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Informed consent and autonomy

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https://www.readbyqxmd.com/read/28078909/apparent-treatment-resistant-hypertension-patient-physician-relationship-and-ethical-issues
#1
Julian E Mariampillai, Per Anders Eskås, Sondre Heimark, Anne Cecilie K Larstorp, Fadl Elmula M Fadl Elmula, Aud Høieggen, Per Nortvedt
BACKGROUND: Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients. RESULTS: The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy...
January 12, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28043243/-association-between-sense-of-coherence-and-occupational-stress-of-workers-in-modern-service-industry-in-shanghai-china
#2
X Y Lu, J M Dai, N Wu, C Shu, J L Gao, H Fu
Objective: To investigate understand the current status of the sense of coherence and occupational stress in modern service workers, and to analyze the association between occupational stress and the sense of coherence. Methods: From March to April, 2016, 834 modern service workers from 3 companies in Shanghai, China (in air transportation industry, marketing industry, and travel industry) were surveyed by non-ran-dom sampling. The self-completion questionnaires were filled out anonymously given the informed consent of the workers...
October 20, 2016: Chinese Journal of Industrial Hygiene and Occupational Diseases
https://www.readbyqxmd.com/read/27996923/a-framework-for-unrestricted-prenatal-whole-genome-sequencing-respecting-and-enhancing-the-autonomy-of-prospective-parents
#3
Stephanie C Chen, David T Wasserman
Noninvasive, prenatal whole genome sequencing (NIPW) may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions...
January 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/27934774/the-moral-agency-of-institutions-effectively-using-expert-nurses-to-support-patient-autonomy
#4
Sonya Charles
Patient autonomy-with an emphasis on informed consent and the right to refuse treatment-is a cornerstone of modern bioethics. Within discussions about patient autonomy, feminist bioethicists have argued for a relational approach to autonomy. Under a relational framework, we must look beyond the individual moment of choice to include the role relationships and specific contexts can play in supporting or undermining autonomy. Given the day-to-day interactions they have with patients, nurses play a significant role in helping patients understand the nature of their illnesses and make truly informed decisions...
December 1, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27922563/-sign-here-nursing-value-and-the-process-of-informed-consent
#5
Wesley E Cook
Protecting patient autonomy is a key nursing role. The Code of Ethics (American Nurses Association, 2010), contextualizes the nurse's call to advocacy within the doctrine of informed consent. This article offers a primer on the legal, ethical, and practical aspects of procedural informed consent and examines the value of nursing's role within the process. The theory of nursing's value is sound, but the literature lacks data. Higher levels of evidence are necessary to make sound decisions about best practice for the process of informed consent...
October 2016: Plastic Surgical Nursing
https://www.readbyqxmd.com/read/27922504/genetic-testing-of-presymptomatic-individuals-at-risk-for-progressive-myopathy
#6
Zachary Simmons
Patients and their family members often ask about genetic testing for asymptomatic individuals who are at risk for developing a genetic disorder. Ordering a genetic test is a complex process involving consideration of many basic ethical principles including autonomy, beneficence, and nonmaleficence, as well as the physician's duty to act in the patient's best interest. Physicians have many choices regarding what tests to order, and they must develop the knowledge and skills to best discuss genetic testing with their patients...
December 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27891023/capacity-issues-and-decision-making-in-dementia
#7
REVIEW
Soumya Hegde, Ratnavalli Ellajosyula
Capacity to make one's own decisions is fundamental to the autonomy of the individual. Capacity is a functional assessment made by a clinician to determine if a patient is capable of making a specific decision. Competency is a global assessment and legal determination made by a judge in court. Capacity evaluation for a patient with dementia is used to determine whether the patient is capable of giving informed consent, participate in research, manage their finances, live independently, make a will, and have ability to drive...
October 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27884857/implementing-shared-decision-making-in-interprofessional-home-care-teams-the-ipsdm-sw-study-protocol-for-a-stepped-wedge-cluster-randomised-trial
#8
France Légaré, Nathalie Brière, Dawn Stacey, Guy Lacroix, Sophie Desroches, Serge Dumont, Kimberly D Fraser, Louis-Paul Rivest, Pierre J Durand, Stéphane Turcotte, Monica Taljaard, Henriette Bourassa, Lise Roy, Geneviève Painchaud Guérard
INTRODUCTION: The frail elderly in Canada face a tough decision when they start to lose autonomy: whether to stay at home or move to another location. This study seeks to scale up and evaluate the implementation of shared decision-making (SDM) in interprofessional (IP) home care teams caring for elderly clients or their caregivers facing a decision about staying at home or moving elsewhere. METHODS: A stepped wedge cluster randomised trial involving 8 Health and Social Service Centers (HSSCs) will be conducted with IP home care teams...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27883307/informed-consent-in-the-medical-care-of-transgender-and-gender-nonconforming-patients
#9
Timothy Cavanaugh, Ruben Hopwood, Cei Lambert
Informed consent as a model of care has evolved as an alternative to the standard model of care recommended by the World Professional Association for Transgender Health's Standards of Care, version 7, which emphasizes the importance of mental health professionals' role in diagnosing gender dysphoria and in assessing the appropriateness and readiness for gender-affirming medical treatments. By contrast, the informed consent model for gender-affirming treatment seeks to acknowledge and better support the patient's right to, and capability for, personal autonomy in choosing care options without the required involvement of a mental health professional...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27833931/patient-and-physician-views-about-protocolized-dialysis-treatment-in-randomized-trials-and-clinical-care
#10
Ashley Kraybill, Laura M Dember, Steven Joffe, Jason Karlawish, Susan S Ellenberg, Vanessa Madden, Scott D Halpern
BACKGROUND: Pragmatic trials comparing standard-of-care interventions may improve the quality of care for future patients, but raise ethical questions about limitations on decisional autonomy. We sought to understand how patients and physicians view and respond to these questions in the contexts of pragmatic trials and of usual clinical care. METHODS: We conducted scenario-based, semi-structured interviews with 32 patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis in outpatient dialysis units and with 24 nephrologists...
2016: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/27803362/toward-optimal-decision-making-among-vulnerable-patients-referred-for-cardiac-surgery-a-qualitative-analysis-of-patient-and-provider-perspectives
#11
Ryan A Gainer, Janet Curran, Karen J Buth, Jennie G David, Jean-Francois Légaré, Gregory M Hirsch
OBJECTIVES: Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population...
November 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27788415/increasing-possibilities-increasing-dilemmas-a-qualitative-study-of-swedish-midwives-experiences-of-ultrasound-use-in-pregnancy
#12
Kristina Edvardsson, Ann Lalos, Annika Åhman, Rhonda Small, Sophie Graner Md PhD, Ingrid Mogren
OBJECTIVE: to explore Swedish midwives' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. DESIGN: an exploratory qualitative study based on focus group discussions (FGDs) was undertaken in 2013 as part of the CROss Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis. SETTING AND PARTICIPANTS: midwives (N=25) were recruited from four public hospitals located in the northern and central parts of Sweden...
November 2016: Midwifery
https://www.readbyqxmd.com/read/27782924/recovery-oriented-mental-health-practice-in-a-community-care-unit-an-exploratory-study
#13
Brian McKenna, Jane Oakes, Niki Fourniotis, Nigel Toomey, Trentham Furness
A recovery-oriented model of care has become the major focus of mental health service delivery in the state of Victoria, Australia. However, there is a total absence of knowledge of recovery-oriented mental health practice in community care units (CCUs). Therefore, the aims of this exploratory study were to: (a) describe what aspects of the current model of care fit within the domains of recovery; and (b) describe the pragmatic processes that staff use to mold their care within the domains of recovery. Twenty-one key stakeholders provided informed voluntary consent to participate in one-to-one interviews...
October 2016: Journal of Forensic Nursing
https://www.readbyqxmd.com/read/27779152/role-of-demographic-and-job-related-variables-in-determining-work-related-quality-of-life-of-hospital-employees
#14
K Shukla, S Shahane, W D'Souza
BACKGROUND: Considering a huge working population in health sector faced with stressful work life, limited autonomy in work and declining work contentment calls for an overemphasis on evaluating and monitoring their satisfaction associated with work-related quality of life (WRQoL). This study evaluates WRQoL of hospital employees and validates the bilingual (English and Marathi) version of WRQoL scale. METHODS: The study was conducted during March-April'2014 on employees of a corporate hospital of Pune, India after ethical approval and informed consent from employees...
October 24, 2016: Journal of Postgraduate Medicine
https://www.readbyqxmd.com/read/27727472/while-respecting-autonomy-don-t-throw-out-the-baby-with-the-antenatal-consultation
#15
Michael van Manen
No abstract text is available yet for this article.
January 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/27691377/ethics-of-coercive-treatment-and-misuse-of-psychiatry
#16
Tilman Steinert
The author discusses a pragmatic approach to decisions about coercive treatment that is based on four principles from principle-based ethics: respect for autonomy, nonmaleficence, beneficence, and justice. This approach can reconcile psychiatry's perspective with the U.N. Convention on the Rights of Persons With Disabilities. Coercive treatment can be justified only when a patient's capacity to consent is substantially impaired and severe danger to health or life cannot be prevented by less intrusive means...
October 3, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/27689223/-autonomy-and-welfare-in-intensive-care-medicine-practical-approach-in-difficult-situations
#17
M Gruß, F Salomon
In intensive care units far-reaching decisions are often made at short notice that require the consent of the informed patient. If this is not possible due to the patient's condition, physicians and legal representatives must ascertain the previously expressed or presumed will of the patient and act accordingly. The legal principles are specified in the Patient Advance Directives Act and the Patient Rights Act. Any indications for medical treatment need a clearly defined aim of the therapy, which can be questioned during the progress of the disease...
September 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27682425/nurses-perspectives-on-moral-distress-a-q-methodology-approach
#18
Pei-Pei Chen, Hsiao-Lu Lee, Shu-He Huang, Ching-Ling Wang, Chiu-Mieh Huang
BACKGROUND: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses' reaction to dilemma such as moral distress is relatively less noticed. OBJECTIVE: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. RESEARCH DESIGN: This study applied Q methodology to explore the perspectives of nurses regarding moral distress...
September 28, 2016: Nursing Ethics
https://www.readbyqxmd.com/read/27681338/reasons-for-family-involvement-in-elective-surgical-decision-making-in-taiwan-a-qualitative-study
#19
Mei-Ling Lin, Chuen-Teng Huang, Ching-Huey Chen
AIMS AND OBJECTIVES: To inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family. BACKGROUND: Making a patient the centre of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking...
September 29, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27677435/natural-childbirth-ideology-is-endangering-women-and-babies
#20
Hans Peter Dietz, Lynda Exton
Natural childbirth ideology has become dominant across much of the developed world. This ideology increasingly clashes with the reality of modern obstetrics, which is dealing with a demographic that is getting older and more obese, hence more complicated, and it has become a danger to the health of women and babies. The most visible expression of these trends is the focus on caesarean section rates which have become a key performance indicator of obstetric services. This trend is resulting in increasingly obvious negative consequences for morbidity and mortality, as chronicled in the Morecambe Bay Report, published in the UK last year...
October 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
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