O presente estudo teve por objetivos conhecer a percepção de enfermeiros sobre dilemas éticos existentes na assistência de enfermagem a pacientes terminais no contexto da UTI de um hospital geral do município de São Paulo e o que é considerado para a tomada de decisão frente a esses dilemas. O estudo foi realizado numa abordagem qualitativa, sendo utilizada a análise de conteúdo proposta por Bardin. Foram realizadas entrevistas com dez enfermeiros atuantes na UTI. Após análise, emergiram as seguintes categorias e subcategorias: Categoria 1– Fatores geradores de dilemas. Subcategorias - valores e crenças, responsabilidade profissional e a relação com a família do paciente terminal; Categoria 2- Fatores que influenciam a tomada de decisão Subcategorias - o esclarecimento da família e do paciente terminal, a postura profissional de enfermeiros e médicos, as dificuldades referidas por enfermeiros, valores e princípios dos profissionais; Categoria 3- Participação no processo de tomada de decisão. Subcategorias - o paciente terminal, a família do paciente terminal, a equipe médica e os enfermeiros.; categoria 4- Interferências na assistência de enfermagem ao paciente terminal; Subcategorias - a organização do cuidado e os valores pessoais; categoria 5- Considerações sobre a terminalidade e sentimentos relacionados ao paciente terminal e categoria 6 - Constatação da obstinação terapêutica. O estudo mostrou que os enfermeiros deparam-se com dilemas éticos decorrentes da internação de pacientes terminais em UTI gerados por diversos fatores: a diversidade de valores; a presença dos pacientes terminais na UTI; os princípios religiosos; os valores pessoais; as incertezas a respeito da terminalidade do paciente e dos limites de intervenção para prolongar a vida; a responsabilidade profissional relacionada à sobrecarga de tarefas; a discordância de tomadas de decisão; a necessidade de priorizar o atendimento entre pacientes terminais e outros com possibilidades terapêuticas; a não aceitação do processo de morte pela família do paciente e a falta de esclarecimento sobre o seu quadro clínico. Foi constatado que os enfermeiros não participam ativamente das tomadas de decisão relacionadas às condutas com o paciente terminal, mas consideram importante a participação da família, o respeito pelo desejo do paciente e a participação de outros profissionais nesse processo. Além disso, para tomar decisão frente aos dilemas éticos, ele leva em conta os seus valores, a ética profissional, a empatia e o diálogo com os colegas. / The aims of the present study are twofold: to know the nurses perception about the existing ethical dilemmas during nursing assistance to terminal patients in the intensive care unit (ICU) context of a general hospital in São Paulo city, and what is considered in the decision-making when facing those dilemmas. The study was carried out with a qualitative approach, utilizing the content analysis proposed by Bardin. Interviews were made with ten practicing nurses in the ICU. After analysis, there emerged the following categories and subcategories: Category 1– Dilemma-generating factors. Subcategories - values and beliefs, professional responsibility, and the relation with terminal patient’s family; Category 2- Factors that influence the decision-making. Subcategories - the explanations to the family and to the terminal patient, the professional posture of nurses and doctors, the difficulties referred to by nurses, and the values and principles of these professionals; Category 3- Participation on process of decision-making. Subcategories - the terminal patient, the family of the terminal patient, the medical team, and the nurses; Category 4- Interferences in nursing support to the terminal patient; Subcategories - care organization and personal values; Category 5- Considerations on the terminality and feelings related to the terminal patient, and category 6 – therapeutic obstinacy verification. The study showed that the nurses face ethical dilemmas resulting from the terminal patient’s admission in the ICU generated by several factors: diversity of values; presence of terminal patients in the ICU; religious principles; personal values; uncertainties regarding the terminality of the patient and the limits of intervention to prolong life; the professional responsibility related to the overload of tasks; decision-taking discord; the necessity to prioritize care between terminal patient and others with therapeutical possibilities; non-acceptance of the death process by the patient’s family, and the absence of explanations about their clinical status. It was verified that the nurses do not participate actively in the decisions for dealing with the terminal patient, but they consider important the family participation, the respect for the patient’s wishes and the participation of other professionals in the process. In addition to that, they take into account their values, professional ethics, the empathy, and the dialogue with colleagues when taking decisions in the face of ethical dilemmas.

In British Columbia (BC) foresters registered with the Association of BC Forest Professionals (ABCFP) have been given the exclusive right to practise professional forestry. As with all professions there is an expectation that Registered Professional Foresters (RPFs) conduct their activities in an ethical manner and are therefore obligated to act as an ethical agent on behalf of society regarding forest resources. If a certain level of ethical agency is desired of professionals we need to understand whether or not an RPF possesses the ability (defined as their discretion) to sufficiently fulfil this responsibility. Rule-based and principle-based standards of forest management, an RPF’s scope of practice, and the socio-political framework of public forest management in BC all come together to define an RPF’s discretionary context, which sets the limits to an RPF’s discretion. This context is highly idiosyncratic to a specific situation or decision and this makes the RPF’s discretion similarly idiosyncratic. This suggests that an RPF should not be accountable for a standard of ethical agency that does not reflect the context-dependent level of discretion they possess. Fifteen interviews of RPFs were conducted for this study to discuss their approach to ethical decision making. The analysis of the interviews revealed 12 major themes, several of which appear to be highly idiosyncratic to the situations described by the participants. The way these themes were perceived by the participants revealed the differences in the discretionary context of their situations. Several aspects of ethical deliberation emerged from the data that appear to be particular to broad employer categories, including delegated decision-making (government), economic and forest health considerations (industry), and the tension between personal and professional values (consultants). / Forestry, Faculty of / Graduate

Bakgrund: Att ta beslut om ej HLR började redan på 50-talet och har visat sig vara ett svårt etiskt beslut. Ofta missförstås begreppet ej HLR och behandlingsbegränsningar av vårdpersonalen, vilket i förlängningen kan leda till olika vård av olika patienter beroende på hur den personal som är i tjänst tolkar begreppet. Sjuksköterskor ställs ofta inför etiska dilemman vid beslut kring behandling i livets slutskede, dels gentemot läkare och undersköterskor men även gentemot patient och anhöriga. Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelser och erfarenheter av behandlingsbegränsningsbeslut gällande ej HLR. Metod: Semistrukturerad intervjustudie av åtta sjuksköterskor på en akutvårdsklinik, analys med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier utifrån sjuksköterskornas upplevelser och erfarenheter av behandlingsbegränsningsbeslut om ej HLR: Sjuksköterskors kunskap & erfarenhet, sjuksköterskors känsla av frustration och sjuksköterskors upplevelse av etiska dilemman. Sjuksköterskorna hade erfarit skillnader i kunskapsläget gällande behandlingsbegränsningar och ej HLR inom alla personalkategorier. Där fanns också en upplevelse av frustration bland annat när det saknades beslut om ej HLR och när de inte delade åsikt med beslutade läkare. Detta resulterade också i att de ställdes inför etiska dilemman när de var tvungna att påbörja HLR på grund av avsaknad av behandlingsbegränsnings beslut om ej HLR. Slutsats: Sjuksköterskorna hade upplevelse och erfarenhet av brister i kommunikationen mellan vårdpersonal inom alla personalkategorier. Önskemål om mer utbildning och diskussion i ämnet utrycktes för att förbättra beslutsfattandet och vården av de patienter som har eller bör ha beslut om ej HLR. / Background: DNR-decisions started in the 50´s and it has been proven as a difficult ethical decision. Often there is a misunderstanding of the concept of DNR and end-of-life decisions among the hospital staff, which can lead to differences in care of patients. Nurses´ often experience ethical dilemmas when decisions regarding treatment must be taken in the final stages of life, both against doctors and other nurses, but also to patients and their relatives. Aim: The aim of this study was to describe nurses' experiences of DNR decisions. Method: A semi-structured interview study of eight nurses in an acute care unit, analysis with qualitative content analysis. Results: The analysis resulted in three categories based on nurses´ experiences of end-of-life decisions and DNR; Nurses knowledge and experience, nurse´ sense of frustration and nurses´ experience of ethical dilemmas. The nurses´ had experienced differences in the knowledge regarding end-of-life decisions and DNR in all categories of staff. There was also an experience of frustration in when there was no decision on DNR and when they did not share the view with the doctor. This also resulted in that they were faced with ethical dilemmas when they had to begin CPR because of the absence of DNR-decision. Conclusion: The nurses had sensed and experienced lack of communication between health professionals in all categories of staff. Desire for more education and discussion on the subject was expressed in order to improve decision making and care of patients who have or should have the decision of DNR.

Abstrakt Studiens syfte Syftet med denna studie är att jämföra hur marknadsföringen från olika typer av resebolag speglar deras inställning och förhållningssätt till etiska dilemman samt att jämföra om eller hur de skiljer sig i frågan. Teoretiska referensramar Studiens slutsatser dras med stöd i Corporate social responsibility, hållbart agerande samt turismens etiska dilemman med code of conduct som främsta referens.    Metod En kvalitativ forskning utifrån pusselbitsansatsen har gjorts med en deduktiv utgångspunkt. Kvalitativa semistrukturerade intervjuer har använts för att samla in primärdata. Intervjuerna gjordes via telefon eller mejl, där även följdfrågor bifogats och svarats på efter vardera intervju.   Empiri Svar från fem olika intervjuer på fyra olika resebolag samt en skribent i ämnet. Intervjufrågor och svar finns bifogat i bilagor och sammanfattat i resultatdelen. Slutsats Studien visar på stora skillnader i hur de olika resebolagen marknadsför sig, vilket verkar ha att göra med dels typen av resebolag och storleken på företaget. Vissa har ett proaktivt förhållningssätt till hållbart agerande och arbetar förebyggande med det, medan andra har ett mer reaktivt eller till och med defensivt förhållningssätt. Branschen har visat sig ha en tendens att utesluta viss information i sin marknadsföring, vilket verkar bero på att de visar det kunderna vill se. Det kunder inte ser, tas inte hänsyn till och det är därmed företagets ansvar att presentera på rätt sätt. Enligt vår studie finns det särskilda typdrag som utmärker resebolagens etiska ställningstaganden i deras marknadsföring, och dessa typdrag speglas även i resebolagens respektive framtidsvisioner. Gällande framtida forskning ser vi gärna att ämnet undersöks ytterligare fast mer koncentrerat, inriktat på endast en typ av resebolag. Även forskning ur konsumentperspektivet hade vi funnit intressant.

This diploma thesis deals with practical ethical issues in specialized mobile palliative care. First of all the terms necessary for understanding the context are explained. Than brief introduction to the legal order and the principles of palliative care in the Czech Republic follows. Diploma thesis summarizes the phases of coping with the disease and the loss of a close person. This is both from adult's and a child's point of view. Next section deals with spiritual and pastoral care of dying, four principles of medical ethics and informed consent. Based on an interview with MUDr. Irena Závadová, supported by specialized literature, the ethical issues and theire possible solutions are mentioned too. This thesis deals with ethical issues as follows: awareness of diagnosis education system in palliative care development of palliative care in hospital facilities opiatophobia antibiotics in palliative and hospice care proxy decision making in a patient with dementia alternative forms of nutrition palliative sedation transfusion in palliative/hospice care Keywords Home hospic, dying, death, specialized mobile palliative care, ethical dilemmas.

This diploma thesis deals with practical ethical issues in specialized mobile palliative care. First of all the terms necessary for understanding the context are explained. History of palliative care. Than introduction to the legal order and the principles of palliative care in the Czech Republic follows. Diploma thesis summarizes the phases of coping with the disease and the loss of a close person. This is both from adult's and a child's point of view. Next section deals with spiritual and pastoral care of dying, four principles of medical ethics and informed consent. Based on an interview with MUDr. Irena Závadová, supported by specialized literature, the ethical issues and theire possible solutions are mentioned too. This thesis deals with ethical issues as follows: education system in palliative care controversial interpretation of the law n. 372/2011 opiatophobia antibiotics in palliative and hospice care nutrition in palliative care palliative sedation transfusion in palliative/hospice care autonomy patient with dementia Keywords Home hospic, dying, death, specialized mobile palliative care, ethical dilemmas.

