Thesis (M.S.)--Boston University

The development of HIV counselling has been one of the major public policy innovations in response to the challenges posed by HIV and AIDS in Britain. This research, using a participative and qualitative methodology, examines how HIV counsellors have conceptualised their approach to the ethical issues associated with their innovatory role. The research takes an overview of two separate phases of fieldwork conducted in 1990 and 1994. The first phase concentrated on establishing the background of self-identified HIV counsellors and how they related to the wider counselling movement which had already developed a distinctive ethic founded on respect for individual autonomy. Their general identification with the wider counselling movement raised issues how this ethic could govern their work with clients affected by HIV. The second phase concentrated on the management of confidentiality within multidisciplinary teams. The results of the research are set within the wider ethical and socio-historical context of AIDS policy development in Britain and explore changes in how HIV counsellors conceptualise ethical issues in the local context of their work. The methodology is that of `descriptive ethical inquiry' accompanied by examination of how this type of inquiry relates to moral philosophy and social sciences. The method of participative research adopted is consultative and careful consideration is given to how this type of research relates to comparable procedures used in the production of professional codes of ethics.

L’article 2 de la loi n°94-43 du 18 janvier 1994, transférant l’organisation des soins en milieu carcéral du ministère de la Justice au service public hospitalier, a souvent été présenté comme une réforme de santé publique s’imposant au vu de l’état des prisons françaises. L’épidémie de sida et le volontarisme des ministres de la Santé suffiraient à rendre compte de ce qui a été qualifié de « révolution sanitaire ». Pourtant au-delà de ces facteurs conjoncturels, les conditions de possibilité de cette réforme s’inscrivent plus largement au croisement d’une double dynamique, professionnelle et carcérale, que cette recherche propose de retracer. En effet, la loi du 18 janvier 1994 est également la réforme d’une profession et d’un secteur d’action publique tous deux fortement contestés. La réforme de l’organisation des soins en prison marque l’échec d’une stratégie de spécialisation médicale, entendue comme la tentative opérée par certains praticiens d’occuper une position spécifique au sein du secteur médical.Initiée au début des années soixante par le premier Médecin-inspecteur des prisons, Georges Fully, l’affirmation d’une « médecine pénitentiaire » spécifique avait alors pour but de conférer aux praticiens une plus grande légitimité, et ainsi autonomie, à l’égard de leur employeur, l’Administration pénitentiaire. La spécialisation était ainsi conçue comme une ressource supplémentaire afin de mettre fin au tiraillement auquel étaient confrontés les praticiens travaillant en détention entre leur statut de vacataire du ministère de la Justice et celui de médecin-traitant des détenus. Toutefois, après la violente contestation des prisons survenue durant les années soixante-dix, l’affirmation d’une médecine pénitentiaire devient pour le nouveau Médecin-inspecteur, Solange Troisier, le moyen de légitimer un secteur d’action publique discrédité : l’organisation des soins en milieu carcéral. La consécration d’une médecine spécifique aux détenus est également pour elle le moyen de faire prévaloir les exigences du Code de procédure pénale sur celles issus du Code de déontologie. La spécialisation de la médecine pénitentiaire devient ainsi un moyen de s’autonomiser non pas du ministère de la Justice mais du secteur médical. La réforme de 1994 marque l’échec de cette tentative de spécialisation médicale. Elle résulte de la rencontre entre un « segment » de praticiens défendant l’idée d’une médecine non-spécifique avec quelques magistrats-militants, issus du Syndicat de la magistrature, en poste à l’Administration pénitentiaire favorables à un « décloisonnement » de l’institution carcérale. La loi du 18 janvier 1994 marque l’aboutissement de cette stratégie et l’échec de la tentative de spécialisation. A la « médecine pénitentiaire », désormais rattachée à un passé stigmatisant révolu, succéderait une « médecine exercée en milieu carcéral ».L’enjeu de cette thèse est par conséquent de retracer la sociogenèse d’une réforme à partir des dynamiques qui traversent un groupe professionnel, d’une part, et des transformations qui affectent un secteur d’action publique, d’autre part. On montrera également que la spécialisation de la médecine ne peut être comprise que si elle est articulée à d’autres logiques et qu’elle ne peut ainsi être réduite à sa seule dimension médicale. / Article 2 of French law No 94-43 of January 18, 1994, which concerns the transfer of the organization of health care in prisons from the Ministry of Justice to the public hospital service, has often been presented as a necessary public health reform considering the state of French prisons. The AIDS epidemic and the voluntary work of the Ministry of Health and the Ministry of Justice have revealed the need for what has been called a “sanitary revolution”. However, the conditions required for this reform would seem to require a dual approach: both professional and institutional, which this study will underline. Indeed, The French law of January 18, 1994 is also the reform of a profession, and of a sector of action, that is strongly criticized publicly. The reform of organization of health care in prisons underlines the failure of a strategy for a medical specialty, and is viewed by a few observers as an attempt by some practitioners to establish a particular position within the medical sector.Launched in the early sixties by the very first Doctor-inspector for prisons, Georges Fully, the assertion of specific “ health care in prison” was designed to give more legitimacy to the practitioners and therefore to allow them a greater level of autonomy from their employer, the prison administration. The specialization was designed to be an additional resource to help to put an end to the tension that the practitioners working in prison had to face, between their contract status at the Ministry of Justice and their status as general practitioners working in prisons . However, after the violent protests in prisons during the seventies, the organisation of “ health care in prisons” became for the new Doctor-inspector, Solange Troisier, a means of legitimizing the work of a discredited public service. The consecration of a specific medical practice for prisoners was also for her a means of asserting the requirements of the Code of Criminal Procedure over those of the Code of Medical Ethics. Thus the specialization of health care in prison became a means of empowerment not for the Ministry of Justice but for the medical sector.The reform of 1994 marks the failure of this attempt of medical specialization. It results from interactions between a group of practitioners defending the idea of a non-specific medical care and several militant magistrates, coming from the trade union of magistrates, working in the prison administration who were in favour of a opening-out of the penitentiary institution. The French law of January 18, 1994, highlights the accomplishment of this type of strategy and the failure to create a specialized health care in prison, the latter being then attached to a stigmatized and outdated past.The issue of this thesis is consequently to explore the sociogenesis of a reform from the dynamics which guide a professional group, on the one hand, and the evolutions which affect a public sector of action, on the other hand. We will also show that the specialization of medicine can be understood only if it is apprehended differently and subsequently cannot be reduced only to its medical dimension.

