The Culture of Biosafety, Biosecurity, and Responsible Conduct in the Life Sciences: A Comprehensive Literature Review

INTRODUCTION

Managing biological risks requires an organizational culture that holistically ensures the biosafety, biosecurity, and biocontainment of infectious disease agents and toxins, in addition to conducting science in a responsible manner, complying with relevant laws, regulations, guidelines, and policies, as well as emphasizing norms, values, and beliefs of the entire life sciences profession.

METHODS

Drawing upon the Federal Experts Security Advisory Panel's (FESAP's) 2014 recommendation to "strengthen a culture that emphasizes biosafety, laboratory biosecurity, and responsible conduct in the life sciences," we undertook a comprehensive literature review of the culture of biosafety, biosecurity, and responsible conduct in the life sciences, including metrics by which to evaluate interventions at the organizational level.

RESULTS

We identified 4031 unique citations published from January 2001 to January 2017 by searching the MEDLINE/PubMed, Scopus, Web of Science, and Global Health databases. In addition, a subset of 326 articles was reviewed in full.

DISCUSSION

We found that while there were discussions in the literature about specific elements of culture (management systems, leadership and/or personnel behavior, beliefs and attitudes, or principles for guiding decisions and behaviors), there was a general lack of integration of these concepts, as well as limited information about specific indicators or metrics and the effectiveness of training or similar interventions.

CONCLUSION

We concluded that life scientists seeking to foster a culture of biosafety and biosecurity should learn from the substantial literature in analogous areas such as nuclear safety and security culture, high-reliability organizations, and the responsible conduct of research, among others.

Ethical competence in DNR decisions -a qualitative study of Swedish physicians and nurses working in hematology and oncology care

BACKGROUND

DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions.

METHODS

Individual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis.

RESULTS

Physicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing.

CONCLUSIONS

In order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient.