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Forsyth P, Maguire B, Carey J, O'Brien R, Maguire J, Giblin L, O'Hare R, Rushworth GF, Cunningham S, Radley A. Alienation and/or anomie in pharmacists: A systematic review and narrative synthesis of the international literature. Res Social Adm Pharm 2025; 21:392-407. [PMID: 39971637 DOI: 10.1016/j.sapharm.2025.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 01/24/2025] [Accepted: 01/24/2025] [Indexed: 02/21/2025]
Abstract
BACKGROUND Flourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave. OBJECTIVES To systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals. METHODS We identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science - Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility. RESULTS Searches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie. CONCLUSION Alienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady.
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Affiliation(s)
- Paul Forsyth
- Pharmacy, NHS Greater Glasgow & Clyde, and Pharmacy, NHS Golden Jubilee, UK.
| | - Barry Maguire
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, UK.
| | - James Carey
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, UK.
| | - Robert O'Brien
- Library & University Collections, University of Edinburgh, UK.
| | | | | | - Roisin O'Hare
- Pharmacy, Southern Health and Social Care Trust, Portadown, Northern Ireland, UK.
| | - Gordon F Rushworth
- Highland & Islands Pharmacy Education & Research, NHS Highland, UK; School of Pharmacy & Life Sciences, Robert Gordon University, UK.
| | - Scott Cunningham
- School of Pharmacy, Applied Sciences and Public Health, Robert Gordon University, UK.
| | - Andrew Radley
- School of Health Sciences, University of Dundee, UK.
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Wernecke K, Nadolny S, Schildmann J, Schiek S, Bertsche T. Ethical conflicts in patient care situations of community pharmacists: a cross-sectional online survey. Int J Clin Pharm 2024; 46:1500-1513. [PMID: 39240277 DOI: 10.1007/s11096-024-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Community pharmacy practice is rarely considered in ethical research, although various ethical conflicts are known for this setting. Data on the actual frequency and perceived burden of ethical conflicts occurring in the community pharmacy setting are required. AIM The survey aimed at investigating the frequency and perceived burden of ethical conflicts, reasons for the perceived burden and influences on decision-making in ethical conflicts in German community pharmacists. METHOD An online survey was conducted among community pharmacists. It contained 15 ethical conflicts in which the ethically required action conflicts with another principle (e.g. law). Basing on these conflicting principles, 12 considerations relevant for decision-making were defined (e.g. solidarity principle). Participants were asked to rate the ethical conflicts in terms of frequency and perceived burden and to rate the influence on decision-making for the considerations. Results were analysed descriptively. RESULTS Five hundred and thirty-five questionnaires were evaluated. The participant's median age was 39 (min-max: 20-78) years, 378 (71%) were female. Seven of the 15 predefined ethical conflicts were rated as occurring predominantly at least once a week. "Generic drug is not most suitable" was rated as the most frequent. Three ethical conflicts were rated mainly with a (very) strong burden. "Concerns for an unborn child" was rated as the most burdensome. Three of the 12 predefined decision-making considerations: pharmaceutical knowledge, legal requirements and personal values were rated primarily as having a very strong influence on decision-making. CONCLUSION Pharmacists in community pharmacies are frequently affected by burdensome ethical conflicts in patient care situations.
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Affiliation(s)
- Kathrin Wernecke
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
- Institute for Educational and Health-Care Research in the Health Sector, Hochschule Bielefeld -University of Applied Sciences and Arts, Interaktion 1, 33619, Bielefeld, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Susanne Schiek
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany.
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany.
