The notion of hospital chaplaincy raises significant concerns, because it provides for the possibility that the chaplain becomes a generic chaplain rather than a member of a particular faith. Despite these reservations, however, I think that Mennonites should serve as hospital chaplains. Instead of seeing themselves as chaplains to all, though, Mennonites ought to see the service they provide as analogous to relief and development work. This would make Mennonite chaplaincy a form of what Mennonite scholar (...) C. Norman Krause calls “agapeic intervention,” which would allow for the ministry to the sick without requiring genericism. (shrink)

The essay investigates the possibilities and limitations of cross-denominational, intercultural and inter-religious hospital chaplaincy. With a view to the actual situation of hospital chaplaincy in Germany and the economic, social and theological constraints under which it offers its services, the author concludes, that the different Christian denominations must organizationally cooperate and share their work if such services are to survive the growing pressures. Constructivist cognition theory is invoked for analyzing the hermeneutical and theological implications of inter-denominational, (...) intercultural and inter-religious pastoral care and counselling. A Lutheran interpretation of the Trinitarian dogma provides a foundational frame of reference. (shrink)

The traditional roles of Christian chaplains in aiding patients, physicians, nurses, and hospital administrators in repentance, right belief, right worship, and right conduct are challenged by the contemporary professionalization of chaplaincy guided by post-Christian norms located in a public space structured by three defining postulates: the non-divinity of Christ, robust ecumenism, and the irrelevance of God’s existence. The norms of this emerging post-Christian profession of chaplaincy make interventions with patients, physicians, nurses, and hospital administrators in defense (...) of specifically Christian bioethical norms and goals unprofessional, because the chaplain is now directed as a professional to support health care services held to standards articulated within a secular morality. These changes are exemplar of the profound recasting of the dominant moral culture with wide-ranging implications for bioethics. (shrink)

Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: all (...) professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (shrink)

IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

Hospital chaplaincy, in its exposure to clients, colleagues, and care-takers from different faith backgrounds, can be understood in either generic or catholic terms. The first understanding, often merely implicit in denominationalist approaches, assumes that some “Absolute” can be prayerfully invoked through the medium of diverse rituals, confessions, and symbols. This position combines the advantage of unprejudiced acceptance of other creeds and traditions with the disadvantage of lacking resources for discriminating among the spiritualities that may be operative within those (...) other creeds and traditions. Catholicism, in linking true spirituality with the one true church as the mystical body of the Tri-une God, secures such a criterion but fails to satisfy the tolerance-of-acknowledgement in the secular sense, which is canonical in contemporary ecumenism. The Orthodox understanding of Catholicism is portrayed as imposing a non-judgemental humility and repentance which provides a solution to that spiritual-human dilemma of inter-faith cooperation in the hospital. (shrink)

Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, (...) twenty-five of which involved unrepresented patients. In thirteen cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient’s best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST or to change code status to Do Not Resuscitate/Do Not Intubate. Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision. In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations , which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states (...) stipulate that certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

Prepaid service is not only a financial tool, but also a common promotion mode in tourism and hospitality. Due to the limited resources of the enterprise, the enterprise needs to reasonably allocate the promotion resources to maximize the effectiveness of the promotion. As two common promotion purchase restrictions, limited-time promotion and limited-quantity promotion how to interact with prepaid services in the form of discounts or freebies to enhance consumers’ willingness to share is the focus of this study. This study carried (...) out three experiments based on framing effect theory, stimulus-organism-response theory, and social capital theory, which has found that the prepaid service mode moderates the relationship between promotion purchase restrictions and consumers’ willingness to share. When the prepaid service mode is a discount type, the limited-quantity promotion can generate higher sharing willingness than the limited-time promotion, and the perceived scarcity plays a mediating role. When the prepaid service mode is a freebie type, the limited-time promotion can generate higher sharing willingness than the limited-quantity promotion, and the perceived certainty of opportunity plays a mediating role. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations, which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate (...) that certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

The objective of this paper is to describe the organization and modality of provision of clinical psychology services for those patients who had to be hospitalized due to COVID-19 during the pandemic in Northern Italy. The IRCCS Policlinico San Donato hospital in Milan was converted into a COVID-19 center in March 2020, and all the staff, including the Clinical Psychology Service Team, were diverted to assist these patients. A description is given of how the service was organized and the (...) modalities which were utilized to assist the patients. Following the pertinent ministerial decrees, guidelines, and relevant literature, the patients were followed up through telehealth. A COVID-19 rehabilitation unit was later opened in April 2020, where all patients were seen and followed up by the Clinical Psychology team, the last patient being discharged at the end of June. Details are given about the type of services provided during the hospitalization at the different points in time. At admittance and subsequent isolation, patients indicated by the medical and nursing staff, and those who specifically requested it, were given psychological support. Patients transferred to the COVID-19 rehabilitation unit were all evaluated for anxiety, depression, posttraumatic stress disorder, and sleep disorders both on admission and at discharge when possible. (shrink)

