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Research ethics in a public health crisis
Updated April 14, 2020
Scientifically-grounded knowledge is essential for responding to a pandemic when the lives of so many are at stake. Bench research to characterize the pathogen is critically important as a foundation for innovations in prevention and treatment. Epidemiological research to understand the mode and rate of transmission is fundamental to implementing sound public health interventions ( Opinion 8.3 , "Physician Responsibilities for Disaster Response & Preparedness"; Opinion 8.4 , "Ethical Use of Quarantine & Isolation").
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Clinical research is key to evaluating the safety and efficacy of therapeutic interventions. Time is of the essence, but the pressure to act does not justify relaxing the standards for ethically conducted research.
The AMA Code of Medical Ethics articulates core standards for research that involves human participants in Opinion 7.1.1 , "Physician Involvement in Research"; Opinion 7.1.2 , "Informed Consent in Research"; Opinion 7.1.3 , "Study Design & Sampling"; and Opinion 7.2.1 ., "Principles for Disseminating Research Results." Opinion 7.1.1 reminds us that research is intended primarily to advance knowledge and benefit future patients. It calls on physicians to participate only in scientifically sound protocols and only in areas in which they have relevant expertise. Research should be carried out "in a manner that minimizes risk and avoids unnecessary suffering."
Opinion 7.1.2 sets out the requirements for informed consent in the context of research, including the nature of the research protocol and its implications for the participant, the risks it poses and the likelihood of direct benefit to the individual. This opinion charges physicians to make clear to prospective participants "(t)he differences between the physician's responsibilities as a researcher and as the patient's treating physician."
Opinion 7.1.3 delineates essential characteristics of ethically sound design in research with human participants. The study must ask a research question that will "contribute meaningfully to medical knowledge and practice," and must be "scientifically well designed to yield valid data" to answer that question—for example, it must use appropriate controls and inclusion/exclusion criteria, as well as "a statistically sound plan for data collection and analysis." In times of urgent need, it can be ethically justifiable to use an alternative to the "gold standard" randomized controlled clinical trial, such as an adaptive trial design, that adheres to the guidance set out in Opinion 7.1.3.
Finally, Opinion 7.2.1 articulates physician-investigators' responsibility to share research findings, including negative findings, "for the ultimate benefit of patients." The duty to report results in a timely, transparent manner includes responsibility to "(r)eport the results of research accurately, including subsequent negative findings. This is particularly important where the findings do not support the research hypothesis."
Additional ethics guidance in a pandemic
The AMA offers an overview of foundational guidance regarding medical ethics for health care professionals and institutions responding to the COVID-19 pandemic.
- Ethics for Physicians & the Health of the Community
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Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID-19 pandemic and potential solutions
- 1 Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
- 2 School of Psychology, University of Leeds, Leeds, UK.
- 3 Royal Victoria Infirmary, Newcastle University Trust Hospital, Newcastle Upon Tyne, UK.
- 4 Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
- 5 Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- 6 School of Medicine, University of Leeds, Leeds, UK.
- 7 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
- PMID: 36823696
- DOI: 10.1111/jocn.16642
Aims and objectives: The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.
Design: Discursive/Position paper.
Method: The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.
Results: Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.
Conclusions: We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.
Keywords: burnout; critical care; nursing; resilience; workforce.
© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
- Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Osborne SR, et al. Med J Aust. 2020 Dec;213 Suppl 11:S3-S32.e1. doi: 10.5694/mja2.50881. Med J Aust. 2020. PMID: 33314144
- Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review. Pollock A, Campbell P, Cheyne J, Cowie J, Davis B, McCallum J, McGill K, Elders A, Hagen S, McClurg D, Torrens C, Maxwell M. Pollock A, et al. Cochrane Database Syst Rev. 2020 Nov 5;11(11):CD013779. doi: 10.1002/14651858.CD013779. Cochrane Database Syst Rev. 2020. PMID: 33150970 Free PMC article.
