Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and (...) other clinical ethics activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress. (shrink)

Debriefing is a standard ethical requirement for human research involving the use of deception. Little systematic attention, however, has been devoted to explaining the ethical significance of debriefing and the specific ethical functions that it serves. In this article, we develop an account of debriefing as a tool of moral accountability for the prima facie wrong of deception. Specifically, we contend that debriefing should include a responsibility to promote transparency by explaining the deception and its rationale, (...) to provide an apology to subjects for infringing the principle of respect for persons, and to offer subjects an opportunity to withdraw their data. We also present recommendations concerning the discussion of deception in scientific articles reporting the results of research using deception. (shrink)

There are few evidence-based interventions that have been developed that mitigate the negative effects of moral distress. Group debriefing is one approach that some clinical ethicists have adopted as a response. However, there is very little academic literature or empirical research that identifies best practices and approaches to debriefing as a response to moral distress. Our aim at the 2020 UnConference was to share our different approaches to debriefing with other clinical ethicists to identify best practices or (...) guiding principles to enhance our respective approaches and meet the needs of healthcare professionals. In this article we share an overview of our respective approaches, reflect on our discussion with other clinical ethicists and healthcare professionals, and propose foundations to move debriefing forward as an intervention to address moral distress in the field of clinical ethics. (shrink)

The use of deception in research is generally permitted so long as participants are debriefed at the conclusion of their participation. Several authoritative research ethics guidelines allow investigators to omit debriefing under certain circumstances, however. Here we examine various justifications for forgoing debriefing in deceptive research, including concerns about subject pool contamination, the risk that revealing the deception will be harmful or distressing to participants, and issues of practicability. We conclude that, contrary to current practice, omitting debriefing (...) is ethically acceptable only when debriefing is impracticable, the deception is innocuous, and no reasonable person would object to involvement in the research. (shrink)

Our team at the Centre for Clinical Ethics has long been engaged in internal discussion about the purpose and value of ethics debriefs and their purported role in reducing moral distress (Morley an...

By examining particular cases of belief perseverance following the undermining of their original evidentiary grounds, this paper considers two theories of rational belief revision: foundation and coherence. Gilbert Harman has argued for coherence over foundationalism on the grounds that the foundations theory absurdly deems most of our beliefs to be not rationally held. A consequence of the unacceptability of foundationalism is that belief perseverance is rational. This paper defends the intuitive judgement that belief perseverance is irrational by offering a competing (...) explanation of what goes on in cases like the debriefing paradigm which does not rely upon foundationalist principles but instead shows that such cases are properly viewed as instances of positive undermining of the sort described by the coherence theory. (shrink)

In this study, it is argued that the trust of previous hermeneutical approaches of promoting ancient biblical texts as applicable to the everyday life of contemporary readers is not only imaginable but also too ambitious. The Hebrew Bible emerged from an Israelite cultural context, which neither speaks to nor deliberates on issues concerning the African cultural contexts. The present essay utilises a narrative approach comprising three main overtures. Firstly, some examples of previous contributions on hermeneutics will be discussed. Secondly, this (...) study interrogates the legitimacy of employing African biblical hermeneutics that utilises ancient Jewish texts as applicable to African societies today. Thirdly and finally, the study will critically appraise for a balanced reading of the biblical text.Contribution: The present study aims at engaging existing hermeneutical contributions towards proposing a balanced reading of the biblical text. In order to achieve that goal, the study engages into a dialogue following hermeneutical approaches, which are popular amongst most African scholars, namely African biblical hermeneutics, black biblical hermeneutics, contextual biblical hermeneutics, feminist hermeneutics and oral hermeneutics. (shrink)

