"Loss of situation awareness" by medical staff: reflecting on the moral and legal status of a psychological concept

This article examines the emergence of "accurate situation awareness (SA)" as a legal and moral standard for judging professional negligence in medicine. It argues that SA constitutes a status, an outcome resulting from the confluence of a wide array of factors, some originating inside and others outside the agent. SA does not connote an action, a practice, a role, a task, a virtue, or a disposition--the familiar objects of moral and legal appraisal. The argument contends that invoking SA becomes problematic when its use broadens to include professional or legally appraisable norms for behaviour, which expect a certain state of awareness from practitioners.

[Code of civil procedure for medical workers--evidence of fact finding and efficacy of judgment]

For a fair trial, fact finding shall certainly be based on evidence, and examination of evidence is performed using means, such as documentary evidence, validity, examination, and expert opinion. In fact finding, in order to eliminate a judge's arbitrariness and to secure justice, we have to make the process of fact finding rational and objective. For this reason, the court must recognize the fact used as the foundation of judgment based on the presented proof on the basis of participation of both parties concerned. As an effect of the judgment, there ensure res judicata and power of execution. They serve as a binding force to a next trial.

[Medical-social aspects of medical staff migration]

The migration of the medical staff represents an increasingly worring reason for romanian health policy-makers. According to the Ministry of Health, in 2009 year, the human resources indicators pointed out 26.5 physicians/ 10,000 inhabitants (whereas the European Union average was 32.8) and 60.4 nurses and midwives (whereas the European Union average was 108.5). Between 2007-2010, over 9000 physicians requested professional certificates in order to practice abroad and the majority have left the country. This phenomenon is related to the Romania's entrance in European Union and it is supposed to continue in the coming years. The direct consequences of the migration of the medical staff consist of significant differences between the country's regions in the health workforce distribution, the most affected by the critical shortage of health service providers being the North-Eastern region, especially in rural area. In order to limit the migration phenomenon, the Ministry of Health elaborated some strategies and workforce policies on medium and long-term, but the results will be difficult to assess.

The West African medical staff and the administration of Imperial tropical medicine, 1902-14

Established in 1902, the West African Medical Staff (WAMS) brought together the six medical departments of British West Africa. Its formation also followed the foundation of schools of tropical medicine in London and Liverpool. While the 'white' dominions were at the centre of Joseph Chamberlain's ambitions of erecting a system of imperial preference, the tropical colonies were increasingly tethered to the future security and prosperity of Greater Britain. Therefore, politicians and businessmen considered the WAMS and the new tropical medicine important first steps for making Britain's West African possessions healthier and more profitable regions of the empire. However, rather than realising these goals, significant structural barriers, and the self-interest and conservatism this helped breed among medical officers, made the application of even the most basic public health measures extremely challenging. Like many policies emanating from Whitehall during this period, what made the WAMS and the new tropical medicine thoroughly imperial was nothing accomplished in practice, but the hopes and aspirations placed in them.

Physician resource planning in Canada: the need for a stronger behavioural foundation

An effective solution to the problem of access to physician services in Canada must extend beyond an over-exclusive focus on the number of providers to consider the behaviour of physicians in greater depth. The amount of labour and associated services supplied by physicians depends importantly on their attitudes regarding work, on practice and non-practice income opportunities, and on the policy environment in which they practise. Hence, the amount of labour supplied by a given stock of physicians can change over time. Only by considering the full range of factors that affect the labour supply of physicians can we effectively plan for physician resources.

Pathologising white male sexuality in late nineteenth-century Australia through the medical prism of excess and constraint

This paper will explore the constructions of white male sexuality in late nineteenth-century Australia by the medical profession. In a period where female sexuality was always suspect, male sexuality, too, was brought into question, and the male body was increasingly constructed as vulnerable to sexual excess and sexual pathology. If male sexuality was to be active and dynamic, this could readily go too far, rendering men merely a slip away from deviance. Here, I will consider these notions of excess and constraint through an examination of sexual norms and perceived perversions, including sexual excess, sodomy and masturbation.

Cuban medical cooperation in Haiti: one of the world's best-kept secrets

This article analyzes Cuba's medical role in Haiti since Hurricane Georges in 1998, with particular emphasis on the Cuban government's response to the 2010 earthquake. The article examines two central themes. First, it assesses the enormous impact on public health that Cuba has made since 1998, and second, it provides a comparative analysis of Cuba's medical role since the earthquake.

The preliminary impact of Maryland's medical director and attending physician regulations

OBJECTIVES

To identify the impact of the regulations implemented in Maryland in 2001, related to nursing home attending physicians and medical directors, and nursing home quality assurance requirements, on Maryland nursing homes, administrators, and physicians.

DESIGN

Two surveys were mailed to all nursing home administrators in Maryland, one for their completion and one to give to their medical directors to complete. These surveys were to be returned by mail to the authors.

