Ethics education for health professionals: A values based approach

Analyzing the Evolution of Medical Ethics Education: A Bibliometric Analysis of the Top 100 Cited Articles

Ethics education plays a pivotal role in healthcare by providing professionals and students with the essential competencies to navigate intricate ethical challenges. This study conducts a comprehensive bibliometric analysis of the most-cited articles on ethics education, investigating parameters such as citation count, document types, geographical origin, journal analysis, publication year, author analysis, and keyword usage. The findings reveal a substantial impact characterized by high citation counts and the influence of a prominent publication focusing on the hidden curriculum and structure of medical education. Moreover, the analysis demonstrates a discernible increase in research output since 2000, signaling a growing recognition of the significance of ethics education in the healthcare domain. Notably, specific journals, particularly those dedicated to medical education and ethics, emerge as major contributors in this field, publishing many articles. Renowned authors have made noteworthy contributions, and emerging themes encompass the ethical implications of virtual reality and artificial intelligence in healthcare education. Additionally, undergraduate medical education garners significant attention, emphasizing the importance of establishing ethical values and professionalism early. Overall, this study highlights the imperative of interdisciplinary collaboration and the necessity for effective ethics education programs to equip healthcare professionals with the requisite skills to navigate complex ethical challenges. The findings inform educators, curriculum developers, and policymakers about enhancing ethics education and ensuring the ethical competence of future healthcare practitioners.

The effects of an ethics laboratory program on moral sensitivity and professional values in nursing students: A randomized controlled study

BACKGROUND

Recently, moral sensitivity and professional values have become increasingly important in nursing education and have been tried to be improved.

OBJECTIVES

To investigate the effects of an ethics laboratory program integrated with the fundamentals of nursing course on the moral sensitivity and professional values of nursing students.

DESIGN

The present study was designed as a randomized controlled study. The 8-week ethics laboratory program was applied to the students in the intervention group. In the ethics laboratory program, interactive education methods, such as ethical scenarios, case studies, roleplay, group discussions, project papers and watching movies, were applied. Control group received the standard fundamentals of nursing curriculum.

PARTICIPANTS

The sample size was determined using stratified block randomization method, and 100 nursing students were assigned to intervention (n = 50) and control group (n = 50).

RESULTS

There was no baseline difference between the groups. The moral sensitivity average of the students in the intervention (82.66 ± 12.57) was lower than the average of the control group (85.64 ± 16.83) after the ethics laboratory program; however, the difference was not statistically significant (p > .05). Similarly, there were no significant differences between the intervention (132.32 ± 16.83) and the control group (131.81 ± 20.55) regarding the average score of professional values. In the responsibility sub-dimension of professional values, there was a statistically significant increase in the intervention group (p < .05).

CONCLUSION

The findings suggest that the ethics laboratory program for nursing students is effective in promoting responsibility sub-dimension of professional values. However, there was no significant effect on students' moral sensitivity and other dimensions of professional values. Further refinements of interventional research in ethics education and measurement of learning outcomes should be developed.

Ethics education to support ethical competence learning in healthcare: an integrative systematic review

Background

Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.

Methods

In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.

Results

The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.

Conclusions

The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.

Value-rich exposures in medical education: phenomenology of practice according to the lived experiences of medical students in Iran

Values ​​predispose people to make the right and especially ethical decisions, and are important for good performance in medical sciences. Students’ lived experiences and the value-rich exposures during their education are some effective means of achieving professional values that help them build their own value frameworks. In this phenomenology of practice study, we aimed to explore and describe the lived experiences of a sample of medical students in Shahid Beheshti University of Medical Sciences regarding their value-rich exposures. In-depth interviews, students’ written stories, recorded video interviews related to past trips and photographs were used to collect data. The data was analyzed based on Van Manen’s thematic analysis method.

Five themes emerged from the data: “in the shadow of a supportive mentor”, “a well-orchestrated, value-rich program”, “human interactions in a value system”, “acquiring values in a real-life environment”, “and seeking values in oneself”. Our study identified different dimensions of value-rich exposure based on the lived experiences of medical students and pointed out some issues that medical education planners can consider to improve the quality of value-based education for medical students.