The intimate connection, within Christianity, of theology and ethics is invoked, and the ethical differences between Christian denominations are exposed, as they present themselves inMellon's case studies, in order to call attention to the unsolvable dilemma in which hospital chaplains find themselves, if they understand their role in a merely conciliatory fashion as that of a “comforter, mediator, educator, ethicist, and counselor”. As witnessed by the Calvinist and Anabaptist traditions Mellon introduces, concepts such as “the patient's good” can mean (...) radically different things in these theological contexts. Attempting to merely mediate between such positions in a spirit of merely generic prayer and on the basis of a merely psychological notion of well-being poses a risk to chaplains' spiritual integrity and faithfulness to their mission. (shrink)

Ethical perspectives on regional, rural, and remote healthcare often, understandably and importantly, focus on inequities in access to services. In this commentary, we take the opportunity to examine the implications of normalizing metrocentric views, values, knowledge, and orientations, evidenced by the recent (2022) New South Wales inquiry into health outcomes and access to hospital and health services in regional, rural and remote New South Wales, for contemporary rural governance and justice debates. To do this, we draw on the feminist (...) inspired approach to rural health ethics involving analysis of power relationships developed by Simpson and McDonald and related ideas from critical health sociology. In presenting this analysis, we extend contemporary thought about spatial health inequities and structural violence. (shrink)

Science and Ethics inextricably intertwinedDawson and Yentis argue that research ethics committees have an obligation to consider the science of applications because this is inextricably entwined with ethics. They lament the fact that the recent English ministerial review of RECs suggests that science should be assessed by others for RECs and not by the committee members themselves. In fact, these views are not as incompatible as they might first appear.The plain truth of the matter is that in a maximum membership (...) of 18, at least a third of whom must be lay members, the capacity of each of the 186 RECs currently in the UK to review …. (shrink)

This article reviews practitioners’ evaluations of in-hospital ethics seminars. A qualitative study included 11 innovative in-hospital ethics seminars, preceded and followed by interviews with most participants. The settings were obstetric, neonatal and haematology units in a teaching hospital and a district general hospital in England. Fifty-six health service staff in obstetric, neonatal, haematology, and related community and management services participated; 12 attended two seminars, giving a total of 68 attendances and 59 follow-up evaluation interviews. The 11 (...) seminars facilitated by an ethicist addressed the key local concerns of staff about the social and ethical consequences of advances in genetics and their impact on professional policies and practice. Seminar agendas were drawn from prior interviews with 70 staff members. During evaluation interviews, participants commented on general aspects that they had enjoyed, how the sessions could be improved, timing, the mix of participants, the quality of the facilitation, whether sessions should be more challenging, after-effects of sessions, and interest in attending seminars and contacting the ethicist in future. Participants valued the increased interprofessional understanding and coherent discussion of many pressing issues that addressed important though seldom discussed ethical questions. The seminars worked well in the different hospitals and specialties. (shrink)

The article deals with the problem of military chaplaincy service formation in the period of independence of Ukraine as one of the priority directions of relations between the state and religious organizations in Ukraine. The current state of military pastoral care is analyzed directly in the context of Catholic churches activities in Ukraine in this aspect. In particular, the institutional component of the Catholic churches is clarified, statistics demonstrating the quantitative and percentage composition of the Catholic churches in the (...) religious network of Ukraine are provided. The results of sociological surveys of the religious situation in Ukraine and the identification of religiosity of the population in the context of Catholic churches are analyzed. The opinion of the population of Ukraine regarding the trust in religious organizations, religious leaders and the military formations of Ukraine is examined. The opinion of the population on the expediency of establishing a military chaplaincy institute in Ukraine is also clarified. The organizational division of the internal structure of the Catholic churches in Ukraine is presented, and it is also clarified which structural units are responsible for coordination with the Ukrainian power structures and organization of pastoral work. Attention is drawn to the review of the cooperation of the Catholic churches in Ukraine with the military formations of Ukraine in the aspect of pastoral activity. Special attention is paid to the coverage of the various areas of pastoral work directly by the military chaplains of the Catholic churches and the coordination of this work by the relevant structural units of the Catholic churches. In particular, conferences, meetings, trainings, pilgrimages on the organization and implementation of pastoral work in the field of military chaplaincy. Also, consideration is given to the activities of the advisory body on military chaplaincy at the Ministry of Defense of Ukraine and its contribution to the establishment of the Institute of Military Chaplaincy in Ukraine. The inter-denominational cooperation of the churches in Ukraine, including the Catholic ones, was considered in establishing a military chaplaincy institution in independent Ukraine through the activities of interfaith associations. It has been found that the issue of legislative securing of the Institute of Military Chaplaincy in the Armed Forces of Ukraine remains urgent. In this regard, the legislative work in this area and the involvement of Catholic churches in Ukraine are highlighted. (shrink)