Since Piaget (1936), the concept of development has concerned the forms of adaptation deployed by the subject within his environment. Inspired by this constructivist perspective, many approaches, such as professional didactics (Pastré, 2011), problematization (Fabre, 2009, 2011) and investigation approaches (Grangeat, 2011, 2013) have advanced the idea of training through situations. As part of the socio-constructivist expectations of the latest teaching programs, we analyze teacher activity during a “débriefing after observation” (Villeret, 2008) about Moon phases conducted in primary school classes (...) (Munoz & Villeret, 2012). In this article we examine whether “débriefing after observation” is a situation that allows for the development of teachers and pupils. We show that this activity allows pupils to learn, “problematize”, conceptualize and develop epistemologically based knowledge. It also allows the teacher to develop his skills to «do problematize» the pupils. These results allow us to discuss further the notion of «potential development situation» (Mayen, 1999) to complement it with the notions of “reactive and effective development situations”. (shrink)

The term “Socratic method” is so pervasive in education across the disciplines that it has largely lost its meaning, and it has lost its roots in its originator—the historical Socrates. In this article we draw from the original source, Plato's ancient dialogues, to understand the theory and principles behind the questioning used in Socratic method. A deep understanding of Socratic method is particularly timely now as nursing leaders call for increased use of theory‐based debriefing across the nursing curriculum. Socratic (...) questioning is ideally suited as a method for debriefing in nursing classrooms because of its ability to enhance critical thinking and self‐reflection of the learner and because of its basis in care for the learner through a learner‐centred design. We present an analysis of the Socratic method in Plato's works and provide an overview of the key Socratic principles and techniques. We illustrate these principles and techniques with examples of how Socratic teaching can be applied in the nursing classroom, and we address the challenges and rewards for nursing faculty implementing Socratic method. Learning about Socratic method directly from Plato's dialogues can provide a richer and more robust understanding of this key pedagogical technique and help nurse educators practice more intentional and informed Socratic questioning and debriefing. (shrink)

Reflection is generally considered to be important for learning from simulation-based training in professional and vocational education. The mainstream conceptualization of reflection is argued to rest on a dualistic ground separating the mind from the body. Drawing on phenomenological analyses of bodily awareness and an ethnographic case study of maritime safety training we show how and why students’ embodied experiences and subjectivity play a foundational role in reflection. We develop and illustrate the notion of bodily-awareness-in-reflection which captures a mode of (...) reflection wherein non-conceptual pre-reflective bodily experiences are integrated with conceptual thought. In this way, we aim to enrich and complement prior work on simulation-based training and embodied professional learning by providing an enactivist epistemological foundation of reflection in debriefing, highlighting awareness of the lived body as a necessary ground of reflective self-knowledge. (shrink)

This article is a reconsideration of Tesch's (1977) ethical, educational, and methodological functions for debriefing through a literature review and an Internet survey of authors of articles published in the Journal of Personality and Social Psychology and Journal of Traumatic Stress . We advocate for a larger ethical role for debriefing in nondeception research. The educational function of debriefing is examined in light of the continued popularity of undergraduate participant pools. A case is made for the methodological (...) function of debriefing to clarify aspects of research participation. Recommendations are made to improve the conducting and reporting of debriefings. (shrink)

What is the ethical significance of debriefing in deceptive research? The standard view of debriefing is that it serves to disclose the deception to the participant and is a means of evaluating and mitigating potential harms that may have resulted from involvement in the research. However, as the article by Miller, Gluck, and Wendler in this issue of the Kennedy Institute of Ethics Journal points out, there has been little systematic attention to the ethics of debriefing, particularly (...) with regard to the role of debriefing in addressing the prima facie moral wrong of deception itself. They argue that in addition to mitigating the harms of deception, debriefing should include an apology to participants for being deceived. In the current paper, I argue that an apology is not morally obligatory in most research contexts. Debriefing should be considered an opportunity to further define the researcher-participant relationship without the need to be remorseful about the research practice. (shrink)

Moral distress, if left unaddressed, leads to a number of harmful emotions and behaviors that take a toll on the personal and professional well-being of healthcare workers. In this article, a clinical case is used to illustrate a moral distress debriefing framework that can be utilized by clinical ethicists and healthcare professionals with the appropriate skill set. The first part of the framework is preparatory; it includes guidance on how to identify the needs of healthcare providers, set goals for (...) a debriefing session, gather relevant information, and plan the logistics of the meeting. The second part of the framework is implemental; it outlines an eight-step method to conduct the session from beginning to end. It describes how to constructively reflect on the experience, explore emotional responses, share coping strategies, and identify takeaways for future positive outcomes. This framework can be used to empower healthcare team members to deal with moral distress and be better equipped to handle challenging situations. (shrink)

