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Wernecke K, Nadolny S, Schildmann J, Schiek S, Bertsche T. Ethical conflicts in patient care situations of community pharmacists: a cross-sectional online survey. Int J Clin Pharm 2024:10.1007/s11096-024-01797-9. [PMID: 39240277 DOI: 10.1007/s11096-024-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Community pharmacy practice is rarely considered in ethical research, although various ethical conflicts are known for this setting. Data on the actual frequency and perceived burden of ethical conflicts occurring in the community pharmacy setting are required. AIM The survey aimed at investigating the frequency and perceived burden of ethical conflicts, reasons for the perceived burden and influences on decision-making in ethical conflicts in German community pharmacists. METHOD An online survey was conducted among community pharmacists. It contained 15 ethical conflicts in which the ethically required action conflicts with another principle (e.g. law). Basing on these conflicting principles, 12 considerations relevant for decision-making were defined (e.g. solidarity principle). Participants were asked to rate the ethical conflicts in terms of frequency and perceived burden and to rate the influence on decision-making for the considerations. Results were analysed descriptively. RESULTS Five hundred and thirty-five questionnaires were evaluated. The participant's median age was 39 (min-max: 20-78) years, 378 (71%) were female. Seven of the 15 predefined ethical conflicts were rated as occurring predominantly at least once a week. "Generic drug is not most suitable" was rated as the most frequent. Three ethical conflicts were rated mainly with a (very) strong burden. "Concerns for an unborn child" was rated as the most burdensome. Three of the 12 predefined decision-making considerations: pharmaceutical knowledge, legal requirements and personal values were rated primarily as having a very strong influence on decision-making. CONCLUSION Pharmacists in community pharmacies are frequently affected by burdensome ethical conflicts in patient care situations.
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Affiliation(s)
- Kathrin Wernecke
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
- Institute for Educational and Health-Care Research in the Health Sector, Hochschule Bielefeld -University of Applied Sciences and Arts, Interaktion 1, 33619, Bielefeld, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Susanne Schiek
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany.
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany.
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Charrois TL, Sewell HD. Clinical decision-making by fourth-year pharmacy students: Towards an understanding of their uncertainty. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:779-786. [PMID: 37537008 DOI: 10.1016/j.cptl.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Clinical decision-making is a critical process underpinning much of a pharmacist's daily activities. While it is known that pharmacists hesitate to make decisions, it remains unclear whether pharmacy students experience similar hesitancy. The objective of this study was to better understand the phenomenon of decision-making in pharmacy students. METHODS This study was designed from a social constructivist paradigm using qualitative case study methodology. The purpose was to investigate issues related to hesitancy in clinical decision-making by fourth-year pharmacy students. Data were collected through observation of students engaging in simulations, post-simulation interviews, and written reflections. Data analysis included multiple stages of coding, followed by pattern identification and discovery of interrelationships. RESULTS The primary themes relating to issues in pharmacy student clinical decision-making were relational factors, teaching and learning, degree of certainty, and personal characteristics. Relational factors include elements of relationships with patients and physicians as well as a sense of autonomy. The theme of teaching and learning included the sub-themes of formal education and learning in the real world. Degree of certainty included patient complexity, weighing risks and benefits, comfort in ambiguity, and a lack of information. Finally, personal characteristics associated with decision-making include personal experiences, leadership skills, and confidence. CONCLUSIONS Pharmacy education needs to focus on ensuring preceptors can help model comfort in ambiguity, that assessments include the reality of practice, and ensuring ample practice of decision-making in a simulated environment.
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Affiliation(s)
- Theresa L Charrois
- Faculty of Pharmaceutical Sciences, University of British Columbia, Office 3323, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - H Douglas Sewell
- Werklund School of Education, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada.
