Evaluation of the perceived impact of an interdisciplinary healthcare ethics course on clinical practice

Ethik-Fortbildungen als Element der Klinischen Ethikarbeit: Ein Überblick über Formate und weitere strukturierende Elemente

Ausgehend von den Erfahrungswerten sechs Klinischer Ethiker*innen an Universitätsklinika in Deutschland wurde eine strukturierte Auseinandersetzung mit dem Arbeitsfeld der Fortbildungen im Rahmen der Klinischen Ethikarbeit vorgenommen. Die Zusammenarbeit wurde von der Fragestellung geleitet, was bei der Konzeption einer Ethik-Fortbildung innerhalb einer Einrichtung zu berücksichtigen ist. Der methodische Zugang zur Beantwortung der explorativen Fragestellung bestand in einem mehrstufigen, deskriptiven Verfahren, das alternierend in gemeinsamen Arbeitssitzungen und individueller Arbeit zwischen den Sitzungen umgesetzt wurde.

Als Resultat zeigt der Aufsatz eine Übersicht über die Bandbreite möglicher Fortbildungsformate auf, die denjenigen Hilfestellung bieten kann, die in ihrer Einrichtung Fortbildungen zu ethischen Themen konzipieren und durchführen wollen. Darüber hinaus bietet er einen Überblick über die bei der Umsetzung jeweils zu berücksichtigenden direkt strukturierenden sowie indirekt strukturierenden Merkmale. Es wird an Beispielen aufgezeigt, welche Formatvarianten sich in Kombination mit welchen direkt strukturierenden Merkmalen in den ausgewählten Universitätsklinika bewährt haben.

Der Beitrag liefert eine Diskussionsgrundlage, um die strukturierte Auseinandersetzung mit konzeptionellen Fragen ethischer Fortbildung in der Klinik zu befördern.

Impact of interprofessional collaboration on chronic disease management: Findings from a systematic review of clinical trial and meta-analysis

Improvement of chronic disease management demands effective collaborative relationships between health and social-care which is achieved through teamwork. Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are recognized as essential for the delivery of effective and efficient healthcare. Although IPC and IPE are key components of primary care, evidence of studies evaluating how an IPE intervention prior to IPC improved chronic patient outcomes remains scarce. The aim of this study was to assess the impact of IPC interventions on the management of chronic patients compared to usual care. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) on IPC interventions on chronicity management and their impact on clinical and process outcomes was conducted. Of the 11,128 papers initially retrieved, 23 met the inclusion criteria. Meta-analyses results showed the reduction of systolic blood pressure (Mean Difference (MD) -3.70; 95 % CI -7.39, -0.01), glycosylated hemoglobin (MD -0.20; 95 % CI -0.47, -0.07), LDL cholesterol (MD -5.74; 95 % CI -9.34, -2.14), diastolic blood pressure (MD -1.95; 95 % CI -3.18, -0.72), days of hospitalization (MD -2.22; 95 % CI -4.30, -0.140). A number of positive findings for outcomes related to IPC were found reflecting an improvement of quality of care and an enhancement in the delivery of patient-centered and coordinated care. Moreover, the need for a purposeful systemic approach linking interprofessional education with interprofessional collaboration and patient health and wellbeing is necessary.

Safeguarding of vulnerable adults training: assessing the effect of continuing professional development

AIM

This article provides an insight into the effect of safeguarding of vulnerable adults continuing professional development (SOVA-CPD) training for nurses.

METHOD

51 participants were recruited from three different cohorts of SOVA-CPD training that had been delivered in east England. A 50-item questionnaire was designed to gather participants' views on their acquisition of knowledge and skills, and perceived changes in practice, and to allow them to describe how they have changed how they work due to the training.

RESULTS

Participants agreed overwhelmingly that the SOVA-CPD had enhanced their competency and skills so that their patients' care could improve. However, despite the benefits that some participants described, the potential positive effects of SOVA-CPD were curtailed by the challenges participants experienced in making changes in their practice settings.

CONCLUSION

The study highlights several benefits of SOVA-CPD for nurses, including the benefits to patient care of a CPD learning environment for practitioners. It suggests that employers should provide environments in which staff who have undertaken SOVA-CPD can trigger and sustain changes to improve patient care.

Organizational ethics: A literature review

The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.

The evaluation of learner outcomes in interprofessional continuing education: a literature review and an analysis of survey instruments

BACKGROUND

Interprofessional education (IPE) is thought to be important in fostering interprofessional practice (IPP) and in optimizing patient care, but formal evaluation is lacking.

AIM

To identify, through review of IPE evaluation instruments in the context of Barr/Kirkpatrick's hierarchy of IPE learner outcomes, the comprehensiveness of current evaluation strategies and gaps needing to be addressed.

METHODS

MEDLINE and CINAHL were searched for work relating to IPE/IPP evaluation published between 1999 and September 2010 that contained evaluation tools. Tool items were stratified by learner outcome. Trends and gaps in tool use and scope were evaluated.

RESULTS

One hundred and sixty three articles were reviewed and 33 relevant tools collected. Twenty-six (78.8%) were used in only one paper each. Five hundred and thirty eight relevant items were identified, with 68.0% assessing changes in perceptions of IPE/IPP. Fewer items were found to assess learner reactions (20.6%), changes in behaviour (9.7%), changes in knowledge (1.3%) and organizational practice (0.004%). No items addressed benefits to patients; most were subjective and could not be used to assess such higher level outcomes.

CONCLUSIONS

No gold-standard tool has been agreed upon in the literature, and none fully addresses all IPE learner outcomes. Objective measures of higher level outcomes are necessary to ensure comprehensive evaluation of IPE/IPP.

Moral distress in physical therapy practice

The purpose of this article is to discuss the theoretical concept of moral distress in the context of current physical therapy practice and ethics knowledge and differentiate it from emotional distress and burnout. Moral distress, largely discussed in nursing, is a theoretical concept that has the potential to elucidate the experiences of physical therapists delivering direct care to patients in complex health care situations and to contribute to physical therapy ethics knowledge and education. It focuses attention on the role of moral agent and the ethical dimensions of practice, offers a basis for dialogue among health professionals, and promotes analysis of the impact of the organizational environment on practice. The article concludes by suggesting how an understanding of the concept of moral distress might inform existing physical therapy ethical decision-making models and future research directions by which the experience of moral distress in physical therapy might be explored.

An interprofessional course in bioethics: training for real-world dilemmas

Future health professionals are often educated with other students of their same discipline when, in practice, they will be working with professionals from other backgrounds to provide care for the patient. Complex issues of ethical concern are common to health professionals due to modern technology. This paper describes the evolution of an interprofessional bioethics course that had a unique combination of students and faculty. Innovative teaching methods were utilized and continuously refined based on student evaluations. Students commonly cited the interprofessional interactions as the most enjoyable part of the learning experience. Establishing a patient-centered focus and an appreciation of the contributions of other disciplines, students learned how to apply ethical decision-making to real cases. At the conclusion of the course, students reported improved attitudes toward interprofessional teamwork. This course format and teaching techniques may be applied at other universities looking for linkages to encourage consistent interprofessional collaboration across disciplines.