In a broad-based study of experiences in psychological research, 65 undergraduates participating in a wide range of psychological experiments were interviewed in depth. Overall findings demonstrated that participants hold varying views, with only 32% of participants characterizing their experiences as completely positive. Participants' descriptions of their debriefing experiences suggest substantial variability in the content, format, and general quality of debriefing practices. Just over 40% of the debriefing experiences were viewed favorably. Positive debriefing experiences were described as (...) including a thorough explanation of the study and detailed information concerning the broader relevance of the experiment to the field of psychology. The most common complaint, characterizing 28.8% of the responses, was that the debriefing was unclear and that insufficient information was provided. Participants' views of psychological research and the discipline of psychology were also elicited. Results are discussed in terms of ethical and methodological implications. (shrink)

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)

This article examines the importation of new gender ideals into a highly masculine organization through top-down and bottom-up processes. We analyze how a dominant group of men undo and redo gender to reproduce their supremacy and create a new, “improved” form of masculinity. Based on qualitative research on the practice of debriefing in the Israel Air Force, we explore how new practices of masculinity are incorporated into a hegemonic masculinity by introducing so-called “soft” organizational practices and thus constructing a (...) new form of “upgraded” masculinity. We show that pilots are involved in two continual and dialectical processes of performing masculinity. The first includes top-down practices neutralizing opportunities to execute exaggerated masculine performances, including new technologies allowing recording and documenting of all flights, a safety discourse emphasizing the protection of human life, and organizational learning based on self- and group critiques aimed at improved performance. The second, a bottom-up process enacted by pilots, is aimed at restoring and mobilizing masculinity and includes rationalized professionalism, competitiveness, and patronizing. Taken together, these constitute a hybrid, “upgraded” masculinity where “soft” characteristics are appropriated by men to reinforce a privileged status and reproduce their dominance within and outside the military. Our case study focuses on the debriefing, a process in which air teams formally reflect on their performance after a particular task/event to improve it. (shrink)

Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland (...) Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care (...) perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties ‘medicalised’. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims’ narrative and their lived experiences. We will use Paul Ricoeur’s phenomenological reflections from ‘Suffering is not the same as pain’ for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering. (shrink)

Cet article décrit les dispositifs psychologiques d’urgence mis en place en France pour prendre en charge les rescapés des attaques terroristes. Ceux-ci comprennent une prise en charge immédiate des victimes, temps d’étayage et de soutien, suivie quelques jours après d’un débriefing ou d’un groupe de paroles. L’auteur rappelle les conséquences psychologiques de l’effraction traumatique, puis rapporte des exemples d’interventions, tant dans l’immédiateté que dans les jours qui suivent. La première action psycho-thérapeutique initiée par ces dispositifs d’urgence est indispensable, mais une (...) attention à plus long terme doit se poursuivre. En effet des troubles psychotraumatiques chroniques peuvent se déclencher chez des rescapés plusieurs années après l’attentat, en particulier lorsqu’un autre se produit, comme cela est illustré par un cas. (shrink)

Cet article décrit les dispositifs psychologiques d’urgence mis en place en France pour prendre en charge les rescapés des attaques terroristes. Ceux-ci comprennent une prise en charge immédiate des victimes, temps d’étayage et de soutien, suivie quelques jours après d’un débriefing ou d’un groupe de paroles. L’auteur rappelle les conséquences psychologiques de l’effraction traumatique, puis rapporte des exemples d’interventions, tant dans l’immédiateté que dans les jours qui suivent. La première action psycho-thérapeutique initiée par ces dispositifs d’urgence est indispensable, mais une (...) attention à plus long terme doit se poursuivre. En effet des troubles psychotraumatiques chroniques peuvent se déclencher chez des rescapés plusieurs années après l’attentat, en particulier lorsqu’un autre se produit, comme cela est illustré par un cas. (shrink)

I am leading a debriefing session—the second part of a three-part model we have started for ethics consultations at our rehabilitation hospital. The debriefing is loosely organized. We begin with follow-up from a recent ethics consultation. For some team members, this is a time to learn how ethics was involved and how things got resolved. I then ask for their responses to the case: what went right, what went wrong.One team member remarks, "I was angry at Maria's daughter. (...) She never let anyone get a word in edgewise, including her mother." Another says, "I was emotionally exhausted. Her daughter was manipulative. She was good at splitting the team and playing us against each other." Respecting the patient's .. (shrink)

Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in (...) acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians, nurses, social workers, and allied health providers. The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at the individual level: a new end-of-life option, patients’ last chance to express control over their lives, patient and family comfort and relief, and a unique learning experience for hospice palliative care providers; the team level: supportive collegial relationships, broadened discussions about end-of-life and palliative care, and team debriefs provide opportunities for education and support; and the institutional level: improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying. (shrink)

climate are both linked to an organization's ability to retain healthcare professionals and increase their level of job satisfaction, leaders have a corollary responsibility to address moral distress. We recommend that leaders should provide access to ethics education and resources, offer interventions such as ethics debriefings, establish ethics committees, and/or hire a bioethicist to develop ethics capacity and to assist with addressing healthcare provider moral distress....

Context: There is a growing recognition in consciousness science of the need for rigorous methods for obtaining accurate and detailed phenomenological reports of lived experience, i.e., descriptions of experience provided by the subject living them in the “first-person.” Problem: At the moment although introspection and debriefing interviews are sometimes used to guide the design of scientific studies of the mind, explicit description and evaluation of these methods and their results rarely appear in formal scientific discourse. Method: The recent publication (...) of an edited book of papers dedicated to the exploration of first-and second-person methods, Ten Years of Viewing from Within: The Legacy of Francisco Varela, serves as a starting point for a discussion of how these methods could be integrated into the growing discipline of consciousness science. We complement a brief review of the book with a critical analysis of the major pilot studies in Varela’s neurophenomenology, a research program that was explicitly devised to integrate disciplined experiential methods with the latest advances in neuroscience. Results: The book is a valuable resource for those who are interested in impressive recent advances in first- and second-person methods, as applied to the phenomenology of lived experience. However, our review of the neurophenomenology literature concludes that there is as yet no convincing example of these specialized techniques being used in combination with standard behavioral and neuroscientific approaches in consciousness science to produce results that could not have also been achieved by simpler methods of introspective reporting. Implications: The end of behaviorism and the acceptance of verbal reports of conscious experience have already enabled the beginning of a science of consciousness. It can only be of benefit if new first- and second-person methods become well-known across disciplines. Constructivist content: Constructivism has long been interested in the role of the observer in the constitution of our sense of reality, so these developments in the science of consciousness may open new avenues of constructivist research. More specifically, one of the ways in which the insights from first- and second-person methods are being validated is by recursively applying the methods to themselves; a practical application of an epistemological move that will be familiar to constructivists from the second-order cybernetics tradition. (shrink)

The study focused on university students' understanding and conceptions of ethical issues in research. Domain-specific and domain-transcending measures were developed to gauge the students' awareness of ethical issues. Responses were obtained from 269 undergraduate and graduate students at a U.S. regional university. Participant withdrawal, the debriefing of research participants, the dissemination of findings, and giving credit to co-contributors were the most challenging ethical issues for the students. Ethical awareness was predicted by professional and organizational socialization, and perspective taking. Contextualization (...) greatly improved the students' ability to recognize ethical issues. Simulations and role-taking are suggested as the means with which to teach students about the ethical issues perceived as challenging. (shrink)