Appealing to Tacit Knowledge and Axiology to Enhance Medical Practice in the COVID-19 Pandemic: A Systematic Review and Hermeneutic Bioethical Analysis

Background: The pressure of coronavirus disease 2019 (COVID-19) pandemic, epidemiological and demographic changes, personnel-patient relationship in healthcare, and the development of biotechnologies do not go unnoticed by the healthcare professional. Changes are so wide and at a high rate that guidelines and mere scientific knowledge, which are represented by evidence-based medicine, are not sufficient to lead actions, thus the experiential aspects in the configuration of an ethos present as a fundamental part of the resources to deal with critical scenarios, such as a pandemic. In this regard, the recognition of tacit knowledge as a way of teaching and learning skills related to ethical aspects such as principles, virtues, and values, revealed as a fundamental part of the clinical field. The challenge is to strengthen binomial evidence-based medicine and values-based in order to achieve excellence in the health care of the patients and the well-being of the clinical personnel.

Method: A 2-fold analysis was conducted taking pediatric endocrinology as an example. First, a systematic review was carried out in electronic databases BIREME, PubMed, and PhilPapers following PEO and PRISMA approaches. A total of 132 articles were garnered. After reading their title and abstract, 30 articles were obtained. Quantitative information was arranged in an Excel database according to three themes: ethics, axiology, and tacit knowledge. A quality criterion that meets our research question was assigned to each article and those which had a quality criterion of 3 (9) were taken to carry out the hermeneutic bioethical analysis, which consisted of three stages, namely naïve reading, codification, and interpretation. The results were analyzed in Atlas.ti. to elucidate the relations between the three main themes in accordance with the objective.

Results: Although there was no difference in the frequency of tacit knowledge skills, including cognitive, social, and technical, for medical practice, there is an intrinsic relationship between epistemic and ethical values with cognitive skills, this means that professionals who practice honesty, authenticity and self-control are capable of seeing patients as persons and thus respect their dignity. This suggested that there is a strong partnership between evidence-based medicine and value-based medicine, which reinforced this binomial as the two feet on which medical practice decisions rested. With regard to tacit knowledge in terms of the context of the COVID-19 pandemic, the challenges refer to (1) adapting and learning a new way of establishing trust with the patient and (2) how to capitalize on the new knowledge that new experiences have posed.

Discussion: The analysis of ethical-tacit knowledge in medicine is a recent phenomenon and is in full development. Although no references were found that dealt with any of the main topics in pediatric endocrinology, there is an interest in pediatrics to explore and discuss educational strategies in ethics related to its tacit dimension as a vector of enhancement in the clinical practice. Educational strategies ought to take into consideration the development of skills that promote reflection and discussion of experiences, even more vigorously in the context of the COVID-19 pandemic.

Pharmacy graduates' perceived impact of long-term undergraduate use of an ethical decision-support tool on their early practice

INTRODUCTION

Values-based practice is an important concept within healthcare decision-making that sits alongside evidence-based practice. Values Exchange (Vx) (http://www.vxcommunity.com) is an online tool that supports the development of ethical and professional decision-making skills through values transparency. The aim of this research was to explore the perceived impact of long-term use of the tool during undergraduate study on pharmacy graduates' early practice.

METHODS

Alumni in their pre-registration year or up to two years qualified were invited to participate via a question at the end of a survey, with additional students invited prospectively during an undergraduate lecture. All had completed three cases per year on Vx during the four-year master of pharmacy course. Semi-structured interviews were audio-recorded and transcribed verbatim, and framework analysis was applied. Ethical approval was obtained.

RESULTS

A total of 18 interviews (nine pharmacists and nine pre-registration tutees) were conducted between May 2015 and March 2016. Thirteen participants were female, 13 were based in community pharmacy, and 10 were Caucasian. Interviews ranged from 50 min to 2 hours. Three themes emerged from the data: (1) the Vx learning environment, (2) learning and reflection, and (3) potential enhancements for learning. Participants perceived Vx to be an effective teaching tool supporting the development of skills necessary to exercise professional judgement in pharmacy practice.

CONCLUSIONS

Vx appears to be a worthy addition to the armoury of teaching methods necessary to support future pharmacists in their preparedness to deal with ethical and professional dilemmas in practice.

Examination of the professional values of the nurses and the associated factors

PURPOSE

This study is conducted to examine the professional values of nurses and their personal and professional characteristics affecting these values.

DESIGN AND METHODS

A total of 369 nurses completed a questionnaire on personal information and nursing professional values scale (NPVS-R).

FINDINGS

The total scores of the nurses on the NPVS-R were found to be 100.87 ± 21.07, and the item mean scores were found to be 3.87 ± 0.81. When the scores for individual scale factors were examined, the highest scores were observed for the "caring" (4.02 ± 0.87) and "activism" (3.90 ± 0.89) factors.

PRACTICE IMPLICATIONS

The fact that nurses are aware of their individual values and how these values affect their behavior can be a guide in human-focused value nursing planning.

