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Ko HK, Lin YC, Wang SY, Hsu MT, Yordy M, Tsai PF, Lin HJ. Teaching and learning in interprofessional ethics education: Tutors' perspectives. Nurs Ethics 2023; 30:133-144. [PMID: 36200369 DOI: 10.1177/09697330221122901] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical dilemmas that arise in the clinical setting often require the collaboration of multiple disciplines to be resolved. However, medical and nursing curricula do not prioritize communication among disciplines regarding this issue. A common teaching strategy, problem-based learning, could be used to enhance communication among disciplines. Therefore, a university in southern Taiwan developed an interprofessional ethics education program based on problem-based learning strategies. This study described tutors' experience teaching in this program. AIM To explore the phenomenon of teaching and learning in interprofessional ethics education for medical and nursing students from the perspectives of tutors. DESIGN Phenomenological qualitative research. METHODS Medical and nursing students completed a 6-week interprofessional ethics education program moderated by either physician or nurse tutors. At the conclusion of the ethics education program, all 14 tutors were invited to participate in focus group interviews. Among them, six tutors (three nursing tutors and three physician tutors) participated in additional individual interviews. All of the contents from the focus group interviews and individual interviews were recorded and transcribed. Using the phenomenological approach, the phenomenon of teaching and learning in interprofessional ethics education were generated. ETHICAL CONSIDERATION The study was approved by the Institutional Review Board. FINDINGS Three themes emerged from the tutors' teaching perspectives, including the instructor's motivation to teach, the use of narrative case scenarios, and the emphasis on improving interprofessional ethics communication. DISCUSSION Problem-based learning creates an interprofessional communication platform in interprofessional ethics education. The phenomenon of value convergence between tutors and students, between different students' professions, and between different students' professional maturities is observed. CONCLUSION Problem-based learning is an effective teaching strategy for creating a communication platform for interprofessional ethics education. Ethic curriculum should emphasize motivating instructor, use narrative case scenarios, and focus on interprofessional communication.
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Affiliation(s)
- Hsun-Kuei Ko
- College of Nursing, 38023Kaohsiung Medical University, Taiwan; Department of Medical Research, 38023Kaohsiung Medical University Hospital, Taiwan
| | - Yu-Chih Lin
- Department of Medical Humanities and Education, School of Medicine, 164791Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shin-Yun Wang
- Department of Medical Humanities and Education, School of Medicine, 164791Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Min-Tao Hsu
- College of Nursing, 164791Kaohsiung Medical University, Taiwan
| | - Morgan Yordy
- College of Nursing, 210832Auburn University, USA
| | | | - Hui-Ju Lin
- Center for Humanities and Arts Education, 15684Kaohsiung Medical University, Taiwan
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Assessing the State of Ethics Education in General Education Curricula at U.S. Research Universities and Liberal Arts Colleges. JOURNAL OF ACADEMIC ETHICS 2023. [DOI: 10.1007/s10805-022-09464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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3
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Seidlein AH, Hannich A, Nowak A, Salloch S. Interprofessional health-care ethics education for medical and nursing students in Germany: an interprofessional education and practice guide. J Interprof Care 2021; 36:144-151. [PMID: 33653196 DOI: 10.1080/13561820.2021.1879748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Early interprofessional learning among nursing and medical students provides various benefits for future collaboration among professionals, and high-quality care for patients. Expert committees, thus, urge the integration of interprofessional education (IPE) in undergraduate studies to achieve significant sustainable improvements in health-care practice. In Germany, IPE interventions are already implemented in some health-care disciplines, but Health-care Ethics are scarcely regarded in undergraduate education. There are, however, several reasons why Health-care Ethics is particularly appropriate for teaching in an interprofessional format. Thus, after reviewing the legal framework and the current curricula of both professions, an IPE course on Health-care Ethics for medical and nursing students was developed and implemented, consisting of seven classes of 180 minutes each. Drawing on the evaluation results after two rounds of the course, this interprofessional education and practice guide reports on challenges, obstacles and perspectives for improvement of an IPE course on Health-care Ethics. It aims to provide guidance for teaching pioneers and innovators who implement similar projects and to foster practice-oriented and open discussion about the possibilities and limits of IPE in Health-care Ethics.