To learn whether criticism and regulation of research practices have been followed by a reduction of deception or use of more acceptable approaches to deception, the contents of all 1969, 1978, 1986, and 1992 issues of the Journal of Personality and Social Psychology were examined. Deception research was coded according to type of (non)informing (e.g., false informing, consent to deception, no informing), possible harmfulness of deception employed (e.g., powerfulness of induction, morality of the behavior induced, privacy of behavior), method of (...) deception (e.g., bogus device or role, false purpose of study, false feedback), and debriefing employed. Use of confederates has been partly replaced by uses of computers. "Consent" with false informing declined after 1969, then rose in 1992. Changes in the topics studied (e.g., attribution, socialization, personality) largely accounted for the decline in deception in 1978 and 1986. More attention needs to be given to ways of respecting subjects' autonomy, to appropriate debriefing and desensitizing, and to selecting the most valid and least objectionable deception methods. (shrink)

Health care professionals who travel from their home countries to participate in humanitarian assistance or development work experience distinctive ethical challenges in providing care and services to populations affected by war, disaster or deprivation. Limited information is available about organizational practices related to preparation and support for health professionals working with non-governmental organizations. In this article, we present one component of the results of a qualitative study conducted with 20 Canadian health care professionals who participated in international aid work. The (...) findings reported here relate to expatriate clinicians’ experiences and perceptions of ethics preparation, training and support. The strategies examined include pre-departure training and preparation, in-field supports and retrospective debriefing of ethical issues. Participants experienced a range of training and supports as beneficial for addressing ethical challenges in humanitarian assistance and development work. Participants also expressed ambivalence or scepticism about the benefits offered by specific modalities. This analysis can contribute to informing discussions of how organizations and individual practitioners can best develop, implement and utilize ethics training and support for international aid work. (shrink)

The first objective of this article is to demonstrate that ethics committee members can learn a great deal from a forensic analysis of two classic psychology studies: Zimbardo’s Stanford Prison Study and Milgram’s Obedience Study. Rather than using hindsight to retrospectively eradicate the harm in these studies, the article uses a prospective minimization of harm technique. Milgram attempted to be ethical by trying to protect his subjects through debriefing and a follow-up survey. He could have done more, however, by (...) carrying out what ethics committees routinely insist on today for those researching sensitive topics. The establishment of counselling supports to identify harm to participants would have minimized additional harm. Were these in place, or in Zimbardo’s case had the Stanford Ethics Committee properly identified Zimbardo’s conflict of interest – he was both a principal investigator and the prison warden – how much harm could have been minimized? The second aim is to examine how some qualitative authors routinely demonize these classic studies. It might appear that there are too few cases of unethical qualitative research to justify such an examination; however, this article identifies a number of recent examples of ethically dubious qualitative research. This would suggest that qualitative research should examine its own ethics before poaching from psychology. (shrink)

Background:Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants.Objective:This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures.Research Design:This is a survey of (...) the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts.Participants and Research Context:No research participants were part of this analysis.Ethical Considerations:This article offers a conceptual analysis and recommendations only.Findings:The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress.Discussion:Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants.Conclusion:This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations. (shrink)

This article discusses the ethical and methodological issues associated with boredom experienced by human participants during psychological experiments. Ways are suggested in which informed consent, briefing, and debriefing can be used to prevent or remedy boredom induced during experiments. We address methodological and ethical concerns, and we discuss the advantages of the proposed approach for experimenters' practice and training of undergraduate students. Future directions for much needed research on these topics are also emphasized.

