Background: Culture is the framework that directs human behaviour in a given situation. Accordingly, culture also influences the meaning and expression of pain. However, the influence of culture on the communication of pain is not always understood and considered by healthcare practitioners. It is often erroneously anticipated that all children (irrespective of cultural origin) will express pain either through quiet endurance or loud verbal complaints. This view could contribute to the inadequate management of pain that is so often described in pain literature. Pain assessment and measurement are integral components of pain management, but are often negatively affected by the healthcare professional’s pre-conceived ideas, as well as by his or her inability to understand the cultural meaning of pain, the non-verbal and verbal language of pain, and the patient’s ability to cope with pain. Method: The aim of this study was to identify the unique meaning of pain in reference to both general and paediatric pain. In addition, the study aimed at gaining insight into the origin and management of pain. This was achieved by means of qualitative methodology. The study group included people from the South African Nguni and Sotho cultures. A total of 42 participants, who were on average 42 years old, were interviewed. Results: The study indeed indicated variances between the experience and expression of pain and the generally accepted idea that pain is not culture based. Conclusion: Health care providers need to be increasingly aware of and sensitive to the cultural expression of pain and how differences in the communication of pain could possibly influence their care plan.

During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals’ policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-of-life care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. A family-centered approach to care has been unilaterally relinquished to a secondary and nonessential role during the current crisis. This phenomenon violates a foundational public health principle, namely, to apply the least restrictive means to achieve good for the many. Instead, there has been widespread adoption of utilitarian and paternalistic approaches. In many cases the foundational principles of palliative care have also been neglected. No circumstance, even a global public health emergency, should ever cause health care providers to deny their ethical obligations and human commitment to compassion. The lack of responsive protocols for family visitation, particularly at the end of life, is an important gap in the current recommendations for pandemic triage and contingency planning. A stepwise approach to hospital visitation using a tiered, standardized process for responding to emerging clinical circumstances and individual patients’ needs should be considered, following the principle of proportionality. A contingency plan, based on epidemiological data, is the best strategy to refocus health care ethics in practice now and for the future.

PURPOSE: Many hospitals have established goals-of-care programs in response to the coronavirus disease 2019 pandemic; however, few have reported their outcomes. We examined the impact of a multicomponent interdisciplinary goals-of-care program on intensive care unit (ICU) mortality and hospital outcomes for medical inpatients with cancer. METHODS: This single-center study with a quasi-experimental design included consecutive adult patients with cancer admitted to medical units at the MD Anderson Cancer Center, TX, during the 8-month preimplementation (May 1, 2019-December 31, 2019) and postimplementation period (May 1, 2020-December 31, 2020). The primary outcome was ICU mortality. Secondary outcomes included ICU length of stay, hospital mortality, and proportion/timing of care plan documentation. Propensity score weighting was used to adjust for differences in potential covariates, including age, sex, cancer diagnosis, race/ethnicity, and Sequential Organ Failure Assessment score. RESULTS: This study involved 12,941 hospitalized patients with cancer (pre n = 6,977; post n = 5,964) including 1,365 ICU admissions (pre n = 727; post n = 638). After multicomponent goals-of-care program initiation, we observed a significant reduction in ICU mortality (28.2% v 21.9%; change −6.3%, 95% CI, −9.6 to −3.1; P = .0001). We also observed significant decreases in length of ICU stay (mean change −1.4 days, 95% CI, −2.0 to −0.7; P < .0001) and in-hospital mortality (7% v 6.1%, mean change −0.9%, 95% CI, −1.5 to −0.3; P = .004). The proportion of hospitalized patients with an in-hospital do-not-resuscitate order increased significantly from 14.7% to 19.6% after implementation (odds ratio, 1.4; 95% CI, 1.3 to 1.5; P < .0001), and do-not-resuscitate order was established earlier (mean difference −3.0 days, 95% CI, −3.9 to −2.1; P < .0001). CONCLUSION: This study showed improvement in hospital outcomes and care plan documentation after implementation of a system-wide, multicomponent goals-of-care intervention.

Psychologists are faced with numerous challenges in their daily practices. Literature indicates that the most frequent ethical transgressions in the 1970s–1990s were the invalid presentation of professional qualifications, unprofessional advertisements, and irresponsible public communications. However, at the turn of the century, it has changed to include sexual or dual relationships with patients as well as unprofessional, unethical, or negligent practice. The objective of this research project is to analyse the case content of all guilty verdicts related to professional standard breaches and ethics misconduct against Health Professions Council of South Africa–registered psychologists in the period 2007–2013 via a qualitative research paradigm focusing on a historical research approach. The findings of this study indicate that only a small fraction of psychologists registered with the Health Professions Council of South Africa are annually guilty of ethics misconduct. The results indicate that the majority, around one-third, of transgressions can be regarded as improper professional role conduct. It was followed by negligent and/or incompetent treatment and/or patient care (27%), fraudulent conduct (20%), and disclosure of confidential information without permission (13%). As the age of electronic and social media advances, along with online diagnosis and therapy, clients may have better access to resources of varying authority and reliability, possibly giving them more confidence to question the practices of their service providers.