SETTING

All nursing homes in all jurisdictions in Maryland.

PARTICIPANTS

Two-fifths of administrators and medical directors in Maryland nursing homes completed and returned the survey.

MEASUREMENTS

Results were tabulated for each question of each survey, and were calculated as percentages of the total responses. Additionally, individual comments were reviewed.

RESULTS

A relatively large sample of administrators and medical directors in Maryland responded. Most respondents were positive or at least neutral about the impact of these regulations on them and their organizations. Many administrators agreed that there had been improvements in medical director participation and performance. There were significant advances in medical director compensation. There were relatively few negative comments about the impact.

CONCLUSION

Requirements for physician and medical director accountability appear to have had a positive impact on medical director performance and relationships with nursing home administrators. Additional study is warranted to measure the impact of that performance on patient care outcomes and facility performance.

Laws relating to HIV/AIDS infection and the rights of employees

Following a holiday in Africa, Brenda, a nurse, was told that she had probably been infected with the human immunodeficiency virus. She felt reasonably fit and since she worked in ophthalmic outpatients, an area where there was a very low risk of infecting patients, she wanted to keep this information to herself. What is the law?

[Physicians and nurses subjected to disciplinary actions because of substance abuse. Ten years of experience with supervision in Copenhagen]

INTRODUCTION

Medical Health Officers supervise medical staff on behalf of the Danish National Board of Health. The Board can impose disciplinary action on registered providers of health care.

MATERIAL AND METHODS

This retrospective investigation was based on case reports from 1 January 1989 to 31 December 1995 on medical staff under individual supervision because of alcohol or drug abuse, with a 3-year follow-up to 31 December 1998 in Greater Copenhagen (about 1.25 million inhabitants).

RESULTS

Altogether 173 health personnel were identified. Of these, 47 physicians and 91 nurses had disciplinary actions imposed on them because of abuse. In well over a third the abuse had lasted less than two years, whereas in a third it had lasted more than five years before admission to individual supervision. Half of both physicians and nurses had undergone psychiatric treatment before that time. Frequent disciplinary actions imposed were examination of urine passed without prior warning and controlled treatment of alcohol abuse. Difficulties in adhering to these conditions were found in one third to half of the cases. The Medical Health Officers notified the National Board of Health of breaches in 64%, often several times for each person. At the end of the follow-up period, 49% were still working. There was a statistically significant excess mortality in the group. Of the 26 dead, four had committed suicide and in a further 12 cases poisoning or abuse was a contributory cause of death.

DISCUSSION

Earlier detection, a tightening of sanctions, and improved treatment are recommended.

How intermediate tax sanctions may be applied to IDSs

Recently issued proposed regulations describing how the IRS intends to enforce the intermediate tax sanctions statute of the Internal Revenue Code have important ramifications for integrated delivery systems (IDSs). The regulations' interpretation of who within an IDS may be subject to excise taxes under the statute is broad, basing an individual's risk of being taxed on his or her degree of influence over a given entity within the organization, rather than over the organization as a whole. To protect individuals within an IDS from exposure to intermediate tax sanctions, the organization should understand who is likely to be at risk and take steps to ensure that all transactions with such persons are in compliance with the conditions set forth in the proposed regulations.

Understanding NHS indemnity

The NHS indemnity scheme began in January 1990 and covers all NHS hospital and community health service staff (but not general practitioners). However, some doctors continue their membership with medical defence organizations for continuing advice and assistance regarding medicolegal issues.

Role extension or expansion: a qualitative investigation of the perceptions of senior medical and nursing staff in an adult intensive care unit

The Scope of Professional Practice (UKCC 1992) has significantly altered the interpretation of nurses' roles, emphasizing individual professional accountability and clinical decision-making. However, 5 years after the issue of the document, uncertainties remain regarding interprofessional legal accountability between medicine and nursing. To investigate issues surrounding role extension or expansion in intensive care nursing, a small qualitative study was conducted centred on one intensive care unit (ICU) within a large teaching hospital. Data were collected by semi-structured interviews from a purposive sample of five senior intensive care nurses and three consultant anaesthetists. Four major categories emerged, identified as: interpretation confusion; education for change; struggles for power and task versus autonomy. The findings revealed that the senior critical care nurses identified themselves as independent, autonomous practitioners involved in clinical decision-making. However, there was evidence of a reluctance to empower more junior staff to perform extended or expanded roles. Medical respondents viewed extended or expanded roles as taking on mechanical tasks for which anyone could be trained to perform. In conclusion, it is argued that although nursing is maturing in its growth towards professionalization, broader issues such as the legal quagmire, failure to adopt the philosophy of role expansion and the existence of sacred boundaries intra- and inter-professionally need to be addressed.