Religiosity and perceptions about research misconduct among graduate nursing students

Aim

This paper aims to study the correlation between religiosity and research misconduct in graduate nursing students and determine other factors that may have an impact on research misconduct in graduate nursing students.

Design

A cross‐sectional descriptive study was used to collect data from 49 graduate nursing students.

Method

The target population comprised all graduate nursing students enrolled at Jordan University of Science and Technology, Jordan. Participants who met the criteria were approached by the researcher and given a letter that provided detailed information about the study, and their informed consent was obtained. The questionnaire was consisted of three parts: a demographic datasheet, research misconduct tool and a religiosity questionnaire.

Results

The results demonstrated a significant interaction between perceptions about research misconduct and one of predictors such as religiosity, where higher religiosity was associated with perceiving research misconduct as a critical issue.

Broadening Our Scope: A Pilot Curriculum in Bioethics for Pathology Graduate Medical Trainees, the Emory University Experience

Despite mandates from the Accreditation Council for Graduate Medical Education and American Board of Pathology, little guidance is available for educating pathology trainees on bioethics. We endeavored to describe the development and implementation of a pathology-specific pilot curriculum in bioethics for pathology trainees at Emory University. After institutional review board review and exemption, we performed a literature search on pathology and ethics, conducted an intradepartmental survey for ethics topics relevant to our trainees and faculty, and referenced the Pathology Milestones related to ethics to develop the framework and materials for the pilot curriculum. The curriculum consisted of 2 introductory and 3 topic-focused sessions over 14 months moderated by pathology faculty with interest and expertise in ethics. Sessions included a short didactic component followed by small group discussions of cases created by the investigators. Surveys were administered to participants before and 16 months after completion of the curriculum. Twenty-nine pathology trainees participated in the curriculum. In baseline surveys, 93% (27/29) of participants believed that ethical dilemmas occur in pathology practice; 62% (18/29) reported having either experienced one or more ethical dilemmas themselves or knowing a pathologist or pathology trainee who had experienced one. In postcurriculum surveys, 87% (13/15) of respondents reported having learned something new, 92% (12/13) anticipated applying this knowledge to pathology practice, and 81% (13/16) would recommend it to a pathology trainee colleague. Limitations include single institution, small sample size, and limited outcome measures for ethics education. Our curriculum may serve as a model for other pathology training programs.

An empirical investigation into the role of values in occupational therapy decision-making

Introduction

The importance of values in occupational therapy is generally agreed; however, there is no consensus about their nature or their influence on practice. It is widely assumed that occupational therapists hold and act on a body of shared values, yet there is a lack of evidence to support this.

Method

The research tested the hypothesis that occupational therapists’ responses to ethically challenging situations would reveal common values specific to the occupational therapy profession. A total of 156 occupational therapists were asked to decide what should be done in five common-place yet ethically complex situations, presented as scenarios for debate.

Results

The results show that while most occupational therapists share very general values, they frequently disagree about what to do in practice situations, often justifying their choices with different and sometimes conflicting specific values. In some cases, the same respondents espouse contradictory values in similar situations.

Conclusion

The extensive literature about decision-making – together with the study’s results – confirm that when occupational therapists make decisions, they draw on multiple factors, consciously and unconsciously. These factors vary between individuals. Value judgements are one part only of a complex process which includes personal experience, intuition, social influences, culture, psychological influences and relationships with both colleagues and clients.

Values exchange: using online technology to raise awareness of values and ethics in radiography education

INTRODUCTION

Ethics and values are increasingly significant aspects of patient-centred healthcare. While it is widely agreed that ethics and values are essential for healthcare delivery, there is also an acknowledgement that these are areas that are challenging to teach. The purpose of this study is to report a small-scale evaluative research project of a web-based technology with the educational potential to facilitate learning in relation to ethics, values, self-reflection and peer-based learning.

METHODS

Five diagnostic radiography students took part in a semi-structured focus group with the aim of exploring their experiences of using Values Exchange, an online ethical decision-making framework, to examine practice-based ethical issues. Transcripts were interrogated for key themes.

RESULTS

From the thematic analysis three major themes emerged, understanding and appreciating others, addressing the theory-practice gap and delivering a safe and effective learning environment. Perceived limitations of the platform included students' fear of misinterpreted responses and possibility of poor group dynamics.

CONCLUSIONS

There are varied approaches to how ethics and values are taught and assessed within health-related environments. Values Exchange is one such teaching tool and has been investigated and described positively by radiography students in this study. Online teaching tools can have a positive effect in helping students identify their own values but require skilled implementation to reap positive rewards.