The handling of patient confidentiality in the medical, and more specifically as dealt with in this article, the pharmaceutical profession, is accepted as a given. Confidentiality cannot, however, always be guaranteed. The reason is that, amongst other things, the utilitarian principle of the ‘greatest good for the greatest number of people’ determines that certain exceptions have to be made in order to protect the health of the nation as a whole. Provision is made for exceptions in the Pharmacy Act where confidentiality may be breached. However, there are certain cases which are not provided for in the Act (and Acts change from time to time). This situation makes it necessary for the pharmacist to make moral judgements in specific instances related to specific patients. The objective of this article is to investigate these exceptions within a philosophical framework and to determine what the philosophical basis of such decisions would entail. This article initially will examine the current Pharmacy Act and the exceptions will be discussed that allow for the breaching of patient confidentiality. This will be followed by a brief exposition of modernist ethics and the issue of confidentiality under the headings of the idea of duty as moral imperative, as well as the utility idea. Pluralistic alternatives such as the ethics of virtue, postmodern ethics, and anti-moralism, will be explored as possible solutions to the pharmacist’s dilemma in this regard. / Thesis (MPhil)--North-West University, Potchefstroom Campus, 2013

The handling of patient confidentiality in the medical, and more specifically as dealt with in this article, the pharmaceutical profession, is accepted as a given. Confidentiality cannot, however, always be guaranteed. The reason is that, amongst other things, the utilitarian principle of the ‘greatest good for the greatest number of people’ determines that certain exceptions have to be made in order to protect the health of the nation as a whole. Provision is made for exceptions in the Pharmacy Act where confidentiality may be breached. However, there are certain cases which are not provided for in the Act (and Acts change from time to time). This situation makes it necessary for the pharmacist to make moral judgements in specific instances related to specific patients. The objective of this article is to investigate these exceptions within a philosophical framework and to determine what the philosophical basis of such decisions would entail. This article initially will examine the current Pharmacy Act and the exceptions will be discussed that allow for the breaching of patient confidentiality. This will be followed by a brief exposition of modernist ethics and the issue of confidentiality under the headings of the idea of duty as moral imperative, as well as the utility idea. Pluralistic alternatives such as the ethics of virtue, postmodern ethics, and anti-moralism, will be explored as possible solutions to the pharmacist’s dilemma in this regard. / Thesis (MPhil)--North-West University, Potchefstroom Campus, 2013