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Affiliation(s)
- Anna-Henrikje Seidlein
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Arne Hannich
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andre Nowak
- Institute of History and Ethics of Medicine, Faculty of Medical, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sabine Salloch
- Institute of History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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DeFoor MT, Chung Y, Zadinsky JK, Dowling J, Sams RW. An interprofessional cohort analysis of student interest in medical ethics education: a survey-based quantitative study. BMC Med Ethics 2020; 21:26. [PMID: 32268890 PMCID: PMC7140336 DOI: 10.1186/s12910-020-00468-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received (41% overall response rate) among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/(D) MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results The majority of respondents were female (333, 59.3%), white (326, 58.0%) and mid-20s in age (340, 60.5%). Almost half of respondents (47%) reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students (28%) were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos.
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Affiliation(s)
- Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA.
| | - Yunmi Chung
- Institute of Public and Preventative Health, Augusta University, Augusta, GA, 30909, USA
| | | | - Jeffrey Dowling
- Augusta University Rehabilitation, Augusta, GA, 30909, USA.,Center for Bioethics and Health Policy, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA
| | - Richard W Sams
- Center for Bioethics and Health Policy, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA.,Department of Family Medicine, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA
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Gholamzadeh S, Shayestehfard M, Torabizadeh C, Ebadi A. Ethical Sensitivity in Nursing Students: Developing a Context–based Education. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Milliken A, Ludlow L, Grace P. Ethical Awareness Scale: Replication Testing, Invariance Analysis, and Implications. AJOB Empir Bioeth 2019; 10:231-240. [PMID: 31580779 DOI: 10.1080/23294515.2019.1666176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Ethical awareness (EA) enables nurses to recognize the ethical implications of all practice actions and is an important component of safe and quality nursing care. Evidence suggests that nurses may sometimes feel underprepared to recognize and address ethical issues as they arise in practice. The Ethical Awareness Scale (EAS) presented strong evidence as a psychometrically sound measure of EA in critical care nurses in pilot testing. The present study extends earlier work by (a) expanding the sample, (b) replicating the psychometric analyses, (c) more deeply investigating data-to-model fit, and (d) providing guidelines for the interpretation of EAS scores and subsequent practice-focused and educational interventions. Methods: This study utilized two sets of cross-sectional EAS survey results with ICU nurse respondents from two hospitals in New England. Invariance testing using simple OLS regression was conducted between the item estimates of both samples. The final Rasch analysis utilized a rating scale model. Finally, a score interpretation framework was developed. Results: 240 participants were included in the combined analysis. Nurses were predominantly female (93.1%), aged 25-35 (39.9%), and Bachelor's degree prepared (73.4%). Mean levels of EA were in the low/moderate range (M = 36.2/54). Cronbach's alpha of 0.86 was achieved. The Rasch analysis demonstrated a variable map structure consistent with the hypothesized item order, scoring categories that were sufficiently used by respondents, and adequate model-data fit. Conclusions: This study demonstrates that the EAS is a psychometrically sound and meaningful measure of EA in critical care nurses with item difficulty estimates that are invariant across samples. A raw score on the EAS can be practically interpreted, given the theoretical description of what a nurse at each level of the scale's continuum may "look" like in terms of EA using the diagnostic interpretation table. These findings have implications for nursing education and practice.
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Affiliation(s)
- Aimee Milliken
- Wiese Postdoctoral Fellow in Bioethics, Brigham and Women's Hospital
| | - Larry Ludlow
- Measurement, Evaluation, Statistics, and Assessment, Lynch School of Education, Boston College
| | - Pamela Grace
- William F. Connell School of Nursing, Boston College, Associate Professor of Nursing and Ethics
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Polczynski AM, Rozmus CL, Carlin N. Beyond silos: An interprofessional, campus-wide ethics education program. Nurs Ethics 2019; 26:2314-2324. [PMID: 30968735 DOI: 10.1177/0969733019832948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center. RESEARCH OBJECTIVES The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program. RESEARCH DESIGN This study was a quasi-experimental design with seniors graduating prior to the intervention serving as the control group. PARTICIPANTS AND RESEARCH CONTEXT The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention. ETHICAL CONSIDERATIONS Study materials for each survey were submitted to the university's IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential. FINDINGS Students' perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students' overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators. DISCUSSION After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric. CONCLUSION Examination of the effectiveness of each part of the intervention is needed.