Students views of an online ethical decision-support tool

BACKGROUND AND PURPOSE

Ethical reasoning is a key skill that must be developed during the undergraduate pharmacy course to prepare students for ethical decision-making in future practice as pharmacy professionals. In this initial study, we sought and documented the views of pharmacy students at a United Kingdom (UK) university on the use of Values Exchange™ (Vx), an online ethical decision-support tool.

EDUCATIONAL ACTIVITY AND SETTING

Students deliberated on up to three ethical case scenarios every academic year using the tool. A preliminary study using a qualitative methodology was conducted with students nearing the end of their third-year of study to explore their views of the tool. Two focus groups were used to collect the data. Discussions were digitally recorded, anonymised and transcribed verbatim. Data was analysed using the five-stage framework approach.

FINDINGS

Four main themes emerged from the data: students felt that Values Exchange™ enabled them to gain a wider perspective on ethical issues; it promoted reflection; it helped to prepare them for future practice; students liked the online environment.

DISCUSSION

Vx prompted students to deliberate on many facets of a case, enabled them to consider and challenge the views of their peers, facilitated reflection and promoted greater honesty in responses and inclusivity, all supporting the development of moral reasoning skills.

SUMMARY

Vx supports the process of ethical decision-making, encouraging a deep approach to learning within a safe virtual environment. Students believed Vx to be an effective tool for developing ethical reasoning skills in preparation for practice.

Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care

Background

Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice.

Methods and findings

The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach.

A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence.

Conclusions

By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.

The 'Magic Light': A Discussion on Laser Ethics

Innovations in technology and science form novel fields that, although beneficial, introduce new bio-ethical issues. In their short history, lasers have greatly influenced our everyday lives, especially in medicine. This paper focuses particularly on medical and para-medical laser ethics and their origins, and presents the complex relationships within laser ethics through a three-dimensional matrix model. The term 'laser' and the myth of the 'magic light' can be identified as landmarks for laser related ethical issues. These ethical issues are divided into five major groups: (1) media, marketing, and advertising; (2) economic outcomes; (3) user training; (4) the user-patient/client relationship; and (5) other issues. In addition, issues arising from two of the most common applications of lasers, laser eye surgery and laser tattoo removal, are discussed. The aim of this paper is to demonstrate that the use of medical and para-medical lasers has so greatly influenced our lives that the scientific community must initiate an earnest discussion of medical laser ethics.

Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long-acting intramuscular injections: a qualitative study

The ethical issues experienced by mental health nurses in administering antipsychotic depot and long-acting intramuscular injections (LAI) were explored in the present study. Mental health nurses face ethically-difficult situations when administering these medications. A phenomenological research method guided by Max van Manen's human science approach describes and interprets the ethical issues involved in performing the procedure. Purposive and snowball sampling was used to select eight participants from two mental health hospitals. Semistructured interviews were carried out to collect data. A thematic analysis was conducted on the data. The four main themes that emerged from the analyses were: (i) lack of alternatives; (ii) safety; (iii) feeling uncomfortable; and (iv) difficulty maintaining the therapeutic relationship. The findings suggest that mental health nurses face ethical challenges in administering LAI. The findings raise much needed awareness of the need for mental health nurses and nurse educators to consider the ethical issues experienced while performing the procedure. There is a need for nurse education providers and organizations to provide opportunities for mental health nurses to address their 'lived experiences'. Educational courses are needed to equip mental health nurses with the technical and critical thinking skills to administer safe and effective antipsychotic depot and LAI.

Ethical challenges in teaching genetics for medical students

Although inclusion of ethics as a study course in medical students' curricula is a common practice, special approaches in teaching ethics in the context of genetics should be considered. In the realm of genomics, there are several ethically sensitive topics such as diagnosis of genetic diseases, in vitro fertilization, and identification of genetic susceptibility to common diseases. In addition, in communication with the general public, genetic terms should be used with caution. Demonstration of the phenotypes of affected individuals should be regarded as a particular aspect of teaching genetics. In a description of a patient's phenotype, not only is it necessary to provide scientifically precise characteristics of a patient; voice timbre, facial expression, and body language should also be carefully controlled. Furthermore, in medicine, the theory-practice gap is a problematic aspect, and students often find it difficult to apply knowledge on ethical issues to real situations in clinics. For this purpose, clinical cases are presented during classes and their analysis requires a very respectful attitude on the part of both students and lecturers. For many genetic diseases, evaluation of minor anomalies such as a curved fifth finger, low situated ears, or missing of some teeth is required. Some minor anomalies are found in healthy individuals too, and interpretation of such features must therefore be considered carefully. This article describes our experiences in teaching genetics at Riga Stradinš University, ethical problems faced while teaching genetics, and their solutions.