Bakgrund: Överrapportering mellan sjuksköterskor vid skiftbyte är en stor och viktig del av sjuksköterskans arbete, och dess innehåll påverkar det resterade arbetsskiftets sysslor. Rapporteringen kan ske på flertalet sätt, exempelvis traditionell rapportering som sker avsides från patienten, eller så kallad bedsiderapportering som sker i patientsalen tillsammans med patienten. Syfte: Denna litteraturstudies syfte var att undersöka evidensen för vilket av de två mest frekvent använda rapporteringssätten som är att föredra: traditionell rapportering eller bedsiderapportering. Vid jämförelsen mellan de båda fanns både sjuksköterskans uppfattning samt patientens uppfattning i åtanke. Metod: En litteraturöversikt utfördes. 12 originalartiklar valdes från databaser för vetenskapliga artiklar, CINAHL och Pubmed. Dessa lästes, analyserades och ledde fram till framställandet av fem resultatkategorier. Hildegard E. Peplau och hennes relationsteori kring omvårdnad bidrog som teoretiskt ramverk. Resultat: Fem teman identifierades ur studiens artiklar: främjande av relation mellan patient och sjuksköterska, ökad vårdsäkerhet för patienterna, involvering av patienten i vården, tidsåtgång för rapportprocessen samt påverkan på patientsekretessen. Resultatet visar att bedsiderapportering föredras av både patient och sjuksköterska, dock gärna en modifierad sådan där känslig information delges utom hörhåll för att bevara sekretessen. Slutsats: Bedsiderapportering föredras av både sjuksköterskor och patienter och är ett steg i rätt riktning mot en patientcentrerad vård. Trots att studier gjorts som bevisar detta är bedsiderapportering inte standard inom vården, något som bör ändras genom fortsatta studier för en säkrare och mer delaktig vård för patienter och ett bättre och effektivare arbetssätt för sjuksköterskor. / Background: Change of shift report between nurses is a big and important part of a nurse’s tasks, and its content and quality affects the coming shift’s tasks. The change of shift report can be carried out in multiple ways, for example traditional report which is conducted away from the patient, or bedside report which is located in the patient’s room with the patient. Purpose: The purpose of this literature review was to investigate the evidence for which of the two most commonly used methods of report is preferable: traditional report or bedside report. The comparison between the two methods of reporting addressed both the nurse’s opinion as well as the patient’s. Methods: The method used was literature review. 12 original articles were selected from databases for scientific articles, CINAHL and Pubmed. They were read and analyzed and resulted in five themes of results. Hildegard E. Peplau and her theory about relations in caring contributed as a theoretical framework. Results: Five themes were identified in the articles of the review: promoting of relationship between patient and nurse, safer care for patients, involving patient in care, time used for report and impact on patient’s confidentiality. The results showed that bedside report is preferred by both the patient and the nurse, preferably a modified version where sensitive information is handled away from the patient to keep the patient’s confidentiality. Conclusion: Bedside report is preferred by both nurses and patients and is a step towards a more patient centered care. Despite previous studies having shown this same result, bedside report is not yet implemented as standard report within the health care system. The conclusion of this review is that this should change and continuous studies should be conducted with an aim of safer care for patients with more patient participation, as well as better and more efficient way of work for nurses.

Throughout the process of receiving healthcare, a patient is affected by several factors and processes. To just name a few, how long a patient must wait at the clinic, how friendly the front desk is, how the nurse treats the patient, how effective the physician is with his or her communication, what the cost of a patient's healthcare is, and how clean the clinic is all affect the patient's experience. When clinics excel in these factors, it promotes a favorable relationship between the patient and the clinic. Patients trust the healthcare provider and desire to continue attending that clinic when they need to. Unfortunately, not every clinic can succeed in all these factors. The purpose of this study was to investigate the relative importance of these factors in a patient satisfaction survey at a university health center.