Background: Internationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process. Methods: This study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed. Results: 3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patientsalmost exclusively verballyis insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated. Conclusions: The review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.
As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low-income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.
School Psychologists are called to increase the well-being of clients they serve. However, despite a focus on supporting academic and behavioral success, school psychology has been used to enforce Eurocentric standards of normalcy and behavior on students in schools, punishing and excluding those deemed different. "Othering" is rooted in a legacy of educational indoctrination and assimilation negatively impacting students from minoritized backgrounds and represents a "colonial present". To evaluate the epistemic violence endemic to school psychology, we conducted a systematic literature review of the most recently published literature across five school psychology journals (n = 627) utilizing a decolonial framework. Articles were coded for demographic inclusion, empirical approach, disciplinary context, minoritized inclusion level, and acknowledgment of author situatedness and roles in maintaining colonialist structures. While, 81% of studies included some degree of minoritized inclusion, less than 5% of these articles utilized culturally responsive approaches or acknowledged colonialism or white supremacy. Recommendations for a movement toward a more decolonial approach to school psychology research are discussed.
The psychological experience of maternal depression and its impact on immigrant Latina/o families often goes unrecognized and unaddressed. Children may feel especially helpless and confused about the changes they observe in their mothers’ mood and behavior, and about the deterioration of family relationships. Given the interdependence of family structures of immigrant Latina/o households, maternal depression can be detrimental to Latina/o youth attributions and coping strategies, and to their relationship with their mothers. The quantitative focus of most research on maternal depression in Latina/o samples limits our understanding of family processes in maternal depression. The current qualitative study explores the perceived impact of maternal depression on Latina/o youths’ attributions and coping strategies. This inquiry involved focus groups with 12 participants aged 9–16 years to explore their perspectives on maternal depression. All youth had participated in a 12‐week multifamily group intervention focused on building family and cultural strengths to address maternal depression on immigrant Latina/o families. Findings of the focus groups illuminated the essential experience of youth living with maternal depression, and indicated that there are developmental considerations for how youth recognize and make meaning of maternal depression, and cope with disrupted family life. Additionally, youth reported engaging in these culture‐specific ways of coping: using close sibling relationships and family structure as support, having fathers and extended family members engage in additional and restorative parenting practices, and participating in religious practices to seek refuge from family stress. We propose considerations for intervention and further areas of research.
The 2015 Varsity Medical Ethics debate convened upon the motion: “This house believes nootropic drugs should be available under prescription”. This annual debate between students from the Universities of Oxford and Cambridge, now in its seventh year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the current usage of nootropic drugs, their safety and whether it would be beneficial to individuals and society as a whole for them to be available under prescription. The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate.
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