Tobacco use disorder treatment in primary care: implementing a clinical system pathway in Alberta.

Objective: To test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians.

Design: A prospective cohort study.

Setting: Sixty primary care sites in Alberta.

Substance use disorders among registered nurses: prevalence, risks and perceptions in a disciplinary jurisdiction.

Aim: To investigate substance use disorders, impaired practice and health risks among nurses in a disciplinary jurisdiction.

Background: The relationship between substance-related risks to patient safety, nurse health and discipline is understudied.

Method: A convenience sample of 4064 registered nurses responded to an Internet survey in 2010.

Technics of touch in the neonatal intensive care.

Medical technologies, although often crucial for the provision of healthcare, may carry unintended significance for patients and their families. The highly technicised neonatal intensive care unit (NICU) is the place where parents of hospitalised baby have their early encounters with their child. The aim of this study is to investigate phenomenologically how the contact and relation between parent and child may be affected by the mediating presence and use of the techno-medical features and equipments of the NICU.

Moral distress and the contemporary plight of health professionals.

Once a term used primarily by moral philosophers, "moral distress" is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? "Plight" encompasses not only the act of pledging, but that of predicament and peril.

Carrying: parental experience of the hospital transfer of their baby.

Some hospital practices that are routine for hospital staff may carry unintended significance for patients and their families. The transfer of neonatal infants between hospitals and hospital environments is one such practice that may be covered by perfectly acceptable rules and regulations but that, at times, gives rise to unsuspected anxieties, pain, and worries in the parent. In this phenomenological study, I explored meaning aspects of the phenomenon transfer to reveal a lived experience of carrying--a carrying across from here to there; a carrying between changing places; a carrying contact of parent-child in-touchness that is enabled or compromised in this experience; a carrying with care; and a carrying as a search for place as home.

Towards an ethical policy for the prevention of fetal sex selection in Canada.

The troubling practice of fetal sex selection has historically been considered an Asian phenomenon. However, recent evidence shows that a similar situation is emerging in North America, albeit on a smaller scale. The Society of Obstetricians and Gynaecologists of Canada has firmly stated its opposition to sex selection for non-medical reasons, as well as to the use of any technology used solely for the purpose of determining fetal sex.

Ethics in a time of contagion: a relational perspective.

In times of contagion, the key role of nurses brings fears, dangers, and unique demands. The ethics of such challenges need to be explored and understood. Using Callahan's framework for thinking ethically and Taylor's "worries" of modern life, the author elucidates some of the challenges and then argues that the current approach to pandemic ethics, with its reliance on moral reasoning, is insufficient to guide nurses' ethical actions.

Thinking ecologically for safer healthcare: a summer research student partnership.

As leaders for nursing education, nursing research, healthcare administration and patient safety, we asked one another: How do we use our collective resources to build health system capacity for clinically based research training and safer healthcare? Drawing on knowledge from the field of ecological restoration, which is the study and repair of damaged ecosystems, we partnered the Safer Systems research program of the Faculty of Nursing, University of Alberta, with Capital Health's Royal Alexandra Hospital (RAH), the Caritas Health Group, the Canadian Patient Safety Institute (CPSI) and several funding agencies to provide hands-on training in clinical research, infection control and patient safety policy development for nursing students during the summer months. As we plan ahead, our student and staff evaluations show that together, we can make concrete, vital contributions to student education, nursing research, evidence-informed practice, clinical quality improvement and national policy. We are using what we have learned to continually expand the range of undergraduate, graduate and post-doctoral clinical learning opportunities in healthcare safety that are available year round.

Fetal listing for organ transplantation in Canada.

This article presents an ethical and legal examination of whether a fetus should be listed to receive a transplanted organ. To date, relatively little discussion of this question has found its way into either the clinical or ethics literature. This article is divided into four sections.

Seeing baby: women's experience of prenatal ultrasound examination and unexpected fetal diagnosis.

Objective: Although prenatal ultrasound (US) is a common clinical undertaking today, little information is available about women's experience of the procedure from the perspective of women themselves. The objective of this study was to explore women's experience of undergoing a routine prenatal US examination associated with an unexpected fetal diagnosis.

Study Design: Qualitative methods were used to explore the prenatal US experience of 13 women.

To stay or to go, to speak or stay silent, to act or not to act: moral distress as experienced by psychologists.

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes.

It's not just a wound..

An ongoing challenge in wound management is a belief that wounds are temporary, routine, and merely physical. However, wounds can be very complex ethically which, in turn, necessitates careful and sensitive attention by practitioners. Five clinical cases are analyzed in terms of their ethical and legal implications.

Stem cell terminology: practical, theological and ethical implications.

Stem cell policy discussions frequently confuse embryonic and fetal sources of stem cells, and label untested, non-reproductive cloning as "therapeutic." Such misnomers distract attention from significant practical and ethical implications: accelerated research agendas tend to be supported at the expense of physical risks to women, theological implications in a multi-faith community, informed consent for participation in research, and treatment decisions altered by unrealistic expectations.

Addressing oppression in psychiatric care: a relational ethics perspective.

In this article we consider oppression in psychiatric care from a relational ethics perspective. We identify the vulnerability of psychiatric patients and the concomitant difficulties that confront medical health practitioners. We suggest that healthcare practitioners can become desensitized to systemic problems in the routine provision of care, that attention to protocols and procedural guidelines is not sufficient to reduce oppression in care, and that the discussion necessary to do so may not be generally supported within clinical environments.

Nursing in a technological world: searching for healing communities.

A research dialectic between philosophy of technology and nurses' work in acute care surfaces parallel technological practices that threaten the healing nature of two modern projects: health care and ecological restoration. A metaphor of ecological restoration is used to explore the consequences of denatured health care work for the welfare of patients, families, practitioners, and healing communities. It is argued that in health care systems where the mismatch between treatment options and resources for care steadily grows, the nursing discipline must develop ecological literacy for a technological world.

Recovering ethics after 'technics': developing critical text on technology.

Much modern science and ethics debate is on high-profile problems such as animal organ transplantation, genetic engineering and fetal tissue research, in discourse that assumes technical tones. Other work, such as narrative ethics, expresses the failed promise of technology in the vivid detail of human experience. However, the essential nature of contemporary technology remains largely opaque to our present ethical lens on health care and on society.