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Biomedical subjects

M J Johnstone

Publications and source records attributed to M J Johnstone.

At least 19 recordsLinked to original sources
PubMed1992

Re-thinking the law, and challenging its traditional role in nursing's affairs: a strategy for professional reform.

Nurses world wide have regarded the law as a powerful tool of professional reform, and have historically looked to the law (its system and processes) to enhance and advance their professional goals. Nevertheless, the nursing profession still has not achieved its ultimate goals. To this day, nurses lack legitimated status as autonomous professionals, and are still burdened with enormous responsibility without the authority to match it. Given that the law is such a powerful tool of professional reform, the question must be asked at this point of nursing history: Why has the nursing profession not received the legal remedies it has sought in its quest to gain legitimated freedom from the subordinate and oppressed position it has historically occupied? In this paper, an attempt will be made to answer this question.

Australia↗
PubMed1990

Approaching ethical issues in critical care units--whose decision is it anyway?

In upholding the patient's interests it is important for intensive care practitioners (nurses and doctors) to distinguish between judgements of fact and judgments of value when making important clinical decisions, and further, not to overstep their authority as health care providers when caring for seriously ill patients. If moral errors and harm are to be avoided in intensive care units it is imperative that not only nurses and other members of the intensive care team are educationally prepared to deal with the complex moral problems posed by intensive care practices, but that the role of the patient (or her/his self-chosen representative) in decision making is fully expanded. In this respect, it is not merely the patient's so-called 'good' which nurses and other health workers must strive to maximise, but also the patients' preferences. In this paper, brief attention will be given to: [1] examining the nature of ethical decisions and the ways in which these differ significantly from clinical medical/nursing and legal decisions; and [2] exploring ways in which nurses (and other members of the intensive care team) can better ensure the realisation of morally just outcomes for patient's requiring intensive care.

Adult↗
PubMed1989

Professional ethics and patients' rights: past realities, future imperatives.

The nature and application of professional ethics in relation to patients' rights is not always clearly understood by healthcare professionals. As a result, patients' rights are not always respected or upheld in a way that they ought to be. An undersirable consequence of this has been that patients have suffered otherwise avoidable harms. The issue of professional ethics and patients' rights is one of concern to all healthcare professionals. It is of particular concern to nurses since they are the ones who are often caught in situations involving abuses of patients' rights. This paper briefly examines the failure of professional ethics to prevent patients' rights' abuses in healthcare contexts. It also makes recommendations on how the nursing profession could respond to this problem.

Altruism↗
PubMed1988

Law, professional ethics and the problem of conflict with personal values.

There are, on occasions, instances in which a nurse may not agree with a given medical order of prescribed treatment. This is particularly likely in cases involving the use of extraordinary means of life-saving treatments on chronically or terminally ill patients. In such instances, the nurse may either (1) refuse to carry out the given medical order(s) or (2) refuse/decline to care for the patient in question (e.g. the nurse may instead request to be assigned a different patient in an attempt to avoid a personal dilemma). In cases where medical orders stand to violate the law, a nurse's refusal to carry out the medical order(s) in question might be seen to be fully justified; where medical orders violate nothing more than a philosophical or personal sense of right and wrong, however, justification for refusing to carry out such orders may not seem so defensible. This paper will critically examine the questions of when, if ever, a nurse might be justified on other than legal grounds (given the sometimes inappropriate and inadequate nature of law) to either (1) refuse to carry out a doctor's orders or (2) refuse/decline to care for a given patient. These questions will be discussed in relation to a real life scenario.

Australia↗
PubMed1988

Management of a patient with Wilms's tumour extending into the right heart chambers: a case report and a review of other published reports.

Wilms's tumours that extend by direct intravascular spread into the right side of the heart are rare. A case of such a tumour was diagnosed by ultrasound. A one stage resection was performed on cardiopulmonary bypass and with profound hypothermic circulatory arrest. It was followed by adjunctive chemotherapy and radiotherapy. The child was alive and tumour free 18 months later. A review of 17 other similar cases indicated that multimodal treatment is justified in patients with extensive intravascular spread of Wilms's tumours.

Cardiopulmonary Bypass↗
PubMed1987

Ethics in focus.

Explore the source record for details and available documents.

Administrative Personnel↗
PubMed1985

Inguinal herniotomy in children: a five year survey.

This retrospective review covers our experience over 5 years of 436 hernia repairs in 392 children upto the age of 15 years. The number of emergency presentations was 71 (18.1 per cent) and 66.2 per cent of these were under the age of 12 months. Most cases were initially treated conservatively and only 18 children required operation on the day of admission. There were 11 recurrences (7 elective and 4 emergency cases) giving a recurrence rate of 2.5 per cent. In all eleven cases the original operation was performed by a junior surgeon. The complication rate (excluding recurrences) was 2.8 per cent but may be an underestimate because of the limitations of a retrospective study. We suspect our results are typical of those to be found in any large British hospital and that with careful training and supervision of junior staff in the technique of inguinal herniotomy the results could be improved and approach those found in specialist paediatric units in America.

Adolescent↗
PubMed1982

The effect of lorazepam on neonatal feeding behaviour at term.

A study was carried out to assess the effect of maternal administration of 5 mg lorazepam orally 1 hour before induction of labour on the well-being of healthy babies at term, as judged by neonatal feeding behaviour. The results, compared in 18 bottle-fed neonates of mothers in the lorazepam group and 20 from the control group of mothers who received no pre-induction medication, showed that lorazepam had no significant effect on the volume of milk taken or the duration of the feeding process during the first 48 hours of life.

Anti-Anxiety Agents↗
PubMedDate not supplied

Law, professional ethics and the problem of conflict with personal values.

There are, on occasions, instances in which a nurse may not agree with a given medical order of prescribed treatment. This is particularly likely in cases involving the use of extraordinary means of lifesaving treatments on chronically or terminally ill patients. In such instances, the nurse may either (1) refuse to carry out the given medical order(s) or (2) refuse/decline to care for the patient in question (e.g. the nurse may instead request to be assigned a different patient in an attempt to avoid a personal dilemma). In cases where medical orders stand to violate the law, a nurse's refusal to carry out the medical order(s) in question might be seen to be fully justified; where medical orders violate nothing more than a philosophical or personal sense of right and wrong, however, justification for refusing to carry out such orders may not seem so defensible. Below, the author critically examines the above questions in relation to a real-life scenario. It should be noted that while brief reference will be made to one or two legal considerations, the author's primary intention is to argue a philosophical-moral position, not a legal one; therefore no apology will be made for omitting certain other legal considerations or points which critics might contend ought to be included in the ensuing discussion.

Codes of Ethics↗
PubMedDate not supplied

Dying with dignity.

Explore the source record for details and available documents.

Humans↗
PubMedDate not supplied

Quality versus quantity of life: who should decide?

The issue of who should rightly decide quality versus quantity of life questions in health care contexts continues to receive widespread attention by health care professionals, academics and the laity. Unfortunately it is far from being resolved. Doctors still consider themselves the rightful, dominant decision-makers. There are many cases where patients' lives have been maintained by extraordinary means without their informed consent, sometimes against their explicit will. However as a better informed public begins to assert its rights, the doctor's role as primary decision-maker in health care is being increasingly questioned.

Beneficence↗