- Individual and organisational strategies to develop resilience in the nursing workforce. Cajanding RJ. Cajanding RJ. Nurs Stand. 2021 Nov 3;36(11):45-50. doi: 10.7748/ns.2021.e11678. Epub 2021 Sep 6. Nurs Stand. 2021. PMID: 34486360
- Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review. Gillman L, Adams J, Kovac R, Kilcullen A, House A, Doyle C. Gillman L, et al. JBI Database System Rev Implement Rep. 2015 Jun 12;13(5):131-204. doi: 10.11124/jbisrir-2015-1898. JBI Database System Rev Implement Rep. 2015. PMID: 26455609 Review.
- Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care wards: a systematic review. King A, Long L, Lisy K. King A, et al. JBI Database System Rev Implement Rep. 2015 Nov;13(11):128-68. doi: 10.11124/jbisrir-2015-2428. JBI Database System Rev Implement Rep. 2015. PMID: 26657467 Review.
- Alexandrova-Karamanova, A., Todorova, I., Montgomery, A., Panagopoulou, E., Costa, P., Baban, A., Davas, A., Milosevic, M., & Mijakoski, D. (2016). Burnout and health behaviors in health professionals from seven European countries. International Archives of Occupational and Environmental Health, 89(7), 1059-1075. https://doi.org/10.1007/s00420-016-1143-5
- Alharbi, J., Jackson, D., & Usher, K. (2020). The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing, 29(15-16), 2762-2764. https://doi.org/10.1111/jocn.15314
- American Psychiatric Association. (2013). APA PTSD fact sheet. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 5-6). American Psychiatric Association. http://www.dsm5.org/Documents/PTSDFactSheet.pdf
- Andersson, M., Nordin, A., & Engström, Å. (2021). Critical care nurses' experiences of working during the first phase of the COVID-19 pandemic-Applying the person-centred practice framework. Intensive & Critical Care Nursing, 69, 103179. https://doi.org/10.1016/j.iccn.2021.103179
- Aryankhesal, A., Hamidi, R. M. Y., Alidoost, S., Behzadifar, M., Sohrabi, R., & Farhadi, Z. (2019). Interventions on reducing burnout in physicians and nurses: A systematic review. Medical Journal of the Islamic Republic of Iran, 33, 77.
- Grant Ref: 632762/Burdett Trust for Nursing
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Home — Essay Samples — Nursing & Health — Health Care — Healthcare Crisis
Healthcare Crisis Essay Examples
Problematic issues in america: poverty and health, the health care crisis in the united states and why nurse practitioners can solve it, modern technology has improved healthcare delivery, ethics and business and medicine, home based healthcare phenomenon, the burden of medicare: potential bankruptcy and headed towards a financial decline, crossroads to cost: medicare and managed care, the concept and reasons of health care reform in india, information and communication technology and the future of healthcare: multi-scenario delphi survey, feeling stressed about your essay.
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Crisis Management in the Healthcare Setup Research Paper
In a crisis, you never get a second chance and the first impression is very important. Hospitals are faced with matters of life and death in their day-to-day activities. This makes the hospitals appropriate and in great need for developing ways and means to manage crises. Emergent situations such as a patient showing up in a very critical condition can easily upset plans. Complete crisis control in the hospitals is rarely achieved since conditions are so variable, high-tempo, so evolving and very uncertain. No two conditions ever appear identical since each situation appears with an element of uniqueness. The hospital, with its multiple sections and departments, has the challenge of ensuring the high stake situations are always kept under control (Woods & Cook, 2002). Right from patient reception to patient discharge, the hospital personnel are faced with the task of managing emergent crises in the best ways possible. The ambulatory or the emergency department is a very crucial area that needs complete focus to manage crises.
