Pursuing reflective equilibrium when hospital patients smoke.

Questions about smoking policies in hospitals, and how exactly to implement them, have been difficult to answer for many years. Policy-makers must consider a tangled web of personal versus public goods. Administrators often have to creatively decide how policies can best be adopted at their particular site.

Care for Dying Children and Their Families in the PICU: Promoting Clinician Education, Support, and Resilience.

Objectives: To describe the consequences of workplace stressors on healthcare clinicians in PICU, and strategies for personal well-being, and professional effectiveness in providing high-quality end-of-life care.

Data Sources: Literature review, clinical experience, and expert opinion.

Study Selection: A sampling of foundational and current evidence was accessed.

Towards the Womb of Neonatal Intensive Care.

Within the mother's womb, life finds its first stirrings. The womb shelters the fetus, the growing child within. We recognize the existential traces of a wombed existence when a newborn calms in response to being held; when a newborn stills in response to his or her mother's heartbeat; and, when a newborn startles in the presence of bright light.

Becoming dead: Two solitudes?

The moral divide between proponents and opponents of medical assistance in dying is wide and can be ascribed to a number of dichotomous beliefs. This article addresses a particular and less commonly described platform for the divide: human acquiescence to physical decline and death as an important stage of life, versus presumptive human mastery over the timing and manner of some peoples' death. Practical ideas are then offered for health systems that wish to bridge the divide, to provide both robust palliative end-of-life care and medical assistance in dying programs for their patients, while keeping health workers whole.

What Is the Role of Ethics Consultation in the Moral Habitability of Health Care Environments?

Ethics consultation has traditionally focused on the provision of expert guidance to health care professionals when challenging quandaries arise in clinical cases. Its role, however, is expanding as demands on health care organizations are negatively impacting their moral habitability. A sign of this impact can be seen in the moral distress experienced by staff and administrators, such that some leave their positions and their organizations.

Ethics Guide Recommendations for Organ-Donation-Focused Physicians: Endorsed by the Canadian Medical Association.

Donation physicians are specialists with expertise in organ and tissue donation and have been recognized internationally as a key contributor to improving organ and tissue donation services. Subsequent to a 2011 Canadian Critical Care Society-Canadian Blood Services consultation, the donation physician role has been gradually implemented in Canada. These professionals are generally intensive care unit physicians with an enhanced focus and expertise in organ/tissue donation.

Do Medical Students' Narrative Representations of "The Good Doctor" Change Over Time? Comparing Humanism Essays From a National Contest in 1999 and 2013.

Purpose: To explore medical students' conceptions of "the good doctor" at two points in time separated by 14 years.

Method: The authors conducted qualitative analysis of narrative-based essays. Following a constant comparative method, an emergent relational coding scheme was developed which the authors used to characterize 110 essays submitted to the Arnold P.

Pediatric palliative care in Canada in 2012: a cross-sectional descriptive study.

Background: Pediatric palliative care focuses on comprehensive symptom management and enhancing quality of life for children with life-threatening conditions and their families. Our aim was to describe Canadian programs that provided specialized pediatric palliative care in 2012 and the children who received it and to estimate the proportion of children who might benefit that received specialized care.

Methods: A cross-sectional descriptive design was used.

A descriptive report of end-of-life care practices occurring in two neonatal intensive care units.

Background: In Canada and other developed countries, the majority of neonatal deaths occur in tertiary neonatal intensive care units. Most deaths occur following the withdrawal of life-sustaining treatments.

Aim: To explore neonatal death events and end-of-life care practices in two tertiary neonatal intensive care settings.

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013.

Background: Advance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.

Methods: Raw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.

Employers' perceptions and attitudes toward the Canadian national standard on psychological health and safety in the workplace: A qualitative study.

The estimated societal and economic costs of mental illness and psychological injury in the workplace is staggering. Governments, employers and other stakeholders have been searching for policy solutions. This qualitative, exploratory study sought to uncover organizational receptivity to a voluntary comprehensive standard for dealing with psychological health and safety in the workplace.

A Scoping Review of Research on the Arts, Aging, and Quality of Life.

Purpose Of The Study: Artistic engagement has been identified as a promising way to improve older adults' quality of life (QoL) and health. This has resulted in a growing, yet diverse, knowledge base. The purpose of this scoping review was to describe and map the nature and extent of research conducted on the arts, aging, and either QoL or health for well older adults.

Organizational Influences on Health Professionals' Experiences of Moral Distress in PICUs.

This article reports the findings of a qualitative study (secondary analysis) that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units (PICUs) across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children.

Children who 'grow up' in hospital: Inpatient stays of six months or longer.

Objective: To describe the clinical course of all infants and children hospitalized for six consecutive months (180 days) or longer at a tertiary/quaternary children's hospital in Western Canada.

Methods: A retrospective review of medical records for all eligible patients from January 1, 2007 to December 31, 2012 at Stollery Children's Hospital (Edmonton, Alberta) was performed.

Results: A total of 61 patients experienced 64 eligible hospitalizations.

Canadian Nurse Practitioners' Therapeutic Commitment to Persons with Mental Illness.

The purpose of this study was to determine how Canadian nurse practitioners (NPs) rate their levels of therapeutic commitment, role competency, and role support when working with persons with mental health problems. A cross-sectional descriptive, co-relational design was used. The Therapeutic Commitment Model was the theoretical framework for the study.

Policy change for infants born at the "cusp of viability": a Canadian NICU experience.

Resuscitation and life-support treatments for infants born at the "cusp of viability" continue to be subject to clinical and ethical debate. Reported positive outcomes for these infants led our Neonatal Program to critically review our historic practice of discouraging resuscitation of infants born at <24 weeks' gestational age. This practice change required a multifaceted, collaborative approach including neonatal, perinatal, and obstetric efforts.

Adolescent parenting in the neonatal intensive care unit.

This review presents data from studies that report on adolescent parents as part of larger neonatal intensive care unit (NICU) parent populations, as well as studies where adolescent parents are given central consideration. A systematic search for English publications from 1990 onward relevant to adolescent parenting in the NICU was conducted. Most studies reporting on adolescent parents focus on parental stress or parenting practices in the NICU.