Publication date: 15 October 2018 Source: Author: Ehiosun O. Marvel NHIS was launched officially on 6th of June 2005. The Scheme is designed to provide comprehensive health care at affordable costs, covering employees of the formal sector, self-employed, as well as rural communities, the poor and the vulnerable groups. However, client satisfaction of services rendered continues to be a major concern for the improvement of NHIS. This study is designed to determine the level and causes of dissatisfaction of clients accessing (...) NHIS clinic at the Kubwa General Hospital, Kubwa, FCT, Abuja. This study employed a descriptive cross sectional survey. 279 NHIS enrollees were recruited for this study at the Kubwa General Hospital. Questionnaires were administered and the level of dissatisfaction and satisfaction of NHIS services were analyzed. The satisfaction rate was 69.2% while the dissatisfaction rate was 22.9%. The respondents were satisfied with the attitude of health workers in NHIS clinic, Kubwa. However, they were dissatisfied with waiting time, attitude of record officers and those in pharmacy department. This study found that the level of dissatisfaction with NHIS services is high despite a high satisfaction level. The Attitude of health workers may influence the dissatisfaction of enrollees. NHIS is still limited to the formal sector. (shrink)

En la actualidad Cuba desarrolla un Programa de Atención Integral al Paciente con Úlcera de Pie Diabético mediante el uso del Heberprot-P, esencial para disminuir la amputación y la discapacidad. El trabajo tiene el objetivo de realizar un diagnóstico sobre la aplicación del Heberprot-P en el Servicio de Angiología del Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey. Se realizaron encuestas a pacientes para identificar necesidades sentidas relacionadas con el tratamiento y para las actitudes manifiestas, y se hicieron entrevistas (...) al personal médico y de enfermería. El diagnóstico permitió corroborar la necesaria investigación con enfoque social del servicio de salud escogido a nivel territorial. Destaca elevar el trabajo de captación de pacientes desde el nivel primario de salud para garantizar un mayor alcance del programa, así como la trascendencia del apoyo familiar y la relación profesional de la salud- paciente a fin de lograr la calidad requerida. At present Cuba is developing a program concerning the care of patient with ulcer of the diabetes foot by means of Heberprot-P essential to reduce the amputation and disability. The aim of this paper is to carry out a diagnosis about social aspects of the application of the Heberprot-P in the Angiology service at Manuel Ascunce Domenech Hospital in Camaguey. Some surveys were carry out to identify certain needs related with the treatment and the attitude shown and on the other hand some interview were made to the medical and nursing staff. The diagnosis allowed to verify the need of the research with social approach. The paper highlight how to incorporate patients from the primary health level, in order this program has a higher scope and the importance of the family support and the professional relationship to accomplish the quality required. (shrink)

BackgroundThere are numerous challenges in the consultation services of the Hospital Ethics Committees (HEC) that can impact the means of providing healthcare. This review aimed to identify the main challenges in the application of consultation services of the HEC and propose possible solutions.MethodsThis systematic review was conducted through searching electronic databases including PubMed, Scopus, Science Direct, ProQuest, and Embase. Inclusion criteria included studies published in English language in a peer-reviewed journal, from 2000 to 2019 were identified, which clearly defined (...) the design, method, and results of the study. Study selections, quality assessments, data extraction, and analysis were completed by two researchers, independently. The thematic analysis was used to analyze the data.ResultsThe search yielded 1204 articles and 6 of these, included the analyses. Challenges were categorized into 9 themes: (a) personal views and believes in healthcare professionals, (b) sense of fear in the healthcare professionals, (c) medical culture, (d) environmental factors, (e) managerial and structural factors, (f) characteristics of the HEC members, (g) factors related to the HEC, (h) problematic process for HEC consultations, and (i) weakness of knowledge about HEC. Accordingly, proposed solutions were organized according to five themes: reforming the HEC executive processes, creating the appropriate communications, developing awareness about HEC, improving the competencies of HEC members, and (e) receiving support from HEC consultations.ConclusionsThis review highlights that proposed solutions serve as examples of strategies, which attempt to solve challenges related to the application of the consultation services of HEC by healthcare professionals. (shrink)

