditions of residency training and culture of medicine interact to exploit the labor of trainees. This perpetuates dominance and authority for the institutions that create and sustain these conditions. The history of the development of residency training programs, the Match, and house staff activism in the 1970s illuminate the systems of power operating within graduate medical education. This history produced the GMEA system we know today that is predicated on self-sacrifice, individualism, and deference to institutional power. As trainees are subject to the practices and beliefs that maintain this system, they internalize and normalize oppression, and in turn enact it upon others as they advance through the hierarchy themselves and acquire more material and social capital. By understanding the history of GME and interrogating these systems, we can begin to imagine a different kind of residency training that might better serve the needs of both learners and the patients they care for. Trauma informed education and critical pedagogy are two lenses that can inform future iterations of graduate medical education. These frameworks offer a different set of values, practices and systems that center healing and aspire to health justice. / Urban Bioethics

In the last forty-odd years, medical ethics has become an increasingly important part of undergraduate medical education. This has been reflected in changes in medical school curricula as well as increased emphasis in standardized testing and accreditation requirements. However, both the scope and aims of ethics education are not well defined and surveys of medical ethics curricula reveal there is significant heterogeneity in the way it is taught to students. Examination of ethics education shows that there is a hidden curriculum that operates alongside the explicit curriculum and influences how students perceive and value the subject. This is in addition to the more general hidden curriculum, which has been identified as a cause of moral regression in medical students. This paper attempts to illuminate the hidden curriculum of ethics education and propose ways in which its negative impacts may be mitigated. / Urban Bioethics

<p>2022-09-06</p>

The social determinants of health make the most impact on our health. There is significant inequality in health due to unfair distribution of the social determinants. Yet, the healthcare system lacks a focus on addressing the social determinants. For this reason, social justice is a necessary part of pursuing equitable healthcare. This goal is complicated by the growing role that technology plays in healthcare and society. Due to the importance of digital information technology, social justice in healthcare must be reoriented to include a focus on its technical aspects. In this paper, I make a case for sociotechnical justice in healthcare, with core concepts and basic principles influenced by Rawlsian Justice. I then present an argument using sociotechnical justice to address a current issue in healthcare before concluding. / Urban Bioethics

In 1976, the legal ruling of the case Estelle v Gamble established the precedence of evaluating unjust healthcare practices and violation of Eight Amendment rights to prisoners with application of a test of deliberate indifference. Since this ruling, many more cases have emerged which present the complexity in application of the deliberate indifference test involving incarcerated pregnant women specifically. The practice of mass incarceration within this country has contributed greatly to the number of women and pregnant women incarcerated, without the necessary advancements or even establishment of healthcare standards within prisons to provide necessary care. Shackling of pregnant incarcerated in the course of their pregnancy and the practice of separating mother and child immediately at birth evidence the continuation of unacceptable practices occurring in the United States of America. To understand this topic and the issues involved, an understanding must be gained of the history, legal course, and healthcare practices faced by pregnant women and mothers who are incarcerated. / Urban Bioethics

Organ transplantation has the potential to improve and prolong the lives of many chronically ill people. However, organs are a scarce resource and a commodity to which not everyone has equal access. Equity issues are particularly evident amongst African Americans concerning kidney donation and transplantation. In this paper, I discuss the history of kidney transplantation and the disparities that exist in the African American community for both organ donation and transplantation. I explain how the organ allocation system has structural barriers that do not account for the social determinants of health. Then I explore the significant barrier of African Americans’ mistrust of the health care system and its role in kidney donation and transplantation. I use the principles of urban bioethics to discuss possible solutions to mistrust including community engagement, diversifying the physician work force, and concepts that move beyond cultural competency to cultural humility and structural competency. / Urban Bioethics

This paper highlights the importance of the provision of interpreter services for patients of limited English proficiency (LEP) in primary care settings in the United States. In the United States today, over 8% of the population is of LEP, and yet no formal funding structure exists to ensure that these patients have access to interpreter services when they see their primary care provider. Research shows that without appropriate interpreter services, LEP patients not only endorse poorer subjective experiences of healthcare, but that these patients also experience objectively worse healthcare, such as less frequent visits to primary care providers, poorer management of chronic illness such as diabetes and hypertension, and higher rates of expensive testing in emergency departments, to list a few examples. This paper was inspired by firsthand experiences of a medical student learner at an urban health center witnessing frequent improper utilization of interpreter services by physicians in primary care settings. The paper traces the federal legal history addressing communication services in healthcare in the United States, reviews papers that juxtapose patient and provider opinions of interpreter services, and concludes with a discussion of potential steps forward for improving interpreter services offered to the large percentage of the US population that is currently receiving subpar care due to unsurmounted barriers to communication. / Urban Bioethics