This is a case study of an ethical dilemma concerning the appropriateness of encouraging care-staff, working within a dementia care home, to either wear a clinical uniform or not to wear a clinical uniform in practice. It is proposed that people living with dementia may sustain higher levels of wellbeing if care-staff wear clothes that are more akin to their care home environment, for example, wearing similar clothes to the residents or even wearing pyjamas and nightwear during a (...) night shift. The counter argument is that the practice may lead to greater levels of distress due to disorientation, increased potential for infection and inability to identify nurses when needed. (shrink)

Academic integrity is becoming increasingly important to managing academic institutions. Accordingly there are efforts to uniformly assess campus attitudes to such issues as cheating in assessments along with the policies and procedures in place to address them. This paper seeks to summarize and understand the attitude of the students and academic staff at an Australian university towards academic integrity, as reflected in the results of a campus-wide survey, using both qualitative and quantitative analysis. The main finding of the quantitative (...) results was the disconnect between academic staff and students belief’s about academic honesty and the reactions of students and academics to dishonest behaviour. Four key themes of academic honesty were identified through qualitative analysis, being those of cheating, student, solutions to cheating and general concerns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Oldest and Most Respected Uniform in the World1Zelig R. Weinstein“And all the peoples of the earth shall see that the name of the LORD is called upon thee; and they shall be afraid of thee.”(Deuteronomy 28:10)Rabbi Eliezer the Great says that this verse alludes to the Tefillin Shel Rosh, the small leather box containing Biblical verses that are worn by Jewish men on their head. During Talmudic times (...) and for centuries after, devout Jewish men would wear Tefillin the entire day. This practice is now only rarely seen. Since the 1960s, there has been a resurgence of public display of one’s adherence to traditional Jewish practices. It is increasingly common to see Jewish men wearing a yarmulke at work and in public spheres. There are perhaps thousands of Jewish doctors who don’t hesitate to wear their yarmulke in their places of practice–hospital, clinic, private practice.In the 1980s I joined the staff of the Department of Radiology at the Bethesda Naval Hospital as the Director of Neuroradiology and Interventional Radiology. As the hospital’s Neuroradiologist I presented the radiological findings for the cases presented at the bimonthly “brain cutting” sessions. These sessions were well attended by staff, residents and medical students from the Departments of Neurosurgery, Neurology, Neuropathology and Radiology. I was the only traditional Orthodox Jew at the hospital, clearly recognizable as such by the yarmulke I always wore (very unusual in the early 1980s). My yarmulke would provoke occasional good–natured kidding particularly from the neurosurgery staff and residents. [End Page 212]During one of these sessions, kidding about my yarmulke from a small group of residents was reaching a crescendo. The kidding came to a sudden halt when the Chief Resident of Neuro-surgery, a born and bred Louisianan, demanded everyone’s attention. When it quieted down he very sternly ordered everyone to carefully look at their uniforms. Everyone seemed perplexed but all followed suit. Almost a half–minute passed before the Chief Resident, with his thick Southern drawl, spoke. “Our [naval] uniforms are, at most, a couple of hundred years old.” He then pointed toward my yarmulke and said: “Dr. Weinstein’s uniform is thousands of years old and a lot more respected than our uniforms.”This was my initiation into the alluring, usually positive and unexpected fascination and respect that my obvious religiosity had on my patients, their families and my many colleagues during the almost seven years I spent at Bethesda.The story I will tell is very poignant. It involved the family of one of the most senior Chief Petty Officers of the United States Navy.Late one Sunday evening, I received a call from the Chief Resident, Dr. Steve Henning, informing me that the family matriarch had been admitted to Bethesda with relatively acute onset of significant neurological findings. The emergent workup confirmed the presence of a large mass, a meningioma, of the frontal lobe region with significant surrounding edema and mass effect. Neurosurgery requested embolization of the feeding vessels prior to surgery. The interventional procedure and possible serious complications were fully explained to the patient, her husband and her two daughters. Consent was signed and early Monday morning the patient was brought to Special Procedures to have the tumor embolized.Prior to the procedure I introduced myself to the patient’s family and spoke to them about the procedure. The patient’s husband and two daughters, one of whom was an active duty Navy nurse the other a minister of a fundamentalist church in the South, were very attentive and expressed concern about the procedure and its outcome. I tried to reassure them and told them I would speak to them during and after the procedure.All went well. Medically, the patient did well during and after the procedure. She was discharged from our care to neurosurgery. The patient and her family thanked us.After the patient left the Special Procedures area the Chief Technologist, Al, approached me and very cryptically asked if I was aware of what happened when the Chief Resident, Dr. Henning, spoke with the patient and family the night before. I was puzzled and replied, no. He... (shrink)