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Affiliation(s)
| | - Cathy L Rozmus
- The University of Texas Health Science Center at Houston, USA
| | - Nathan Carlin
- The University of Texas Health Science Center at Houston, USA
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Machin L, Bellis KM, Dixon C, Morgan H, Pye J, Spencer P, Williams R. Interprofessional education and practice guide: designing ethics-orientated interprofessional education for health and social care students. J Interprof Care 2018; 33:608-618. [DOI: 10.1080/13561820.2018.1538113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- L.L. Machin
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - K. M. Bellis
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - C. Dixon
- Doctorate of Clinical Psychology, Lancaster University, Lancaster, UK
| | - H. Morgan
- Department of Sociology, Lancaster University, Lancaster, UK
| | - J. Pye
- Department of Sociology, Lancaster University, Lancaster, UK
| | - P. Spencer
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - R.A. Williams
- Department of Management Science, Lancaster University, Lancaster, UK
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Milliken A. Toward Everyday Ethics: Strategies for Shifting Perspectives. AACN Adv Crit Care 2018; 28:291-296. [PMID: 28847865 DOI: 10.4037/aacnacc2017406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Aimee Milliken
- Aimee Milliken, Boston College, Connell School of Nursing, Maloney Hall, 140 Commonwealth Ave, Chestnut Hill, MA 02467
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Hudon A, Blackburn É, Laliberté M, Perreault K, Mazer B, Ehrmann Feldman D, Williams-Jones B, Hunt M. Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project. J Interprof Care 2018; 32:452-462. [PMID: 29469598 DOI: 10.1080/13561820.2018.1435514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants' experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants' expectations were met. Structured telephone interviews 9-10 months after the workshop collected participants' perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.
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Affiliation(s)
- Anne Hudon
- a Department of Physical Therapy, School of Rehabilitation , Faculty of Medicine, University of Montreal , Montréal , Québec , Canada.,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada
| | - Émilie Blackburn
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,d School of Physical and Occupational Therapy , McGill University , Montréal , Québec , Canada
| | - Maude Laliberté
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada.,e Department of Social and Preventive Medicine, School of Public Health , University of Montreal , Montréal , Québec , Canada
| | - Kadija Perreault
- f Department of Rehabilitation, Faculty of Medicine , Université Laval , Québec City , Québec , Canada.,g Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Montréal , Québec , Canada
| | - Barbara Mazer
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,d School of Physical and Occupational Therapy , McGill University , Montréal , Québec , Canada
| | - Debbie Ehrmann Feldman
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada
| | - Bryn Williams-Jones
- c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada.,e Department of Social and Preventive Medicine, School of Public Health , University of Montreal , Montréal , Québec , Canada
| | - Matthew Hunt
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,d School of Physical and Occupational Therapy , McGill University , Montréal , Québec , Canada
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Megregian M. Ethics Education in Midwifery Education Programs in the United States. J Midwifery Womens Health 2016; 61:586-592. [DOI: 10.1111/jmwh.12462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
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Steele L, Mukherjee S, Stratton-Powell A, Anderson I, Timothy J. Extent of medicolegal burden in neurosurgery - An analysis of the National Health Service Litigation Authority Database. Br J Neurosurg 2015; 29:622-9. [PMID: 26083139 DOI: 10.3109/02688697.2015.1054362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Neurosurgery remains amongst the highest malpractice risk specialties. We aimed to better understand the medicolegal burden in neurosurgery by analysing a large volume of claims recorded by the National Health Service Litigation Authority (NHSLA). METHODS The NHSLA database was retrospectively interrogated for all closed (i.e. with legal outcomes) claims in neurosurgery recorded between 1997 and 2011. Collected data included clinical event; subspecialty; patient injury sustained; reason for claim; legal outcome and litigation costs. RESULTS The total neurosurgical litigation cost associated with 617 closed claims over the time period investigated was £67.4 million. 282 claims (46%) were successful with damages awarded. The annual claim volume and damages paid increased between 2002 and 2011 by 50% and 140%, respectively, and two-thirds of these increases were attributable to spinal claims. 30% of the total litigation cost was legal fees. The leading causes of damages paid in cranial surgery were delayed diagnosis (29%) and delayed treatment (24%). In contrast, the leading causes of damages paid in spinal surgery were delayed diagnosis (32%) and surgical negligence (22%). The greatest mean damages awarded per claim were for brain damage (£617,000), compared to only £51,000 for fatality. CONCLUSION Neurosurgical litigation in NHS hospitals has significantly increased over the last decade, predominantly due to spinal claims. A neurosurgical claim has a very high likelihood of success, and even for unsuccessful claims, associated legal fees are considerable. Causes of claims are differently distributed between cranial and spinal neurosurgery, although overall, delay to diagnosis accounted for the predominant share of claims volume and damages. There was a significant medicolegal burden associated with serious long-term injury and need for life-long care as in the case of brain damage as compared with death as an outcome. This analysis represents the largest U.K. study on litigation in surgery to date.