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Crisis management in healthcare
The healthcare sector, by extension, covers community health situations. The community, as a unit, is under the jurisdiction of the hospital on matters of health. Control of disease outbreaks is an activity that requires complete readiness just In case of an unprecedented outbreak. No individual has all the knowledge to handle any situation as a person. Therefore, this implies that negotiations, discussions and information sharing are vital in effective crisis management. The healthcare practitioners need to consult widely within and without in order to counter crises. Areas of particular focus in effective healthcare crisis management are patient safety and care, patient communication, health information management, emergency management, environmental health, medication safety, risk mapping and organizational staffing.
Patient safety and care
The process starting from the reception up to the discharging of the patient needs much attention in order to avert any crises. Patients, as variables, need to be treated differently. Patients need to arrive at the hospital with their health care records. The records serve as guidelines towards effective Medicare. Records would provide the healthcare personnel with information concerning the patient’s prevailing condition and his or her disease history. This effectively averts any possibility of misdiagnosis. Crisis at this level may be managed through computerization of every patient healthcare record. Patients will not always arrive at hospitals with their records at hand. This is particularly of significance to accident victims or any other casualties (Nemeth & Klein, 2011). Patient-care also applies to the monitoring of patients in the waiting room. If not appropriately monitored, patients can decompensate in health, which implies that their condition may worsen while waiting. The patients may also wait for very long hours and leave without seeing the physician or clinician, depending on their nature of illness.
For effective medical care, a patient needs to communicate his or her own problems. Miscommunication may mean misdiagnosis and consequently, crises. Miscommunication may be as a result of language barrier, inaudibility due to a medical problem or even drunkenness. Failure in communication can also result from failure to listen due to diverted attention. The possibility of having a translator for every patient who has a communication barrier may seem a little far-fetched but in essence, it is very necessary. A patient unable to speak audibly should at least have a companion who could state some background information about the patient. This may also apply to disabled patients. They include the dumb patients or the accident victims.
Health information management
Health information management implies appropriate handling of health records. Patient medical cards should be kept in a manner that they can be easily distinguished or identified to avoid loss or confusion. Confusion may be very detrimental since this may literary mean giving the right treatment for the wrong patient. This is especially important in managing the in-patients.
In the hospital setup, the emergency department is the most demanding section. The emergency department also covers ambulatory services. The ambulatory department deals in the transiting in and out of the critically ill patients. The automobiles used as the ambulances have no option but to always be ready to be on the move whenever prompted. The emergency department personnel need to be in constant contact with the other medical personnel. Information flow in and out of the emergency department to the other departments needs to be constantly steady. The emergency department also needs to know when to make transfers to the other sections (Nemeth, Walter, & Wears , 2008). Transfers should always be accompanied by complete clearance and with the permission of the other services. Patients discharged from the emergency section need appropriate follow up. The emergency or rather the ambulatory department is a department that lies at the sharper end of the entire healthcare setup.
Working towards perfecting health without checking on the environment is like planning to solve a problem and forgetting to check on the cause of the problem. Proper environmental management means successful prevention of diseases and a majority of common illnesses. The environment is a friend when treated like so but could be lethal if treated otherwise. The environment can bear multiple health hazards when neglected. People need fresh and clean environs to stay health. Such issues as proper waste disposal, proper sewage management and clearing of bushes around homes are amongst some of the basic environmental care. Environmental pollution is a current challenge to proper healthcare management. Air pollution, which includes noise and water pollution, is one of the forms of environmental pollution methods that have adverse effects on human health. For example, water pollution would imply impure water for domestic use and this has a direct connection to ill health. Environmental education is a vital tool in the management and prevention of pollution. Human beings need clean air and clean pure water for drinking and this is the main reason why they need to remain so. It is the duty of the healthcare department, through the community health department, to ensure that the community and entire population is educated on the need to have a pollution-free environment. This is a perfect risk management approach.