RESUMEN Fundamento: La asignatura Atención Integral a la Población, se imparte durante el quinto año de la carrera de Estomatología. Objetivo: Exponer los criterios de los estudiantes, egresados y profesores respecto al proceso docente educativo de la asignatura Atención Integral a la Población. Métodos: Se realizó una investigación educacional observacional-descriptiva transversal en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Camagüey, desarrollada desde septiembre 2015 a octubre 2017.El universo estuvo constituido por 63 estudiantes del quinto año, 90 (...) egresados del curso 2015-2016 y 14 profesores. Fueron utilizados métodos de investigación educacional cualitativos. Resultados: Los estudiantes, en la totalidad, percibieron que la asignatura influye en su formación como futuro profesional de la Estomatología, refirieron sentirse desorientados en cuestiones referidas a la distribución de contenidos, mientras que los profesores reconocieron la necesidad de determinar los temas, objetivos, sistema de conocimientos y habilidades para lograr una uniformidad en el trabajo sistemático y la evaluación frecuente en las diferentes sedes universitarias, los estudiantes carecen de una guía para realizar el estudio independiente; con vistas al examen final de la asignatura y estatal que contenga un plan de temas organizados y reúna los conocimientos esenciales a estudiar. Conclusiones: El diagnóstico develó que los estudiantes, egresados y profesores coincidieron en la necesidad de la consolidación de conocimientos, adquisición de habilidades y la interdisciplinariedad, así como la orientación del estudio independiente para el examen final de la asignatura y estatal. ABSTRACT Basis: Comprehensive assistance to the Community subject is taught in 5th -year Dentistry Career. Objective: to set out opinions of the students, graduated and professors about the teaching learning process of Comprehensive assistance to the Community subject. Methods: A transversal descriptive-observational educational research was carried out in the Dentistry faculty in the University of Medical Sciences in Camaguey, from September 2015 to October 2017. The universe was composed by 63 5th -year Dentistry students, 90 graduated of the 2015-2016 academic year and 14 professors from the teaching staff. Qualitative educational research methods were used. Results: All the students realized that the subject has an influence on the future professional training in Dentistry. They referred to be confused about the contents distribution, while the professors recognize the necessity to determine the topics, objectives, set of knowledge and skills in order to achieve uniformity in the systematic job and the common evaluation. The students do not have a guide to do their independent study taking into account the final exam. Conclusions: The diagnostic revealed that students, graduated and professors agreed in the necessity to reinforce knowledge, skills acquisition, and interdisciplinary, as well as independent study guidelines for the final exam in Dentistry. (shrink)

Introduction. Higher education systems at the present stage of development are facing new serious challenges. On the one hand, universities function as independent units, on the other, they are part of the regional system, they attract and share the attention of the stakeholders interested in the system (applicants, students, research and teaching staff, business structures, etc.). The purpose of the study is to assess the competitiveness of regional higher education systems through the formed system of indicators, as well as (...) to draw conclusions about the degree of uniformity in the development of these networks. Methods. To assess the state of the higher education system in Russia, the author uses an indicative method of analysis, which makes it possible to determine the degree of compliance of the indicator values achieved by now with the criteria that meet the set requirements for the development of society. Scientific novelty of the research. The novelty of the research consists in forming a set of indicators, which makes it possible to draw conclusions about the competitiveness of regional systems and the degree of their development uniformity, as well as the number of universities in the regional system and their influence on the entire system, according to their uniform development relative to each other. Results. Following the results of diagnosing the regional higher education systems, the author identifies the regions-leaders and the regions-outsiders. The diagnostic results are compared with the data of international rankings. Conclusions. The conclusion states that the region with fewer but equally developing universities (for example, the Belgorod region or the Republic of Tatarstan) have higher indicators of competitiveness. On the contrary, regional higher education systems, represented by a large number of universities, but with unevenly developing performance indicators, are characterized as less competitive, i.e. the performance indicators of the leading university are leveled within the system as a whole. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Veterans Affairs National Center for Clinical EthicsJames L. Bernat (bio)The veterans health administration is the largest health care system in the United States and, indeed, is larger that the health care system of many foreign countries. In February 1991 the Department of Veterans Affairs (V.A.) in Washington, D.C. awarded a contract to the clinical ethics group at the Veterans Affairs Medical Center in White River Junction, Vermont to (...) establish the V.A. National Center for Clinical Ethics. In this article I describe the organizational context, mission, operation, and future direction of the Center, which William A. Nelson, Ph.D., and I co-direct.The Veterans Health AdministrationThe Department of Veterans Affairs operates 171 hospitals providing services ranging from primary, secondary, and tertiary medical care to psychiatric hospitals, rehabilitation centers, and nursing homes. The V.A. also provides outpatient services at all hospitals and at dozens of free-standing outpatent clinics. V.A. medical centers employ over 14,000 physicians and serve approximately 4.5 million veteran patients (Hollingsworth and Bondy 1990; Mirvis 1990).The V.A. serves an important educational function, providing training sites for medical students, postgraduate physicians, and trainees in other health-related fields. Approximately 78 percent of V.A. medical centers are affiliated with medical schools. Over one-third of all American medical students and over 40 percent of interns and residents spend a portion of their training in V.A. medical centers. More than 100,000 students in all health-related fields train in V.A. facilities annually (Hollingsworth and Bondy 1990).Research is another mission of the V.A. Many academic physicians and scientists derive their research and salary funding from V.A contracts and awards. The V.A. Research Career Development Program provides the means for many medical school faculty members to achieve successful careers as scientists and clinical investigators. Although research accounts for only slightly more than 1 percent of the V.A. medical budget, two V.A. researchers have been awarded the Nobel Prize (Hollingsworth and Bondy 1990). [End Page 385]In comparison to other medical care settings, the average V.A. patient is likely to be older, poorer, male, less well-educated, more chronically ill, and more expensive to care for. Many patients first patronize the V.A. system after they have been bankrupted by the costs of a major illness. Unlike young, healthy patients ideally favored by health maintenance organizations, these patients immediately require large expenditures for hospitalizations, medications, and other treatments. Additional burdens have been placed on V.A. facilities by a record of chronic federal underfunding over the past decade, despite expanded patient censuses at every facility.Bioethical issues arise in V.A. facilities with great frequency for several reasons. Older and poorer patients are often sicker, have fewer home-support resources, and have completed fewer advance directives for health care. Chronic operational underfunding requires explicit health care rationing systemwide. Academic physicians within the V.A. system have multiple professional duties that have the potential for conflict. Although their primary duty is to their patients, they also must serve the federal government and their medical school academic supervisors. The practice of medical care rationing pits the physician's professional duty to his patient against his duty to the system (Mirvis 1990).The V.A. has responded to these bioethical demands with several initiatives. Hospital ethics advisory committees have been developed in nearly every V.A. medical center. The V.A. National Bioethics Committee has been empaneled to encourage uniform policies across the V.A. system concerning bioethical issues. Most recently, funds were provided for the V.A. National Center for Clinical Ethics.Functions of the National Center for Clinical Ethics (NCCE)The NCCE has a fourfold mission: 1) to enhance the quality of clinical ethics programs at all 171 V.A. medical centers nationwide; 2) to staff the V.A. National Bioethics Committee; 3) to assist administrators and planners in the V.A. Central Office on policy development concerning bioethical issues; and 4) to study, organize, and coordinate clinical, educational, and research bioethics programs throughout the system.Enhancing the quality of clinical ethics programs at V.A. medical centers is largely an... (shrink)

