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The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses.We conducted a secondary thematic qualitative analysis using grounded theory methodology.Data collection occurred through semi-structured, in-depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.'s Public Health Emergency Preparedness Framework and inductively for emergent themes.Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need.From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.

The popularity of and market for natural medicines (herbal remedies, dietary supplements, and vitamins) is accelerating. At the same time, evidence for their effectiveness (both in general and for specific conditions) and safety remains poor in many instances. Independent evaluations have identified products that are poorly manufactured, contaminated, or mislabeled. We examine data on cannabidiol (CBD) to exemplify these problems. Yet consumers often are unaware of these concerns and problems and continue to believe that "natural" means "safe." The current US regulatory framework founded in the 1994 Dietary Supplement Health and Education Act (DSHEA) does not adequately protect the health of US consumers and urgently needs to be revised. At the same time, clinicians should update themselves regularly with the best available evidence on the natural medications most relevant to their areas of practice. We recommend some evidence-based resources that will help clinicians and their patients remain current in this area.

This commentary examines 4 ethical issues in a case of clinicians considering conducting research on children in conflict zones: (1) whether any time or resources should be taken away from treating acute injuries in order to conduct research; (2) obtaining consent for children to participate in research, which is particularly challenging given that children can be separated from parents or guardians; (3) whether the research is feasible at the moment, since starting research that stands little chance of being completed is ethically questionable; and (4) maintaining neutrality, impartiality, and humanity. Research that puts participants and researchers at risk of additional harm must be considered carefully. Here, we propose that both research and clinical care might occur simultaneously when researchers engage humbly with involved communities as the research is being designed, conducted, and reported in order to understand and resolve ethical issues involved.

The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic.NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic.Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method.Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme.NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

This chapter agues for the importance of case studies in generating evidence to guide and/or support policymaking across a variety of fields. Case studies can offer the kind of depth and detail vital to the nuances of context, which may be important in securing effective policies that take account of influences not easily identified in more generalised studies. Case studies can be written in a variety of ways which are overviewed in this chapter, and can also be written with different purposes in mind. At the same time, case studies have limitations, particularly when evidence of causation is sought. Understanding these can help to ensure that case studies are appropriately used to assist in policymaking. This chapter also provides an overview of the types of case studies found in the rest of this volume, and briefly summarises the themes and topics addressed in each of the other chapters.

This chapter brings together some of the general themes that can be gleaned from a consideration of all the case studies in this volume taken as a whole. Despite the substantive uniqueness of specific cases, no less than the ones collected here, there remain some key advantages to examining cases in detail and drawing on the broader lessons that can be learned from adopting the case study method. Equally important are the lessons that can be learned about how ethically generated evidence can help inform trustworthy and effective policies.

‘One Health’ is the concept that human health and well-being are linked to the health of animals and the environment. The goals of One Health include addressing potential or existing global and transnational health risks, which require policies that are systematic, coordinated, collaborative, multidisciplinary and cross-sectoral. One Health is particularly well-suited for zoonotic diseasesand emerging and re-emerging infectious diseases (EIDs). Epidemics, emergenciesand disasters raise many ethical issues for all involved, including communities, responders, public healthspecialists and policymakers. Our case study describes ethical dilemmas encountered during an animaldisease outbreak investigation in the Somali region of Ethiopia during the 2019 Coronavirus Disease (COVID-19) pandemic with concurrent drought and human conflicts. Outbreak investigations were conducted through systematic collection, analysis and evaluation of pertinent data, and results disseminated to relevant stakeholders. Our observations highlighted the importance of addressing community humanitarian needs and potential risks to responders, including researchers, when responding to animaldisease outbreaks without compromising ethical principles. Community engagement was crucial in resolving technical and ethical issues. Policy gaps related to ethical issues during animalhealth emergencies were observed. Our case study supports the formulation of guidelines and policies for One Health research ethics in Africa and elsewhere to strengthen capacityand ethical decision-making.

The ebook edition of this title is Open Access and freely available to read online. Ethical Issues in Covert, Security and Surveillance Research showcases that it is only when the integrity of research is carefully pursued can users of the evidence produced be assured of its value and its ethical credentials.