The purpose of the study was to evaluate the didactic potential, and applicability of fiction in religious education. The subject I wanted to examine was J.R.R. Tolkiens The Fellowship of the Ring and whether it could be enriching for religious studies in upper secondary school, focusing on normative ethics.The study used a qualitative research method and the empirical material consisted of J.R.R. Tolkiens The Fellowship of the Ring. The book was read several times and sorted and reduced using focused coding searching for ethical dilemmas and different thematic units. The result was analyzed with the help of the high school’s curriculum, previous research, and selected theoretical concepts, normative ethics and didactic potential.The results showed that the book contained a large number of ethical dilemmas and several thematic units wich could help realize its didactic potential. The book’s usefullnes and didactic potential, focusing on normative ethics in religious studies, could then be proven on the basis of the upper secondary school’s and religious studies curriculum, as well as using previous research. The ethical dilemmas and thematic units found throughout the book make it highly usefull for discussing issues of normative ethics in the classroom.

Sammanfattning Bakgrund: Varje år insjuknar omkring 10 miljoner personer i världen i en demenssjukdom. Dessa personer behöver ibland vårdas på sjukhus på grund av olika akuta försämringar. Sjuksköterskor behöver arbeta utifrån ett personcentrerat förhållningssätt för att kunna tillgodose alla de behov en person med demenssjukdom har.     Syfte: Att beskriva vårdpersonals upplevelser i vården av personer med demenssjukdom på sjukhus. Metod: Kvalitativ litteraturöversikt med induktiv ansats. Analys av elva vetenskapliga artiklar genomfördes utifrån Fribergs beskrivning av fem-stegsanalys.    Resultat: Analysen resulterade i två teman och sju subteman. Under temat “Omvårdnadsaspekter av betydelse” presenteras subteman bemötande, kommunikationshinder, etiska dilemman och anhörigas inflytande. Under temat “Organisatoriska aspekter av betydelse” presenteras subteman vårdmiljö, tidsbrist samt utbildning och kunskap. Slutsats: Vårdpersonal har en viktig roll i främjandet av en god vård för alla parter i omvårdnaden av personer med demenssjukdom på sjukhus. Ett flertal omvårdnadsaspekter och organisatoriska aspekter begränsar vårdpersonalen i deras omvårdnadsarbete och behöver ses över. För att uppnå en säker vård av kvalitét för personer med demenssjukdom på sjukhus behövs förslagsvis ökad kunskap och utbildning. En anpassad vårdmiljö samt ett bra samarbete inom det interprofessionella teamet och med anhöriga är även stor betydelse. / Summary Background: Around 10 million people worldwide get dementia every year. These people sometimes need to be cared for in hospital due to various acute deteriorations. Nurses need to work in a person-centered approach in order to meet all the needs of a person with dementia. Aim: To describe nursing staffs’ experience in the care of people with dementia in hospitals. Method: A qualitative literature review with an inductive approach. Analysis of eleven scientific articles was carried out based on Friberg's description of five-step analysis. Result: The analysis resulted in two themes and seven subthemes. The theme “Aspects of importance in nursing” presents the subthemes personal treatment, communication barriers, ethical dilemmas and the influence of relatives. The theme “Organizational aspects of importance” presents the subthemes healthcare enviroment, lack of time, and education and knowledge.  Conclusion: Nursing staff play an important role in promoting good care for all parties in the care of people with dementia in hospitals. A number of nursing aspect and organizational aspects limit the nursing staff in their work and need to be considered. In order to achieve safe, quality care for people with dementia in hospitals, increased knowledge and education are suggested. An adapted healthcare environment and a good collaboration within the interprofessional team and with relatives is also of great importance.

Production has relocated to the Eastern world, whilst consumption is dominating the Western world. Taking into consideration the cultural differences between East and West sanctions a problem, as it is identified that corporate social responsibility (CSR) practices require adaptation to the different cultural contexts. For this reason, it is of interest to study how the values in a middle-income country influence the attitudes that are formed towards CSR to further contextualise the need for adaptation of CSR. To accomplish the aim to the fullest extent, and to adequately form an understanding of how the values influence the attitudes towards CSR in a middle-income country, this study takes place in Colombo, Sri Lanka. As Sri Lanka is a country that has a prevalent textile industry, along with a strong focus on CSR activities and ethical production, augments the choice for the enactment of this study. In the essence of this, the encompassing purpose of this study is as follows: To illustrate how cultural values influence attitudes regarding CSR practices from a future managerial perspective in the setting of Sri Lanka, and if the cultural factors play an important role in the formation of values that inhere to CSR. The methodology of the research consists of focus groups that implicate a vignette technique that builds on the theoretical chapter. Five focus groups were performed, which comprised of fifteen students in total, all current fashion students within textiles, design and marketing at the University of Academy of Design (AOD) located in Colombo, Sri Lanka. By using the vignette technique enables the authors to compose ten scenarios, building on the concepts of CSR in where Carroll’s pyramid is of significance, along with cultural dimensions that are represented by Hofstede and Schwartz. Through these scenarios, the authors explore the attitudes of future managers, namely students, in their attempt to act upon ethical dilemmas. Thereafter, thematic analysis was used to extract four themes from the participants’ insights. These themes add up to the Sri Lankan Business Mindset, Hierarchy, Level of Recognition and Who is Responsible. The findings of this study suggest that in an attempt to approach CSR in a manner which strives to shape the values towards ethical reasoning, it is essential to take into consideration the four actors that are identified as responsible – namely the government, society, company, and individual.

Föreliggande studies syfte var att undersöka yrkesverksamma psykologers erfarenheter och hantering av yrkesetiska dilemman kopplat till sociala medier. Studien utgjordes av en kvalitativ ansats och baserades på sex semistrukturerade intervjuer. Datamaterialet analyserades genom induktiv tematisk analys, som mynnade ut i tre huvudteman: Psykologen på sociala medier- föreställningar och förväntningar, Gränser samt Vägledning. Två huvudteman bestod i sin tur av två underteman vardera. Resultatet visade att psykologers erfarenheter av yrkesetiska dilemman bestod av både konkreta erfarenheter och en generell medvetenhet inför potentiella dilemman på sociala medier. De yrkesetiska dilemman som framkom i relation till sociala medier berörde i huvudsak interaktion med patienter, hantering av information om patienter samt självutlämnande information om psykologen. En central aspekt av yrkesetiska dilemman berörde samspelet och gränsdragningen mellan rollen som privatperson och rollen som psykolog på sociala medier. Hanteringen av yrkesetiska dilemman bestod av förebyggande åtgärder och strategier som syftade till att tydliggöra och dra gränser mellan de olika rollerna, där yrkesetiska principer och stöd från arbetsplatsen fungerade vägledande. Studiens resultat kan bidra till att skapa en dialog på arbetsplatser och utbildningar kring etiska dilemman. Därtill belyser studien värdet av en medveten reflektion kring ämnet, vilket kan vara till nytta för den enskilde psykologen i arbetet med patienter. Den kunskap som studien bidrar med kan även vara relevant vid en eventuell uppdatering av Psykologförbundets yrkesetiska principer. / The aim of the present study was to explore psychologists' experiences of ethical dilemmas related to social media, and how these ethical dilemmas are managed. This was explored using a qualitative approach and was based on six semi-structured interviews. The data was analyzed through inductive thematic analysis, which resulted in three main themes: The psychologist on social media - perceptions and expectations, Boundaries and Guidance. Two of the main themes consisted of two sub-themes each. The results showed that psychologists' experiences of ethical dilemmas consisted of concrete experiences and a general awareness of potential dilemmas on social media. The ethical dilemmas that emerged in relation to social media concerned interaction with patients, managing information about patients and self-disclosing information about the psychologist. A central aspect of ethical dilemmas concerned the interplay and demarcation between the private role and the role as a psychologist on social media. The management of ethical dilemmas consisted of preventive measures and strategies aimed at clarifying and establishing boundaries between the various roles, where ethical principles and support from the workplace acted as a guide. The results of the study can contribute to creating a dialogue in workplaces and educational systems about ethical dilemmas. In addition, the study highlights the value of awareness about the subject, which can be useful for the individual psychologist in working with patients. The study may also act as a basis in an eventual update of the Swedish Psychological Association's professional ethical principles.