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Simegn W, Weldegerima B, Endeshaw A, Sisay G, Mohammed A, Wondimsigegn D, Dagne H. Assessment of Community Pharmacy Professionals' Attitude and Perception Towards Ethical Issues in Amhara Region, Ethiopia: A Cross-Sectional Survey 2020. Risk Manag Healthc Policy 2021; 14:4127-4139. [PMID: 34629917 PMCID: PMC8495226 DOI: 10.2147/rmhp.s328328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this study was to assess the attitude and perception of community pharmacy professionals' towards ethical issues. Methods We have undertaken a cross-sectional study among community pharmacy professionals in three selected towns (Gondar, Bahir Dar, and Debra Markos) of Amhara region in Ethiopia from February to March 2020. All community pharmacy professionals who were giving services during the data collection period were the study population. We used a pretested, semi-structured questionnaire developed from a review of previous study. Epi-info 7.1 was used for data entry, and SPSS version 20 was used for data analysis. Logistic regression was done, and a variable with a p-value < 0.05 with 95% confidence interval was considered to be associated with outcome variable. Results A total of 305 community pharmacy professionals participated in the study with a response rate of 95.3%. About 252 (82.6%) of respondents received education regarding professional ethics. Majority (89.8%) of the participants had ever accessed ethical information at their work site. Only 145 (47.5%) participants had ever recorded ethical issues in their working site. The most common reasons that obstruct to explain ethical issues to customers were shortage of time (85.9%), unavailability of reliable resources (40.0%), and poor ethical knowledge (37.7%). The reporting rate of respondents is less than 50% for most ethical scenarios. Sex, age, educational status, work experience, number of customers per day, working site, information about ethics, and training about ethics were observed to have a significant association with attitude and perception of community pharmacy professionals towards ethical issues. Conclusion Community pharmacy professionals had poor attitude and perception towards ethical issues. Interventions should be devised to uphold ethical awareness of community pharmacy professionals. A large-scale study is also recommended.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Berhanemeskel Weldegerima
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Alem Endeshaw
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Gashaw Sisay
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Abdulwase Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Dawit Wondimsigegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Amhara Region, Ethiopia
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Borhani F, Abbaszadeh A, Bahrampour A, Ameri GF, Aryaeenezhad A. Investigating the relationship between the ethical atmosphere of the hospital and the ethical behavior of Iranian nurses. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:193. [PMID: 34250127 PMCID: PMC8249973 DOI: 10.4103/jehp.jehp_891_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/21/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The ethical guidelines and ethical atmosphere of the hospital affect the quality of nursing care. Improving the health of patients in most cases depends on the observance of ethical points and ethical behaviors by nurses. The aim of this study was to determine the effect of hospital ethics and ethical training guidelines on improving the quality of nursing care and nurses' professional ethics. MATERIALS AND METHODS This is a descriptive-analytical study. This study was performed by multi-stage relative cluster sampling on 260 qualified nurses in 2014. Data were collected using the Hospital Ethical Climate Questionnaire and the Judgments about Nursing Decisions Questionnaire and analyzed using SPSS software version 19. RESULTS The results showed that nurses' perceptions of the ethical climate of hospitals were relatively positive. The ethical behavior of nurses was moderate and good. Nurses' perception of the ethical climate scores was not related to the ideal ethical behavior of nurses (r = 0.11, P = 0.86). The ethical climate perceptions of nurses were related to real workplace ethical behavior score (r = 0.188, P = 0.002). The results also showed that ethical guidelines can improve the quality of nursing care. CONCLUSION Considering the results of this study, it seems that holding nursing ethics training programs can be a big step toward promoting the professional behavior of nurses and the observance of professional ethics by nurses.
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Affiliation(s)
- Fariba Borhani
- Department of Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Abbaszadeh
- Department of Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Bahrampour
- Professor of Biostatistics, Department of Epidemiology and Biostatistics, School of Public Health, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Golnaz Forough Ameri
- Department of Health Community, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Azita Aryaeenezhad
- Department of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Hobeika E, Hallit S, Sacre H, Obeid S, Hajj A, Salameh P. Factors associated with empathy among community pharmacists in Lebanon. J Pharm Policy Pract 2020; 13:32. [PMID: 32817799 PMCID: PMC7427059 DOI: 10.1186/s40545-020-00237-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Empathy is the cornerstone of the relationship between the healthcare provider and the patient. In Lebanon, no studies have investigated the factors associated with empathy among community pharmacists. Hence, the importance of this research to better understand empathy and help community pharmacists with this vital aspect of their practice. Objective This study aimed to evaluate empathy and possible factors associated with it among Lebanese community pharmacists. Methods This cross-sectional study was carried out between March and July 2018. It enrolled a proportionate random sample of 435 community pharmacists from all Lebanese districts. The Epi info software calculated the minimum sample size, based on a total number of 3762 community pharmacists, with an expected frequency of 50% of pharmacists with low empathy, and a 95% confidence interval. The minimal sample size required was 350 community pharmacists; our sample size was 435 to account for missing values. Results Our results revealed that 228 (53.4%) pharmacists had low empathy. Lower empathy was significantly associated with more physical (Beta = − 0.331) and mental (Beta = − 0.126) work fatigue, higher age (Beta = − 0.125) and a practice experience between 3 years and less than 6 years compared to less than 6 months (Beta = − 2.440). Conclusion This study shed the light on some factors associated with empathy among Lebanese community pharmacists. Low empathy levels were significantly associated with factors such as age, practice experience, and mental and physical work fatigue, all of which impact the practice, as the accepted model of pharmacy practice requires that pharmacists establish effective communication and use interpersonal skills. Therefore, developing empathetic communication skills is considered essential. Furthermore, increased mental and physical work fatigue should not hinder community pharmacists’ access to self-care, whether for their mental or physical health.
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Affiliation(s)
- Eva Hobeika
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Sahar Obeid
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Departments of Psychology and Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Aline Hajj
- Laboratory of Pharmacology, Clinical Pharmacy and Quality Control of Drugs, Faculty of Pharmacy, Pôle Technologie-Santé (PTS), Faculty of Pharmacy, Saint-Joseph University, Beirut, 1107 2180 Lebanon.,Faculty of Pharmacy, Saint-Joseph University, Beirut, 1107 2180 Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,Faculty of Medicine, Lebanese University, Hadat, Lebanon
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