Rapid Ethical Assessment is an approach used to design context tailored consent process for voluntary participation of participants in research including human subjects. There is, however, limited evidence on the design of ethical assessment in studies targeting cancer patients in Ethiopia. REA was conducted to explore factors that influence the informed consent process among female cancer patients recruited for longitudinal research from Addis Ababa Population-based Cancer Registry. Qualitative study employing rapid ethnographic approach was conducted from May–July, 2017, at the Tikur (...) Anbessa Specialized Referral Hospital. In-depth and key informants’ interviews were conducted among purposively selected 16 participants. Regular de-briefings among the study team helped to identify emerging themes and ensure saturation. Interviews and debriefings were tape recorded in Amharic, and transcribed and translated to English. Coding of the transcripts was facilitated by use of NVivo software. Thematic analysis was employed to respond to the initial questions and interpret findings. Perceived barriers to voluntary study participation included lack of reporting back study results of previous studies, the decision making status of women, hopelessness or fatigue in the patients, shyness of the women, data collectors approach to the patient, and patient’s time constraints. Most of the patients preferred oral over written consent and face-to-face interview over telephone interview. Provision of detail information about the study, using short and understandable tool, competent, compassionate and respectful enumerators of the same gender were suggested to assure participation. Due to the perceived severity, the use of the term “cancer” was associated with fear and anxiety. Alternatively, uses of phrases like “breast or cervical illness/disease” were suggested during patient interviews. Voluntary participation is not straight forward but affected by different factors. Using competent, compassionate and respectful enumerators, short and precise questioning tools to limit the time of the interview could improve voluntary participation. Moreover, careful consideration of the patients and families concept of the disease such as wording and information has to be taken into account. This assessment helped in improving the consent process of the ongoing project on breast and cervical cancer patients. (shrink)

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

In contrast to the behavioral sciences, the nature and impact of ethical procedures such as informed consent and constraints on the use of deception have been addressed infrequently in the marketing discipline. This article describes an initial investigation into the methodological and ethical practices reported in published marketing research articles since the mid-1970s. Empirical articles appearing in the Journal of Marketing Research and the Journal of Consumer Research between 1975 and 1976, 1989 and 1990, and 1996 and 1997 were coded (...) according to methodological and ethical practices employed and compared with recent trends in the social psychological research literature. The marketing findings revealed an increase over time in laboratory experimentation, the utilization of active deception and debriefing, and the use of university student samples. Although the results suggest that marketing researchers use deception with less frequency and intensity overall than social psychologists, the observed rise in deception procedures in marketing investigations stands in stark contrast to the situation in social psychology, where deception rates have been declining along with a corresponding increase in nonexperimental methodologies and nonstudent samples. The article concludes with a call for greater attention to the ethical, methodological, and disciplinary consequences of the increasing use of deception in marketing research and emphasizes the need for more complete reporting of ethical procedures in published research. (shrink)

In this article, I outline my position regarding the use of deception in psychology experiments, based on my experience as a confederate. I describe an experiment I participated in and the problems resulting from the study: subjects' differing responses to the deception; angry reactions of some subjects to the experiment; and the general discomfort of both subjects and confederates, in particular, who had their doubts concerning the external validity of the study and the ethics involved in running it. issues of (...) informed consent and debriefing are also addressed; it is argued that the success of deception depends on the subject being misinformed as to the experiment's true nature and that debriefing itself sometimes angers subjects. I encourage a decrease in the use of deception and the reexamination of a system that attempts to balance the pain of experimental participants with anticipated benefit to scientific knowledge. (shrink)

The Internet offers many new opportunities for behavioral researchers to conduct quantitative and qualitative research. Although the ethical guidelines of the American Psychological Association generalize, in part, to research conducted through the Internet, several matters related to Internet research require further analysis. This article reviews several fundamental ethical issues related to Internet research, namely the preservation of privacy, the issuance of informed consent, the use of deception and false feedback, and research methods. In essence, the Internet offers unique challenges to (...) behavioral researchers. Among these are the need to better define the distinction between private and public behavior performed through the Internet, ensure mechanisms for obtaining valid informed consent from participants and performing debriefing exercises, and verify the validity of data collected through the Internet. (shrink)

Background International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs. Methods We systematically searched PubMed, Global Health and (...) Embase databases using the search terms “(ethics) AND (medical electives)”. Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results. Results A total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. More publications were written from the medical student perspective (n = 14), than by the host-institution (n = 5), with nearly half written from third-party perspectives (n = 18). Negative impacts on local host students and impact upon patient care were identified as additional ethical considerations. Conclusions Our review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students’ access to medical education and patient care, continued work is needed to ensure equitable partnerships. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses and post-elective debriefs to increase medical students’ awareness of the impact of their presence on host communities. (shrink)