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Affiliation(s)
- Louise Steele
- a Department of Neurosurgery , Leeds Centre for Neurosciences, Leeds General Infirmary , Leeds , UK
| | - Soumya Mukherjee
- a Department of Neurosurgery , Leeds Centre for Neurosciences, Leeds General Infirmary , Leeds , UK
| | | | - Ian Anderson
- a Department of Neurosurgery , Leeds Centre for Neurosciences, Leeds General Infirmary , Leeds , UK
| | - Jake Timothy
- a Department of Neurosurgery , Leeds Centre for Neurosciences, Leeds General Infirmary , Leeds , UK
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Jafree SR, Zakar R, Fischer F, Zakar MZ. Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses. BMC Med Ethics 2015; 16:16. [PMID: 25888967 PMCID: PMC4369076 DOI: 10.1186/s12910-015-0011-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners. Methods The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses’ clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety. Results Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient’s socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors. Conclusion Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.
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Affiliation(s)
- Sara Rizvi Jafree
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan. .,Forman Christian College, Sociology Department, University of the Punjab, 21 FCC Maratib Ali Road, 54000, Gulberg, Lahore, Pakistan.
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan.
| | - Florian Fischer
- School of Public Health, Department of Public Health Medicine, Bielefeld University, P.O. Box 100 131, 33501, Bielefeld, Germany.
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan.
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Dahnke MD. Utilizing codes of ethics in health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2014; 19:611-623. [PMID: 24449124 DOI: 10.1007/s10459-013-9484-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 11/26/2013] [Indexed: 06/03/2023]
Abstract
Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy, however, regarding the value and use of these codes both in professional practice and in the education of healthcare professionals. I intend to review and analyze the various aims and purposes of ethics codes particularly within the study and practice of healthcare in light of various criticisms of codes of ethics. After weighing the strength and import of these criticisms, I plan to explore effective means for utilizing such codes as part of the ethics education of healthcare professionals. While noting significant limitations of this tool, both in practice and in education, I plan to demonstrate its potential usefulness as well, in both generating critical thinking within the study of ethics and as a guide for practice for the professional.
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Affiliation(s)
- Michael D Dahnke
- Division of Graduate Nursing, Department of Health Services Administration, College of Nursing and Health Professions, Drexel University, 1501 Cherry Street, Room 111, Friends Center, Philadelphia, PA, 19102, USA,
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Kumar H, Gokhale, Jain K, Mathur DR. Legal awareness and responsibilities of nursing staff in administration of patient care in a trust hospital. J Clin Diagn Res 2014; 7:2814-7. [PMID: 24551645 DOI: 10.7860/jcdr/2013/7737.3886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The enactment of various legal provisions like Consumer Protection Act, Right to Information Act and standardization of procedures and practices have brought nursing care under legal ambit. Needless to say, the level of legal awareness amidst nursing staff in India is abysmally low. Present study was undertaken to assess the level of legal awareness and responsibilities of nursing staff in administration of patient care at a trust hospital. METHODS An open ended questionnaire was prepared to assess the level of legal awareness among the nursing staff. The GNM and ANM nursing staff deployed at the nursing home and general wards only were randomly screened and specialty nurses were exempted. RESULTS The knowledge on various legal provisions, as was applicable to nursing, across all categories of nurses which were under review, was found to be poor. The nursing staff had poor knowledge on patients' rights and also on their legal obligations towards patients. The GNM nurses fared better than ANM nurses. However, 46.67 % of nurses were found to be aware about cases of omission or commission. CONCLUSION This study substantiated the fact that nurses had poor knowledge on the law that governed their profession and that in days to come, it would become increasingly difficult for them to avoid law suits which were prepared against them, unless remedial actions were taken.