Background According to data from the Internal Displacement Monitoring Centre’s Global Report on Internal Displacement 2019, Ethiopia had the highest number of people newly displaced within their own country due to violence. Several regions in the country experience on-going ethnic tensions and violent tribal conflict, which leaves smallholder farmers suspicious and distrustful of any outside activities in their locale, fearing harm from other ethnic groups. Changes in the central Ethiopian government have also led to suspicion of non-local agencies. The Campylobacter Genomics and Enteric Dysfunction (CAGED) research project’s objective is to improve the incomes, livelihoods and nutrition of smallholder farmers and was conducted during this period of increased tension and violence. The project aims to assess the impact of reducing exposure to chicken excreta on young children’s gut health and growth. To inform the study design, formative baseline field data was collected between March 2018 and February 2019 by a team of trained and experienced human and animal health professionals from the same region, who speak the local language. Discussion This research is important to determine whether Campylobacter infection in chickens contributes to illness and stunting in children. Stunting is widespread in humanitarian settings, with major implications for children’s well-being and social inequalities. During this research, violence against other researchers elsewhere in Ethiopia led to mistrust and lack of engagement by the community. Hostile reactions developed until the team was fearful about returning to certain households. The team designed mitigation strategies in response, including establishing two types of community advisory boards. One used pre-existing village elder structures and another included village youth. Data collection team members received training in principles of ethics, consent, and crisis management, and were provided on-going support from local and international principal investigators and the study’s ethics advisor. Conclusion Tension and conflict led to mistrust of outsiders which generated fear among the CAGED data collectors The resulting challenges were addressed by innovative strategies which also delayed the research process. The interventions resulted in successful completion of the field activities. The lessons learned are being implemented with other projects being conducted in various parts of Ethiopia.

The categories and subcategories within the core theme “research ethics committee (REC) review process”. The analysis identified two core themes, one being Research Ethics Committee Review. This table lists the five categories identified within this theme, and the subcategories within each of these categories. (DOCX 24 kb)

List of Disaster Research Ethics Guidelines. A list of the 14 research ethics guidelines included in this review providing their year of issue, issuing organization, reference, reach and scope. (DOCX 27 kb)

The categories and subcategories within the core theme “Vulnerability”. The analysis identified two core themes, one being Vulnerability. This table lists the four categories identified within this theme, and the subcategories within each of these categories. (DOCX 23 kb)

Research is needed to make responses to disasters and humanitarian emergencies more evidence-based. Such research must also adhere to the generally accepted principles of research ethics. While research into health interventions used in disasters raises distinctive ethical concerns, seven ethical principles developed for clinical research are applied here to disaster research. Practical examples from disaster settings are used to demonstrate how these ethical principles can be applied. This reveals that research ethics needs to be seen as much more than a mechanism to obtain ethical approval for research. Research ethics involves ethical principles and governance frameworks, but must also consider the role of ethical virtues in research. Virtues are essential to ensure that researchers do what they believe is ethically right and resist what is unethical. Research ethics that truly protects participants and promotes respect needs to include training in ethical virtues to ensure disaster research is carried out to the highest ethical standards. This article is based on a presentation at the Evidence Aid Symposium on 20 September 2014, in Hyderabad, India.

This paper maps key research questions for humanitarian health ethics: the ethical dimensions of healthcare provision and public health activities during international responses to situations of humanitarian crisis. Development of this research agenda was initiated at the Humanitarian Health Ethics Forum (HHE Forum) convened in Hamilton, Canada in November 2012. The HHE Forum identified priority avenues for advancing policy and practice for ethics in humanitarian health action. The main topic areas examined were: experiences and perceptions of humanitarian health ethics; training and professional development initiatives for humanitarian health ethics; ethics support for humanitarian health workers; impact of policies and project structures on humanitarian health ethics; and theoretical frameworks and ethics lenses. Key research questions for each topic area are presented, as well as proposed strategies for advancing this research agenda. Pursuing the research agenda will help strengthen the ethical foundations of humanitarian health action.