This implies safety of drugs and safety in the usage of the drugs. Drugs are a vital component of Medicare and should be handled appropriately in order to produce the expected and required results. Drug inappropriateness may imply a number of conditions inappropriateness and may be the use of a drug to treat the wrong disease, which points to misdiagnosis. Inappropriateness also entails drug contamination as a result of drug adulteration or improper storage. These two situations may result in a compromise on the quality of a drug. Any drug that is contaminated or is of poor quality can never work appropriately. Apart from possibility of causing new infections to the patients, it may also result in under dosage. To counter this crisis, all drug companies need to receive food and drugs Act’s approval before being let into the market to sell their ware. This is to guard against fake companies producing fake drugs. Drugs are appropriate when used for the correct reasons. Misdiagnosis leads to the use of wrong drugs. This could be as a result of poor communication between the patient and the doctor, a problem whose solution could be found in alleviation of communication barriers as earlier discussed. Drug abuse, as a result of addiction to a particular reason or lack of proper knowledge about the drug, can be detrimental to the life of an individual. Medication safety also covers medical instruments used in disease diagnosis and treatment. Therapeutic machines such as the radiology machines should be used with caution. Improper fixing of parts could be very detrimental since the radiation should only be given in specific dosages.
The healthcare, as a body, interacts with clients through its staff. Organizational staff, in terms of crisis management, implies having the right people to do the right jobs. The staff should consist of qualified personnel whose selection procedures are meritorious.
In order to avert crisis, one should ensure that he or she is able to prevent any possibility of occurrence. Crisis occurs as a result of system breakdown. The breakdown could be avoided in a way if not prevented. To avoid the breakdown, a possibility of risk occurring should be diagnosed earlier enough. This process is known as risk mapping (Hoffmann, Crandall, & Shadbolt, 1998). Risk mapping entails performing a situation analysis and this may involve going through the entire system setup. Information is vital in risk mapping. This involves consultations, discussions, seeking advice and looking for material aid. Once the mapping is done, the issues can then be dealt with individually.
The above discussion leads to the questions, why do these risks occur and what can we possibly do to make things more safe, efficient and even more reliable? My take on this is that research on this area of healthcare would be very vital and necessary. To do this, it would be very important to involve all stakeholders, bring them all on board and discuss about how to avert the crises. Prevention, as they say, is better than cure and before we are faced with a crisis, we should workout the symptoms. This can only be achieved through earlier diagnosis of the looming crises. Crisis management – in this case healthcare – starts right from care for the environment to actual treatment and handling of patients (Woods & Cook, 2002). Risk management, which implies identifying and alleviating of a risk before it happens, is different from crisis management, which involves dealing with a problem that is beforehand. It consists of skills and methods required to identify, understand, asses and cope with a nasty situation. Sir Abraham Lincoln – former US president – once said that people live in the midst of anxiety and alarms. He then argued that crisis management had become a defining occurrence in the people’s day-to-day activities.
Crisis management, in terms of healthcare, always provides no time for second impression. The first impression counts and may be the only impression. This work impresses on the various areas of lookout of being able to put out a fire immediately and effectively. Awareness is an important tool in crisis management. However, it is said that one could never be completely armed enough to counter healthcare crises. Crisis management centers on managing a critical condition and ensuring that it never goes out of hand. A situation such as a disease outbreak is an emergency that has everything to do with control. Failure to contain the disease could turn catastrophic since lives are always at stake. As it is always affirmed, failure to plan is a plan to fail. One would never want to encounter failure especially when life is in question.