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Affiliation(s)
- Hemant Kumar
- Professor, Commandant, General Hospital , Rajouri, J & K, India
| | - Gokhale
- Camp commandant, 13 Sector, Romeo forces , J & K, India
| | - Kalpana Jain
- Assistant Professor, Department of Pathology, Graded Pathologist, General Hospital , Rajouri, J & K, India
| | - D R Mathur
- Professor, Department of Pathology, Principal & Controller, Jodhpur Medical College & Hospital , Jodhpur, Rajasthan, India
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Frolic A, Jennings B, Seidlitz W, Andreychuk S, Djuric-Paulin A, Flaherty B, Peace D. From reactive to proactive: developing a valid clinical ethics needs assessment survey to support ethics program strategic planning (part 1 of 2). HEC Forum 2012. [PMID: 23184460 DOI: 10.1007/s10730-012-9204-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As ethics committees and programs become integrated into the "usual business" of healthcare organizations, they are likely to face the predicament of responding to greater demands for service and higher expectations, without an influx of additional resources. This situation demands that ethics committees and programs allocate their scarce resources (including their time, skills and funds) strategically, rather than lurching from one ad hoc request to another; finding ways to maximize the effectiveness, efficiency, impact and quality of ethics services is essential in today's competitive environment. How can Hospital Ethics Committees (HECs) begin the process of strategic priority-setting to ensure they are delivering services where and how they are most needed? This paper describes the creation of the Clinical Ethics Needs Assessment Survey (CENAS) as a tool to understand interprofessional staff perceptions of the organization's ethical climate, challenging ethical issues and educational priorities. The CENAS was designed to support informed resource allocation and advocacy by HECs. By sharing our process of developing and validating this ethics needs assessment survey we hope to enable strategic priority-setting in other resource-strapped ethics programs, and to empower HECs to shift their focus to more proactive, quality-focused initiatives.
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Affiliation(s)
- Andrea Frolic
- Professional Affairs, Hamilton Health Sciences, McMaster University Medical Center, 1F9-1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.
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Lennon-Dearing R, Florence JA, Halvorson H, Pollard JT. An Interprofessional Educational Approach to Teaching Spiritual Assessment. J Health Care Chaplain 2012; 18:121-32. [DOI: 10.1080/08854726.2012.720546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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University students' attitudes towards Voluntary Interruption of Pregnancy. Leg Med (Tokyo) 2012; 14:209-13. [PMID: 22498236 DOI: 10.1016/j.legalmed.2012.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 11/20/2022]
Abstract
An evaluation of the future professional trends was performed by analyzing the attitudes of university students to the Voluntary Interruption of Pregnancy (VIP). An anonymous questionnaire was distributed to 300 students (Medicine, Nursing and Law) of the University of Santiago de Compostela, with questions on their personal beliefs, opinion on the law and intention to participate in VIP. Of the 245 respondents (response rate 82%), 66.5% were pro-abortion and their attitudes towards VIP were consistent with their opinion on the beginning of life and with the ethical arguments related to the fetus and the mother. No differences were found with age, sex or degree. The students showed to be well informed on the VIP law, and the majority of them considered unsuitable termination of pregnancy in minors without parental consent. Students' intentions to take part in abortion provision were influenced by their views on abortion, level of participation and circumstances of pregnancy. Although the majority of participants would be willing to perform VIP in situations that affect fetus and mother's life or health (87-66%), their intentions clearly diminished in other situations, such as abortion on demand (17%). These data suggest that conscientious objection of health professionals can even increase with the new policy, a fact that might affect VIP availability. It is important to stress the need of ethical training to help in the solution of conflicts between patient and health professional values.
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A Comparison of Student Performance between Two Instructional Delivery Methods for a Healthcare Ethics Course. Camb Q Healthc Ethics 2011; 20:493-501. [DOI: 10.1017/s0963180111000181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of the humanities in nursing curricula, increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields.
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Caldicott CV, Braun EA. Should professional ethics education incorporate single-professional or interprofessional learning? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2011; 16:143-146. [PMID: 19130279 DOI: 10.1007/s10459-008-9150-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 12/15/2008] [Indexed: 05/27/2023]
Abstract
Since ethical issues in the contemporary delivery of health care involve doctors, nurses, technicians, and members of other health professions, the authors consider whether members of diverse health care occupations might benefit from studying ethics in a single classroom. While interprofessional courses may be better at teaching the ethics of the relationships between and among the various health professions, single-professional courses may be better at teaching the ethics of relationships between particular kinds of professionals and patients. An ethics instructor's professional discipline affects his/her credibility with the students, and the course readings may not always be relevant to the actual work of a given discipline. With these challenges in mind, the authors suggest that the boundaries of ethics education in the health professions be reconceived to accommodate the professional mission of a specific discipline as well as the interdependence and collaboration that marks high quality health care.
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Affiliation(s)
- Catherine V Caldicott
- Center for Bioethics and Humanities, SUNY Upstate Medical University, 725 Irving Avenue, Suite 406, Syracuse, NY 13210, USA.