Mobile applications and socio-sexual networking websites are used by outreach workers to respond synchronously to questions and provide information, resources, and referrals on sexual health and STI/HIV prevention, testing, and care to gay, bisexual and other men who have sex with men. This exploratory study examined ethical issues identified by online outreach workers who conduct online sexual health outreach for GB2M. Semi-structured individual interviews were conducted between November 2013 and April 2014 with online providers and managers to explore the benefits, (...) challenges, and ethical implications of delivering online outreach services in Ontario, Canada. Interviews were digitally recorded and transcribed verbatim. Thematic analyses were conducted, and member-checking, analyses by multiple coders, and peer debriefing supported validity and reliability. Four themes emerged on the ethical queries of providing online sexual health outreach for GB2M: managing personal and professional boundaries with clients; disclosing personal or identifiable information to clients; maintaining client confidentiality and anonymity; and security and data storage measures of online information. Participants illustrated familiarity with potential ethical challenges, and discussed ways in which they seek to mitigate and prevent ethical conflict. Implications of this analysis for outreach workers, researchers, bioethicists, and policy-makers are to: understand ethical complexities associated with online HIV prevention and outreach for GB2M; foster dialogue to recognize and address potential ethical conflict; and identify competencies and skills to mitigate risk and promote responsive and accessible online HIV outreach. (shrink)

Attention to the ethical concerns of healthcare aides can provide important information about patients’ needs to careproviders, improve the ethical environment of an institution, and benefit aides who suffer from bearing ethical concerns alone. All persons benefit from sharing their ethical concerns with others. Among other benefits, ethics consultation offers careproviders, caregivers, healthcare aides, patients, and patients’ loved ones an opportunity to have their concerns heard.John Fletcher tried to follow every ethics consultation with a debriefing for all participants, including (...) patients and family members, to increase the possibility for continued healing after the conclusion of the consultation, and there are good reasons to follow this practice. (shrink)

Short-term international medical outreach experiences are becoming more popular among medical students. As the popularity of these trips grows, participants, scholars, and institutions have become more aware of the potential pitfalls of such experiences. Loyola University Chicago Stritch School of Medicine has an approximately 20-year international service immersion program that has sent more than 1,400 participants to more than 30 countries. Recently, ISI programming has been adjusted to provide students more formal sessions exploring the ethics of the ISI trips. Students (...) are required to attend both pre- and post-trip educational sessions covering a wide range of relevant global health topics as well as participating in in-country reflections and post-trip debriefings. This recent adjustment has evolved further to become the foundation for the SSOM’s four-year Global Health Honors program that not only encourages an ethical foundation for the student’s ISI experience but also hopes to provide a foundation for students as they look toward a future career in global health. (shrink)

Because they failed to include our informed consent, guided imagery scenarios, and debriefing, the relevance of Korn, Huelsman, Reed, and Aiello's (1992) data remains unknown. The design of their Study 1 did not test the greater objectivity of role taking over involved participation. The design of their Study 2 did not demonstrate the effects of demand characteristics. The older "personal acquaintances" were not at higher risk of rape as they claimed. Properly gathered data from the University of Connecticut's laboratory (...) demonstrated that participants regarded the guided imagining of rape to be personally and scientifically beneficial, educating them about the crime and the experience of the rape victim. Prior research had demonstrated that exposure to rape stimuli in combination with debriefing had an educational effect on the decreased endorsement of rape myths. Previously published ethical principles for balancing the rights of scientists, subjects, and society explicate our ethical stance. Informed consent precludes the occurrence of wrongful harms. This poorly designed and poorly reasoned "ethical" critique was unfounded; yet, it might produce a chilling effect on both the use of guided imagery and freedom of inquiry into politically sensitive topics. (shrink)

Spaulding vs. Zimmerman is a lawsuit that raised the issue of the extent of how much information a negotiator can withhold from the other side and still remain within the bounds of ethical propriety. The author took the case and fashioned it into an exercise an organization can use as a vehicle for members to analyze their personal ethical choices under difficult, real world circumstances. The exercise is powerful and may be administered at any level of management training. It is (...) disguised as a negotiation, so the ethical issues are obscured by the parties’ negotiation goals and tactics. The debriefing will lead to productive discussions about personal ethics/values decisions. The exercise can be as simple or complex as the moderator chooses. The general fact sheet, the employee’s facts, and the employer’s facts are attached in the Appendix. The user is encouraged to copy them for their specific needs. (shrink)