The Report of the Ad Hoc Adivisory Group on the Operation of NHS Research Ethics Committees has resulted in a strange mixture of the timid, the revolutionary, and the bizarre.The Report of the Ad Hoc Advisory Group on the Operation of NHS Research Ethics Committees is a curious document.1 The remit of the review was focused on the workings and effectiveness of NHS research ethics committees and the multicentre committees ). The Group was primarily set up in response to a (...) series of complaints from medical researchers about the new research governance regime in the UK as a result of the Clinical Trials Directive2 and the Governance Arrangements for NHS Research Ethics Committees.3 The opportunity was also taken to consider the role of research ethics committees in a wider context, and take account of recent developments in relation to the ethics review of social care research,4 student projects,5 as well as recent legislation such as the Human Tissue Act,6 and the Mental Capacity Act.7 However, the resulting report is a strange mixture of the timid, the revolutionary, and the bizarre.A good example of the report’s timidity is its reluctance to propose fundamental change to the process of review or seriously limit the type of research that requires REC review. To its credit AHAG does suggest that some research ‘especially surveys and many studies on NHS staff, could normally be conducted safely without a requirement for REC review’ .1 This is, of course, to be welcomed. However, the report ultimately seems dismissive of the general complaint from researchers that the current process is inappropriately uniform. For example, in section 3.2, it is argued that the ‘common perception that the NHS REC system is dominated …. (shrink)

The decision by the Department of Health to introduce amendments to the uniform and workwear policy for the NHS in response to increasing problems with infection control seemed uncontroversial. There was, however, some difficulty with implementing the policy, which arose largely because of the conflict this caused for staff who wished to keep their arms covered for reasons which stemmed from religious beliefs. This paper uses textual analysis to examine how those reasons and challenges were discussed in online commentary (...) within a medical and nursing journal. The papers shows that there was a marked difference in how the two groups of professionals responded to the changes to workwear, and exposes a worrying degree of religious intolerance expressed by contributors to the nursing journal. (shrink)

THE PURPOSE OF THIS ARTICLE IS NOT TO EXAMINE THE CONCEPT\nOF THE IDEAL OBSERVER AS TO ITS QUALIFICATIONS AS AN\nETHICAL THEORY, BUT TO EXPOSE THE IMPLICATIONS IT HAS FOR\nAN UNDERSTANDING OF THE ROLE OF RATIONALITY IN ETHICAL\nDISCOURSE. THE "IDEAL OBSERVER THEORY" IS REALLY NOT\nVALUE-FREE, ACCORDING TO THE AUTHOR. THE MEANING OF SUCH AN\nOBSERVER IS FULLY EXPLORED, IN TERMS OF BEING "IMPARTIAL,"\n"FULLY INFORMED," "IDEALLY RATIONAL," ETC., AND RATIONALITY\nIS FINALLY NOTED TO BE NOT A PERFECT UNIFORMITY OF\nATTITUDES AMONG IDEAL OBSERVERS BUT THE (...) FREEDOM AND\nWILLINGNESS TO ASK FOR REASONS, TO ARGUE. (STAFF). (shrink)