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Wright D, Brajtman S. Relational and embodied knowing: Nursing ethics within the interprofessional team. Nurs Ethics 2011; 18:20-30. [DOI: 10.1177/0969733010386165] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article we attempt to situate nursing within the interprofessional care team with respect to processes of ethical practice and ethical decision making. After briefly reviewing the concept of interprofessionalism, the idea of a nursing ethic as ‘unique’ within the context of an interprofessional team will be explored. We suggest that nursing’s distinct perspective on the moral matters of health care stem not from any privileged vantage point but rather from knowledge developed through the daily activities of nursing practice. Because of their position vis-à-vis patients and families in everyday clinical care, nurses cultivate ethical knowledge of at least two forms: (1) relational knowledge; and (2) embodied knowledge. Through the integration of these forms of knowledge, nurses develop a unique moral perspective and can make a meaningful contribution to the realm of ethics in interprofessional care.
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Lennon-Dearing R, Lowry LW, Ross CW, Dyer AR. An interprofessional course in bioethics: training for real-world dilemmas. J Interprof Care 2010; 23:574-85. [PMID: 19842951 DOI: 10.3109/13561820902921621] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Robin Lennon-Dearing
- Department of Social Work, East Tennessee State University, Johnson City, Tennessee 37614, USA.
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Numminen OH, Leino-Kilpi H, van der Arend A, Katajisto J. Nursing students and teaching of codes of ethics: an empirical research study. Int Nurs Rev 2009; 56:483-90. [DOI: 10.1111/j.1466-7657.2009.00748.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Skela Savic B, Pagon M. Relationship between nurses and physicians in terms of organizational culture: who is responsible for subordination of nurses? Croat Med J 2008; 49:334-43. [PMID: 18581611 DOI: 10.3325/cmj.2008.3.334] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIM To investigate how nurses and physicians perceive organizational culture, their integration into the organizational processes, and relations within a health care team. METHODS We performed a cross-sectional study that included 106 physicians and 558 nurses from 14 Slovenian hospitals in December 2005. The hospitals were randomly selected. We distributed the questionnaires on the same day to physicians and nurses during a morning shift. The total number of distributed questionnaires represented a 20% of each personnel category at each hospital. The following variables were studied: organizational culture, integration of nurses and physicians in hospital processes, and subordination of nurses to physicians. RESULTS Physicians and nurses favored a culture of internal focus, stability, and control. Both groups estimated that they had a low level of personal involvement in their organizations and indicated insufficient involvement in work teams, while nurses also felt that they were subordinated (mean+/-standard deviation, 3.6+/-0.9 on a scale from 1 to 5) to physicians (2.7+/-1.0; P<0.001). Control orientation correlated positively with the subordination of nurses (PP<0.005) and negatively with personal integration in an organization (PP<0.005). CONCLUSION We found out that subordination of nurses can be explained by market culture, level of personal involvement, and the level of education. Our research showed that the professional growth of nurses was mainly threatened by organizational factors such as hierarchy, control orientation, a lack of cooperation and team building between physicians and nurses, as well as insufficient inclusion of both physicians and nurses into change implementation activities.
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Hariharan S, Jonnalagadda R, Walrond E, Moseley H. Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados. BMC Med Ethics 2006; 7:E7. [PMID: 16764719 PMCID: PMC1524795 DOI: 10.1186/1472-6939-7-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 06/09/2006] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. Methods A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003. Results The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) Conclusion The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.
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MESH Headings
- Barbados
- Codes of Ethics
- Ethics Committees, Clinical
- Ethics, Clinical
- Ethics, Medical
- Ethics, Nursing
- Health Knowledge, Attitudes, Practice
- Helsinki Declaration
- Hippocratic Oath
- Humans
- Jurisprudence
- Medical Staff, Hospital/ethics
- Medical Staff, Hospital/psychology
- Medical Staff, Hospital/statistics & numerical data
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/psychology
- Nursing Staff, Hospital/statistics & numerical data
- Patient Rights
- Referral and Consultation
- Surveys and Questionnaires
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Affiliation(s)
- Seetharaman Hariharan
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
| | - Ramesh Jonnalagadda
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
| | - Errol Walrond
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
| | - Harley Moseley
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
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Sharing the experience: Interdisciplinary education and interprofessional learning. Nurse Educ Pract 2005; 5:317-9. [DOI: 10.1016/j.nepr.2005.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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