The ethical crisis in business and information technology is very real. Countering this crisis by creating organizational cultures grounded in moral character is the challenge people face as leaders if they are to regain the respect and confidence of the public. As educators of future business and information technology leaders, how can educators prepare their students to understand, appreciate, and contribute to the establishment of cultures of character in the organizations which employ them—and which they may ultimately lead? In this (...) article the authors distinguish among four corporate cultures with respect to ethics —cultures of defiance, compliance, neglect, and character—and present a blueprint for constructing an organizational culture grounded in moral character. With respect to showing students how to contribute to such a culture, the authors then describe how to establish an effective learning context for teaching about ethics, proffer a number of practical suggestions for student assignments and experiences that can empower students to understand, appreciate, and contribute to organizational cultures of character, and explain how to enhance experiential learning by conducting an effective debriefing session. The authors conclude the article by providing three examples from their own experience illustrating how these ideas can be incorporated into programs designed to show business and information technology students how to contribute to organizational cultures grounded in moral character. (shrink)

Ethical guidelines are vague concerning how situations should be handled when researchers encounter participants in preexisting psychological distress. Ethical issues of beneficence, autonomy, and the nature of informed consent may arise in these situations. This study investigated the ethical practices and beliefs of 84 psychopathology researchers when confronting research participants in distress. Results indicated that psychopathology researchers in general engaged in diverse ethical practices in providing debriefing, treatment referrals, and providing for distressed participants. Characteristics of the designated studies and (...) of the researchers accounted for significant differences in ethical practices. In addition, the type of psychopathology being assessed accounted for significant differences in ethical practices and beliefs. Guidelines are offered to aid researchers who encounter participants in preexisting distress. (shrink)

The purpose of this study was to investigate the ways novice social studies teachers perceived difficult discourses in their classrooms. Specifically, we sought to understand what social studies teachers think is difficult about navigating political discourses, and how they describe the nature of those discourses in order to draw conclusions about why some teachers choose to avoid or engage in political or social issues discussions with students. We used a collective case study and a grounded theory analysis of video recorded (...) class sessions and video guided debriefings with teachers to explore this phenomena. We found that the degree to which teachers thought the discourse to be difficult to navigate was shaped by: emotional safety of students, teacher's own ideologies, and the distances of students’ identities from the discourse. (shrink)

Musical systems develop associations over time between aspects of musical form and concepts from outside of the music. Experienced listeners internalize these connotations, such that the formal elements bring to mind their extra-musical meanings. An example of musical form-meaning mapping is the association that Western listeners have between the major and minor modes and happiness and sadness, respectively. We revisit the emotional semantics of musical mode in a study of 44 American participants (musicians and non-musicians) who each evaluated the relatedness (...) of 96 melody-word pairs. Among the tonal melodies, we manipulated mode (major and minor) and timbre (clarinet and flute) while systematically controlling for other musical factors including pitch register and melodic contour. Similarly, among the English words, we manipulated word affect (happy and sad) while systematically controlling for other lexical factors including frequency and word length. Results demonstrated that participants provided a higher proportion of related responses for major melodies paired with happy words and minor melodies paired with sad words than for the reverse pairings. This interaction between mode and word affect was highly significant for both musicians and non-musicians, albeit with a larger effect for the former group. Further interactions with timbre suggested that while both clarinet and flute conveyed happiness when in the major mode, the clarinet was somewhat more successful than the flute at conveying sadness in the minor mode. Debriefing questionnaires suggested that the majority of the participants, including all of the non-musicians, had no awareness of the major-minor manipulation, and instead directed their attention to register and contour. We argue that the affective character of the major and minor modes is but one example of form-meaning mapping in music, and suggest further exploration of the roles of timbre, register, and contour in conveying musical emotions. (shrink)