***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Moral distress is the knowledge of the ethically appropriate action to take but the inability to act upon it . This phenomenon is one experienced in the critical care setting . To help staff members cope with moral distress , a team conducted workshops at one facility to help the staff identify and cope with this distress . The workshop consisted of discussion s of distressing situations in the intensive care unit , didactic information on  moral distress , formulation of an individual plan to reduce stress , and strategies to deal with moral distress  in the intensive care unit . This article discusses the workshop and its effect on participants ' coping with moral distress We report the results of a r and omized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme , as well as their responses to a simulated clinical case . Twenty-five per cent of the house officers received a lecture series ( Limited Intervention or LI ) , 25 per cent received lectures and case conferences , with an ethicist in attendance ( Extensive Intervention or EI ) , and 50 per cent served as controls . A post-intervention question naire was administered . Knowledge scores did not differ among the groups . Confidence regarding ethical issues was significantly greater in the aggregate intervention group ( 3.9 on a 1 to 5 scale ) compared to the control group ( 3.6 ) . Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls ( 4.0 v 2.8 ) . Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile ( EI = 57 per cent , LI = 87 per cent , Controls = 82 per cent ) . We conclude that ethics education can have an impact on house officers ' confidence and their responses to a simulated case , and that the EI was more effective than the LI . Such results have implication s regarding the implementation of ethics education during residency Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials OBJECTIVE The aim of this study was to explain the role of patient advocacy in the Advance Care Planning ( ACP-ing ) process . Nurses rate prolonging the dying process with inappropriate measures as their most disturbing ethical issue and protecting patients ' rights to be of great concern ( Johnston et al 2002 ) . Paradoxically ethical codes assume nurses have the autonomy to uphold patients ' health-care choices . Advance Directives ( AD ) design ed to improve end-of-life care are poorly taken up and acute hospitals are generally not geared for the few they receive . The Respecting Patient Choices Program ( RPCP ) improves AD utilisation through providing a supportive framework for ACP-ing and primarily equipping nurses as RPC consultants . Assisting patients with this process requires attributes consistent with patient advocacy arising out of nursing 's most basic tenet , the care of others . DESIGN Likert Scales survey administered pre and six months post-intervention to pilot and control groups , with coinciding focus groups . SETTING Selected wards in an acute care public hospital in South Australia . SUBJECTS Nurses on the palliative care , respiratory , renal and colo-rectal pilot wards and the haem-oncology , coronary care , cardiology and neurology/geriatric control wards . INTERVENTION The RPCP during the 2004 - 2005 South Australian pilot of the ( RPCP ) . MAIN OUTCOMES The organisational endorsement of ACP-ing gave nurses the autonomy to be patient advocates with respect to end-of-life care , reconciling clinical practice to their code of ethics and easing distress about prolonging the dying process inappropriately . RESULTS Statistically significant survey results in the post-intervention group showed nurses experienced : encouragement to ensure patients could make informed choices about their end-of-life treatment ( 84 % ) ; the ability to uphold these wishes in practice ( 73 % ) ; and job satisfaction from delivering appropriate end-of-life care ( 67 % ) ; compared to approximately half ( 42 - 55 % ) of respondents in the pre-intervention and control groups . Focus group participants shared that it used to be hard to advocate for patients , but now they could act legitimately and felt ethically comfortable about ensuing end-of-life-care . CONCLUSION Findings suggested patient advocacy , fostered by the supportive RPC environment , effectuates the ACP-ing process . It is recommended that the RPCP should be recognised and developed as integral to promoting quality end-of-life assurance and associated job satisfaction The objective of the study was to determine the effect of the Konstanz method of moral dilemma discussion ( KMDD ) on moral judgment in allied health students . The study employed the Moral Judgment Test , translated from English into Thai and vali date d in 247 students , as an moral judgment instrument . The scale satisfied four validity criteria : preference hierarchy , quasi-simplex structure of stage preference , affective-cognitive parallelism , and positive correlation between education and moral competence score ( C-index ) . Test-retest reliability at a 1-month interval was 0.90 . To investigate the impact of the KMDD , 83 pharmacy technician and dental nursing students were asked to participate in the study . The subjects were r and omly assigned into control ( n = 41 ) or experimental ( n = 42 ) groups . The experimental group participated in a 90-min KMDD once a week for 6 consecutive weeks . Students in the control group also met once a week for 6 weeks to discuss the topics not related to ethics . All subjects completed the Moral Judgment Test before and after the intervention and again 6 months later . Split-plot ANOVA of the C-indexes at the beginning