Barriers to mental health interventions globally remain a health concern; however, these are more prominent in low- and middle-income countries. The barriers to accessibility include stigmatization, financial strain, acceptability, poor awareness, and sociocultural and religious influences. Exploring the barriers to the utilization of mental health services might contribute to mitigating them. Hence, this research aims to investigate these barriers to mental health service utilization in depth at the Kabutare District Hospital of the Southern Province of Rwanda. The qualitative approach (...) was adopted with a cross-sectional study design. The participants were patients with mental illnesses seeking mental health services at the hospital. Ten interviews were conducted in the local language, recorded, and transcribed verbatim and translated by the researchers. Thematic analysis was applied to analyze the data collected. The results revealed that the most common barriers are fear of stigmatization, lack of awareness of mental health services, sociocultural scarcity, scarcity of financial support, and lack of geographical accessibility, which limit the patients to utilize mental health services. Furthermore, it was revealed that rural gossip networks and social visibility within the communities compounded the stigma and social exclusion for patients with mental health conditions. Stigmatization should be reduced among the community members for increasing their empathy. Then, the awareness of mental disorders needs to be improved. Further research in Rwanda on the factors associated with low compliance to mental health services with greater focus on the community level is recommended. (shrink)

The domestic situation of the past few years shows the practices of employees’ unpaid leave and layoffs and the constant drain on capital, talent, and technologies in hospitality. Owners expect to reduce the losses to as low as possible by saving on human costs. Nevertheless, in face of such a changing environment, hospitality has to accumulate high-quality human capital through systematic investment, sensitive development, and continuous learning and growth to discover competitive advantages through the cultivation of human capital. The pre-service (...) education of new employees could accelerate their familiarity with the operations of the company and their understanding of their job role and duties. More importantly, with good planning, it could make employees feel emphasized with and respected with the result of largely changing their thoughts and working habits. Aiming at supervisors and employees in hospitality in Zhejiang as the research objects, a total of 420 copies of our questionnaire are distributed, and 357 valid copies were retrieved, with a retrieval rate of 85%. According to the results to propose discussions, it is expected to generate systematic and proper education methods for the pre-service education in hospitality, promote the education effectiveness, and promote employees’ capability and organizational performance. (shrink)

The basics -- The dignity of the human person -- Autonomy, consent, refusing treatment and boundaries -- Ethics and non-autonomous patients -- Confidentiality, privacy, data protection, truth telling and trust -- Ethical issues at the beginning of life -- Ethical issues about babies, children and young adults -- Ethical issues at the end of life -- Dying and death: ethical issues -- Loss, grief and bereavement, burn-out and the wounded healer -- Conscientious objection and loyalties.

According to UNESCO guidelines, one of the four forms of bioethics committees in medicine are the Hospital Ethics Committees. The purpose of this study was to evaluate how the above guidelines are implemented in real practice. There were 111 hospitals selected out of 176 Polish clinical hospitals and hospitals accredited by Center of Monitoring Quality in Health System. The study was conducted by the survey method. There were 56 hospitals that responded to the survey. The number of HECs members (...) fluctuated between 3 and 16 members, where usually 5 members were part of the board committee. The composition of the HECs for professions other than physicians was diverse and non-standardized. Only 55 % of HECs had a professional set of standards. 98 % of HECs had specific tasks. 62 % of HECs were asked for their expertise, and 55 % prepared <6.88 % of the opinions were related to interpersonal relations between hospital personnel, patients and their families with emphasis on the interactions between superiors and their inferiors or hospital staff and patients and their families. Only 12 % of the opinions were reported by the respondents as related to ethical dilemmas. In conclusion, few Polish hospitals have HECs, and the structure, services and workload are not always adequate. To ensure a reliable operation of HECs requires the development of relevant legislation, standard operating procedures and well trained members. (shrink)

The image of the hospital is presented to the public as a place of healing. Though the oft‐criticized total institutions of the past have been notably dismantled, the totalizing practices therein are now operationalized in the health care system. Through the lens of Erving Goffman, this article offers ways in which health care institutions operationalize totalizing practices, contributing to the mortification of patients and nurses alike in service to the bureaucratic machine. This article examines the ways in which totalizing (...) practices may disrupt the agency of both patients and nurses alike. (shrink)