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Georgiev K, Cvetkov J, Naumovska Z, Simonoska Crcarevska M, Kapedanovska Nestorovska A, Sterjeva T. The ethical dilemmas in community pharmacy practice: quantitative study in Macedonia. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
| | | | - Zorica Naumovska
- Faculty of Pharmacy, University “Ss Cyril and Methodius”, Mother Theresa 47, 1000 Skopje, Republic of N. Macedonia
| | - Maja Simonoska Crcarevska
- Faculty of Pharmacy, University “Ss Cyril and Methodius”, Mother Theresa 47, 1000 Skopje, Republic of N. Macedonia
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Fino LB, Alsayed AR, Basheti IA, Saini B, Moles R, Chaar BB. Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:88-105. [PMID: 35125200 DOI: 10.1016/j.cptl.2021.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/23/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. EDUCATIONAL ACTIVITY AND SETTING Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. FINDINGS Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. SUMMARY This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia; President of Applied Science Private University, Amman, Jordan.
| | - Ahmad R Alsayed
- President of Applied Science Private University, Amman, Jordan.
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia; President of Applied Science Private University, Amman, Jordan.
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
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Owens CT, Baergen R. Pharmacy Practice in High-Volume Community Settings: Barriers and Ethical Responsibilities. PHARMACY 2021; 9:pharmacy9020074. [PMID: 33916737 PMCID: PMC8167746 DOI: 10.3390/pharmacy9020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
Pharmaceutical care describes a philosophy and practice paradigm that calls upon pharmacists to work with other healthcare professionals and patients to achieve optimal health outcomes. Among the most accessible health professionals, pharmacists have responsibilities to individual patients and to public health, and this has been especially evident during the COVID-19 pandemic. Pharmacists in high-volume community settings provide a growing number of clinical services (i.e., immunizations and point-of-care testing), but according to job satisfaction and workplace survey data, demands related to filling prescriptions, insufficient staffing, and working conditions are often not optimal for these enhanced responsibilities and lead to job dissatisfaction. Professional codes of ethics require a high level of practice that is currently difficult to maintain due to a number of related barriers. In this paper, we summarize recent changes to the scope of practice of pharmacists, cite ethical responsibilities from the American Pharmacists Association Code of Ethics, review data and comments from workplace surveys, and make a call for change. Corporate managers, state boards of pharmacy, and professional organizations have a shared responsibility to work with community pharmacists in all settings to find solutions that ensure optimal and ethical patient care. Attention to these areas will enhance patient care and increase job satisfaction.
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Affiliation(s)
- Christopher T. Owens
- Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID 83209, USA
- Correspondence: ; Tel.: +1-208-406-4161
| | - Ralph Baergen
- Department of Philosophy, Idaho State University, Pocatello, ID 83209, USA;
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Lambert de Cursay C, Akliouat N, Karamé C, Gagnon-Lépine SJ, Porteils C, Brière AL, Bussières JF. [Evaluation of the ethics of pharmaceutical practice: A literature review]. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:446-456. [PMID: 33309606 DOI: 10.1016/j.pharma.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ethics are at the heart of pharmacy practice. METHOD This is a literature review. The main objective is to carry out a review of studies relating on the evaluation of ethics in pharmacy practice. Documentary research on Pubmed was carried out from 1990 to 2020. All studies relating to pharmaceutical ethics that may be applied to the pharmacy practice in pharmacies or in health establishments and that conducted a qualitative or quantitative evaluation of pharmaceutical ethics (e.g. surveying pharmacists or pharmacy students, using a measurement tool, quantifying or qualifying a perception or behaviour) were included. RESULTS The studies come mainly from Anglo-Saxon countries (29/38). Studies related to pharmacy practice, mainly target pharmacists (n=27) and pharmacy students (n=16), and more often have a quantitative component of (n=28). The main ethical dilemmas observed dealt with emergency oral contraception (EOC), voluntary termination of pregnancy with drugs, euthanasia, commercial practices of the pharmaceutical industry, refusal to dispense a prescription in a broader context and plagiarism or dishonesty in academic settings. CONCLUSION Few studies have been conducted on the review of ethics of pharmacy practices from 1990 to 2020. Pharmacy students and practicing pharmacists are regularly exposed to ethical dilemmas and respond to these dilemmas with due consideration, taking into account six principles, eight values and other factors. Exposure to these dilemmas creates inaction, stress and distress. A few possible solutions have been identified.
