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Biomedical subjects

M J Keffer

Publications and source records attributed to M J Keffer.

12 recordsLinked to original sources
PubMed1998

The perception of ethical dilemmas in clinical practice.

The empirical diagnosis presented in this paper is based on interviews with nurse practitioners and physicians designed to elicit their perceptions on the nature and role of ethical dilemmas in clinical practice. Having selected five of these perceptions or views which were common and significant, the philosophical therapy offered consists in, first, a general discussion of ethical dilemmas and, second, a critical analysis of each of the five views with the aim of pointing out confusions and errors, the recognition of which can be of applied and practical help in the clinical setting.

Attitude of Health Personnel↗
PubMed1996

Reflective action--strategies for solving client-nurse partnerships in primary care.

In this grounded theory study, which addressed the research question. 'What strategies do nurses use to form client-nurse partnerships,' a variety of data sources were used. The first data set consisted of participant observation, and reports of focus groups formed as part of the 'First International Conference on Nursing Theory and Primary Health Care' at Massey University, New Zealand which was attended by an international group of 80 nurses in 1990. As an adjunct to the formal presentations, members of the focus groups addressed four questions: a) Is a nurse-client partnership viable in primary care? b) What do you plan to do to promote this partnership? c) What do you think others should do? and d) What is the next step? Reports from these focus groups, pooled with questionnaires (n = 17) and informal interviews completed this data set. The central process that described participants' perceptions of the viability of nurse-client partnerships was named reflective action. Ethical questions arose and were placed along a continuum of viability. A second data set consisted of interviews with, and selected literature by, Canadian nurses on partnerships in primary care. The perceptions of this international study group are seen as adding to our knowledge of barriers to nurse-client partnerships in primary care, and strategies for transcending these barriers.

Focus Groups↗
PubMed1994

The do-not-resuscitate order. Moral responsibilities of the perioperative nurse.

To provide care that is consistent with a patient's view of his or her best interests, the perioperative nurse must be a knowledgeable, informed member of the OR team. This knowledge must include familiarity with and understanding of all policies that relate to the care of the surgical patient--including DNR policies. The nurse must be willing to assert his or her moral agency in developing DNR policies that will eliminate potential conflict among the OR team members regarding patients with DNR designations. Only by being a knowledgeable moral agent can the perioperative nurse function as an effective advocate of the patient as a person.

Conflict, Psychological↗
PubMed1991

Differential regulation of insulin-like growth factor-I (IGF-I) and IGF-II release from cultured neonatal mouse calvaria by parathyroid hormone, transforming growth factor-beta, and 1,25-dihydroxyvitamin D3.

In a previous study we found that PTH stimulated bone resorption and release of insulin-like growth factor-I (IGF-I) and IGF-II from cultured neonatal mouse calvaria. Since IGF-I and IGF-II stimulate osteoblast proliferation and collagen synthesis, these results suggested that increased release of IGFs during resorption could mediate in part coupling of bone formation to bone resorption. In the present study two other osteolytic agents, transforming growth factor-beta (TGF beta) and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3 were examined for effects on IGF release from neonatal mouse calvaria. Like PTH, TGF beta stimulated resorption and increased release of IGF-I and IGF-II. 1,25-(OH)2D3, however, stimulated resorption and IGF-II release comparable to PTH, but inhibited release of IGF-I. 1,25-(OH)2D3 (0.1-100 nM) inhibited basal release of IGF-I, and 10 nM 1,25-(OH)2D3 inhibited release of IGF-I induced by PTH or TGF beta. The effects of 1,25-(OH)2D3 were specific to this vitamin D metabolite and did not occur with 25-hydroxyvitamin D3 or 24,25-(OH)2D3 at the same concentration. Calcitonin (50 mU/ml) decreased 1,25-(OH)2D3 stimulation of resorption, but did not affect 1,25-(OH)2D3 stimulation of IGF-II release and inhibition of IGF-I release. This evidence that effects of 1,25-(OH)2D3 on release of the IGFs were independent of bone resorption supports the conclusion that 1,25-(OH)2D3 modulated the production and secretion of IGF-I and IGF-II in calvarial cells. The results of this and the previous study suggest that PTH, TGF beta, and 1,25-(OH)2D3 differentially regulate mouse calvarial cell IGF-I and IGF-II production.

Animals↗
PubMedDate not supplied

Ethical decisions with limited resources. How is that possible?

Ethical decision making is a process case managers can use to help negotiate through complicated situations. In our complex health care delivery systems, case managers often have competing benefits and burdens to balance. In this article, the author presents an ethical decision making model that can assist in the process of decision making. The obligations of case managers to patients remain constant-attempting to be of benefit, but as the trajectory of care changes from acute to chronic to dying, the understanding of benefit will change. Caring for patients and their families within a managed care environment entails always keeping the benefit of the self, patient, family, employers, and society all in balance.

Beneficence↗