revealed that the experimental and control groups were not different ( 20.57 + /- 13.45 and 24.98 + /- 16.12 ) . However , the experimental group scored significantly higher than the control group did after the intervention ( 35.18 + /- 10.96 and 24.20 + /- 14.70 ) and 6 months later ( 33.00 + /- 11.02 and 23.67 + /- 14.35 ) . The KMDD appears to be a practical and effective intervention for developing moral judgment in allied health students . The effect on moral judgment remains at least 6 months after the intervention Background : The literature and research on nursing ethics and advocacy has shown that generally very few nurses and other clinicians will speak up about an issue they have witnessed regarding a patient advocacy concern and that often advocacy in nursing is not learned until after students have graduated and begun working . Objective : To evaluate the effectiveness of narrative pedagogy on the development of advocacy in student nurses , as measured by the Protective Nursing Advocacy Scale . Design : We tested the hypothesis that use of a narrative pedagogy assignment related to ethics would improve student nurse ’s  perception of their advocacy role as measured by the Protective Nursing Advocacy Scale using a quasi-experimental nonr and omized study using a pre-test , intervention , post-test design . Data collection occurred during class time from October 2012 to December 2012 . The Protective Nursing Advocacy Scale tool was administered to students in class to assess their baseline and was administered again at the completion of the educational intervention to assess whether narrative pedagogy was effective in developing the nursing student ’s perception of their role as a patient advocate . Ethical considerations : Students were informed that their participation was voluntary and that the data collected would be anonymous and confidential . The survey was not a grade d assignment , and students did not receive any incentive to participate . The institutional review board of the college determined the study to be exempt from review . Setting : School of Nursing at a small liberal arts college in the Northeastern United States . Participants : A consecutive , nonprobability sample of 44 senior-level nursing students enrolled in their final nursing semester was utilized . Findings : Results indicated significant differences in student nurse ’s perception of their advocacy role related to environment and educational influences following an education intervention using an ethics digital story . Conclusion : Using the Protective Nursing Advocacy Scale , we were able to measure the effectiveness of narrative pedagogy  on nursing student ’s  perception of the nurse ’s advocacy role The aim of this study was to compare the learning effectiveness of peer tutored problem-based learning and conventional teaching of nursing ethics in Taiwan . The study adopted an experimental design . The peer tutored problem-based learning method was applied to an experimental group and the conventional teaching method to a control group . The study sample consisted of 142 senior nursing students who were r and omly assigned to the two groups . All the students were tested for their nursing ethical discrimination ability both before and after the educational intervention . A learning satisfaction survey was also administered to both groups at the end of each course . After the intervention , both groups showed a significant increase in ethical discrimination ability . There was a statistically significant difference between the ethical discrimination scores of the two groups ( P < 0.05 ) , with the experimental group on average scoring higher than the control group . There were significant differences in satisfaction with self-motivated learning and critical thinking between the groups . Peer tutored problem-based learning and lecture-type conventional teaching were both effective for nursing ethics education , but problem-based learning was shown to be more effective . Peer tutored problem-based learning has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and re source constraints Increased work complexity and financial strain in the health care sector have led to higher dem and s on staff to h and le ethical issues . These dem and s can elicit stress reactions , that is , moral distress . One way to support professionals in h and ling ethical dilemmas is education and training in ethics . This article reports on a controlled prospect i ve study evaluating a structured education and training program in ethics concerning its effects on moral distress . The results show that the participants were positive about the training program . Moral distress did not change significantly . This could be interpreted as competence development , with no effects on moral distress . Alternatively , the result could be attributed to shortcomings of the training program , or that it was too short , or it could be due to the evaluation instrument used . Organizational factors such as management involvement are also crucial . There is a need to design and evaluate ethics competence programs concerning their efficacy 
    Output:
    
Findings : It is possible to affect the ethics of healthcare practice s through professionals and students .
Many of the interventions were related to the ethical or moral sensitivity of the professionals , such as moral courage and empowerment .
A few of the interventions focused on identifying ethical problems or research ethics .
Conclusion : Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals .
Such outcomes are promising in developing ethical safety for healthcare patients and professionals