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Affiliation(s)
- C Lambert de Cursay
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - N Akliouat
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - C Karamé
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - S-J Gagnon-Lépine
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - C Porteils
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - A-L Brière
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada; Faculté de pharmacie, université de Montréal, Montréal, Québec, Canada.
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Fino LB, Basheti IA, Saini B, Moles R, Chaar BB. Exploring pharmacy ethics in developing countries: a scoping review. Int J Clin Pharm 2020; 42:418-435. [PMID: 32277402 DOI: 10.1007/s11096-020-01021-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Background Healthcare ethics have been profoundly influenced by principles of bioethics that emerged post-World War II in the Declaration of Geneva 1948. 'Beneficence' (to do good), 'Non-Maleficence' (to do no harm), 'Justice' (fairness and justice in access) and 'Respect for Autonomy' (respect for patient individuality, including decision making, privacy, and right to refuse), have become foundational principles of contemporary medical codes of ethics. These principles are well reflected in most professional pharmacy code of ethics globally. This domain remains relatively unexplored in most developing countries and the majority of what has been published in this area relates to western cultures. There have been no attempts to pool findings from a similar scope of research emanating in developing countries. Aim of the review This study aims to explore the scope of pharmacy ethics in the literature pertaining to developing countries. Methods An extensive search of three relevant (Scopus, CINAHL, IPA) databases was conducted from Jan 2000 to Feb 2020, in order to identify relevant studies conducted in or focussed on ethics in pharmacy in developing countries. A separate Google Scholar search was carried out in an effort to locate supplementary articles, hand-searched articles were also included to achieve an exhaustive investigation of all current relevant studies. Results The full text of 20 relevant articles that met inclusion criteria were critically analysed and qualitatively categorised into three emerging themes; Ethical challenges in pharmacy practice, Approaches used in teaching pharmacy ethics, and Code of ethics analysis and implementation. Conclusions: Findings of this literature review illuminated a gap in pharmacy ethics literacy in developing countries and variances in pharmacists' ethical attitudes in handling ethical dilemmas, as well as a lack of familiarity with ethical principles and codes of ethics. Pharmacists' lack of respect for patients' autonomy and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most of developing countries. However, attempts are being made to rectify this gap by efforts to incorporate ethical and professional education in undergraduate curricula, and by studies in which new codes of ethics are being implemented.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Rajiah K, Venaktaraman R. The Effect of Demographic and Social Factors on the Decision-Making of Community Pharmacists in Ethical Dilemmas. J Res Pharm Pract 2019; 8:174-177. [PMID: 31728350 PMCID: PMC6830021 DOI: 10.4103/jrpp.jrpp_19_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/26/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of the study is to investigate the effect of demographic and social factors on the decision-making of community pharmacists when confronted with ethical dilemmas during their professional practice. METHODS This was a questionnaire-based, cross-sectional study. A total of 1057 community pharmacists were approached. The final participants were 742. Independent-sample t-test and one-way analysis of variance were used to analyze the factors (age, gender, work experience, education qualification, number of pharmacists per pharmacy, and pharmacy location). FINDINGS Older pharmacists, experienced pharmacists, and urban pharmacists have less ethical dilemma compared to the younger pharmacists, less work experience pharmacists, and rural pharmacists, respectively. CONCLUSION Individual factors such as age, gender, work experience, and educational level and organizational factors such as the number of pharmacists in a pharmacy and location of pharmacy may influence the ethical dilemma of community pharmacists.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, Institute of Pharmacy, Shri Jagdishprasad Jhabarmal Tibrewala University, Jhunjhunu, Rajasthan, India
| | - Rajesh Venaktaraman
- Department of Pharmacy Practice, Adichunchanagiri College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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