Hoffmann, R., Crandall, B., & Shadbolt, N. (1998). Use of the critical decision method to elicit expert knowledge : a case study in cognitive task analysis methodology. Hum Factors , 40(2), 254–276. Nemeth, C., Klein, G. (2011). The naturalistic decision making perspective . New York, NY: John Wiley and Sons. Nemeth, C., & Wears, R. (2008). An agenda for healthcare team communication research : Aldershot: Ashgate Publishing. Nemeth, C., Walter, J., & Wears, R. (2008). The path to resilience in ambulatory care . MD: Bethesda. Woods, D., & Cook, R. (2002). Nine steps to move forward from error. Cogn Technol Work 4(2), 137–144
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Healthcare Crisis Research Paper
Show More When you hear the word crisis, what do you think of? I think of chaos, trauma and terrible situations. In these situations, what do you expect people to be doing? I picture panic and more chaos, but I also picture relief efforts. When there is a disaster, there is also a response to help those in need. That response is action. When crisis happens, we react by taking action. We are in the midst of a crisis right now. Healthcare is in crisis and you've likely seen more stories about it than you care to read. You've probably seen more information on health and the crisis that we are in than you even know what to do with. I'm not surprised, because it is everywhere. We are talking about it in elections, news stories and even at work. Healthcare …show more content… Why aren't we taking action? Healthcare is in crisis, but most people and most businesses are not taking action. The causes of this healthcare crisis are simple: health. In reality, health is what is in crisis. Taking action to prevent these causes would be logical action, right? Well, for some reason, not everyone is ready to act just yet. Businesses are still thinking that wellness is a cost. They are content just waiting for the next insurance bill to arrive, knowing that it is going to be higher than last year's and simply pay it. Most companies are fine making "business decisions" that make no business sense. Employee health benefits are an expense in your business. In most businesses, it is the second highest expense. There is no other area or expense that you expect to be more expensive each year. What's worse is that you have no other area of your business that you simply accept the change in cost without even trying to reduce it. Again, we are in crisis. When a crisis takes place, there is clearly a need for change. When you are doing something a certain way and it is causing a crisis, it is time to something different. And what better time to take action than in a …show more content… When you are preventing issues and saving money, you are being proactive. Taking action is the key. If you don't take action in a crisis, when will you take action? If you don't take action in this crisis, I fear it will be too late to take any action because the consequences have gotten so far out of
Current health care financial crisis.
Over the past few years, US Sates has been facing finance crisis in the healthcare sector. The current budget issues over health care have been politicized, showing a record of fewer than five resources allocated to the health sector over the last thirty years. Research proves that the health care in the State is going through inevitable financial crisis resulting from alleged expenditures by various budget analysts. Growth and increment of Medicare are the found cause of the budget problems in the…
Healthcare Succession Planning: An Integrative Analysis
PhD, RN. Healthcare Succession Planning: An Integrative Review. The Journal of Nursing Administration, 39(12), 548-555. Carriere, Muise, Cummings, and Newburn-Cook used an integrative review of succession planning in healthcare to identify consistencies in approaches and strategies for succession planning for chief nursing officers and healthcare managers. Articles were then compared with successful business succession planning strategies to determine if the healthcare strategies were…
Opioids In Nursing
“The American Nurses Association (ANA) recognizes the central role nurses have in addressing this crisis and has set out to develop resources aimed at prompting a comprehensive approach”. (Association, "Nurse's Role in Addressing Nation's Opioid Crisis "). As nurses, confronting this crisis by using the resources available will increase our education, knowledge, skills and abilities. Resources provided and supported by the ANA include prescriber…
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The Ongoing U.S. Health Care Crisis: A Data Update While efforts to repeal the Affordable Care Act were narrowly defeated, grave problems in health care persist. Twenty-eight million remain uninsured, a number that is likely to increase. Millions more who have coverage cannot afford care because of high cost-sharing requirements.
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Aims and objectives: The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations. Design: Discursive/Position paper.
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We will write a custom Research Paper on Crisis Management in the Healthcare Setup specifically for you. for only $16.05 $11/page. 808 certified writers online. Learn More. Complete crisis control in the hospitals is rarely achieved since conditions are so variable, high-tempo, so evolving and very uncertain.
Healthcare Crisis Research Paper Improved Essays 1189 Words 5 Pages Essay Sample Show More When you hear the word crisis, what do you think of? I think of chaos, trauma and terrible situations. In these situations, what do you expect people to be doing? I picture panic and more chaos, but I also picture relief efforts.