Medical ethics

The purpose of this study was to investigate the process used by Haitians and Haitian Americans who must make healthcare decisions for a terminally ill family member. There is a large population of Haitians and Haitian Americans in South Florida and there has been no research regarding their decision-making process about end-of-life healthcare. The study design was descriptive, applying constructivist grounded theory methodology. Data were collected using semi-structured, face-to-face qualitative interviews. Data analysis and collection occurred simultaneously. Participants (n=12) were purposefully recruited, with 11 from a single, faith-based community. The findings resulted in six concepts: (1) imminent or actual death, (2) disrupted unity, (3) managing disrupted unity, (4) consequences, (5) restoring unity, and (6) creating memories you can live with. These six concepts, elaborated by an additional 17 dimensions, were incorporated into a process model relating to the cultural value of communal unity to the end-of-life decision-making process. The implications of this study include a need to improve the congruence between the nursing care provided at this vulnerable time and the cultural values of this population. Successful access to this population through the structure of the faith-based community points the way to increasing access to appropriate end-of-life healthcare. Practice implications informed by caring science include the importance of nurses’ coming to know the family and listening to the unique care needs.

Medical information is very private and sensitive. With the digitization of medical data, it is becoming accessible through distributed systems, including the Internet. Access to all this information and appropriate exchange of data makes the job of health providers more effective, however, the number of people that can potentially access this information increases by orders of magnitude. Private health information is not well protected. We present guidelines for security models for medical information systems. First, we model the structure of the medical information in the form of object-oriented patterns. Second, we study models and patterns in use today and compare them to our patterns. Next we define requirements necessary for controlling access, and describe the common policies and restrictions of security models for medical applications. We present some of the medical record access control restrictions directly in a conceptual model of the medical information.

This study investigates the relationship of three protective factors : self transcendance, social interest, and spirituality to well-being among adults living with HIV or AIDS. It is the first study to explore the relationships of these protective factors to well-being. A convenience sample of 115 adults living with HIV or AIDS completed the Self-Transcendance Scale, the Social Interest Index- Short Form-Revised, the Spiritual Perspective Scale, and the Index of Well-Being. The participants were adults diagnosed with HIV or AIDS residing in a large southeastern U.S. city. Data were analyzed with correlational and multiple regression methods. Statistically significant positive moderate to strong relationships were found between well-being and self transcendance (r=.66, p<.001 ), social interest (r=.51, p<.001), and spirituality (r=.39, p<.001). A stepwise regression demonstrated that self transcendance held the highest variance on well-being among the three protective factors (43%). Additionally, self-transcendane and social interest accounted for 45% of the variance in well-being. In short, the hypothesized positive relationship among these protective factors with well-being was supported. This study provides theoretical and empirical support for linking self transcendance, social interest, and spirituality to well-being among adults living with HIV or AIDS. The clinical implications of these findings are also discussed.