A South African perspective on community psychology practice competencies

The appropriateness of the paradigm underlying competency frameworks and their specific application in the list of definitions developed by a Task Group of Society for Community Research and Action (SCRA) for US community psychologists need further consideration. This paper considers the technicist and behavioural roots of some of these concepts, illustrating tensions when applying them to community psychology. It then proposes a competency perspective from the global South. Drawing from focus group discussions with, and written reflections from, postgraduate Master's students in training as clinical and counselling psychologists, this paper builds inductively from the recorded data. Following a template analysis of the material, four integrating themes were evident. The distinctive nature of community psychology is highlighted through the themes: relational foundations, activity evolution, self-management and the awareness and influences of processes. Proposals for an alternative framework ("RASP") are based on its emergence from the applications of learning to practice, emphasising community-based principles. The importance of reflection as the basis for the learning is highlighted. The imperatives to foreground social justice and to enable reflexive thinking on action are discussed, along with concepts based on Humanist and Social Constructivist paradigms, to lead to more interactive and inclusive processes in work on competencies.

E-cigarette, or Vaping, Product Use-Associated Lung Injury-Lessons Learned: A Case Series

E-cigarette, or vaping, product use has been declared an epidemic, and a new disease has emerged from their use. We describe 4 patients with significant acute lung injury related to e-cigarette use who underwent bronchoscopy and bronchoalveolar lavage. All cases posed anesthetic challenges, including increased airway reactivity, hypoxia, increasing oxygen requirements, and, in 2 severe cases, the need for continued postprocedural mechanical ventilatory support. It is imperative that all members of the treating team are aware of the disproportionate risk of respiratory complications to anticipate the possible need for increased postprocedural respiratory support.

Engineering Student's Ethical Awareness and Behavior: A New Motivational Model

Professional communities are experiencing scandals involving unethical and illegal practices daily. Yet it should not take a national major structure failure to highlight the importance of ethical awareness and behavior, or the need for the development and practice of ethical behavior in engineering students. Development of ethical behavior skills in future engineers is a key competency for engineering schools as ethical behavior is a part of the professional identity and practice of engineers. While engineering educators have somewhat established instructional methods to teach engineering ethics, they still rely heavily on teaching ethical awareness, and pay little attention to how well ethical awareness predicts ethical behavior. However the ability to exercise ethical judgement does not mean that students are ethically educated or likely to behave in an ethical manner. This paper argues measuring ethical judgment is insufficient for evaluating the teaching of engineering ethics, because ethical awareness has not been demonstrated to translate into ethical behavior. The focus of this paper is to propose a model that correlates with both, ethical awareness and ethical behavior. This model integrates the theory of planned behavior, person and thing orientation, and spheres of control. Applying this model will allow educators to build confidence and trust in their students' ability to build a professional identity and be prepared for the engineering profession and practice.

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Zusammenfassung. Der klinische Alltag konfrontiert Fachpersonen aus Medizin und Pflege regelmässig mit ethischen Problemen, die gemeinsam mit Patienten und deren Angehörigen angegangen werden müssen. Entsprechend sollte der Umgang mit ethischen Fragen Teil der Aus- und Weiterbildung von Fachpersonen sein, wobei dies meist Deliberation umfasst. Psychologische Kompetenzen werden durch diesen Ansatz meist nur indirekt gefördert. Wir stellen in diesem Beitrag das Konzept der «moralischen Intelligenz» vor, das aktuelle Kenntnisse der Moralpsychologie mit ethischen Gesichtspunkten vereint und Kompetenzen definiert, die Gegenstand von Diagnose und Training sein können. Anhand der moralischen Sensitivität wird skizziert, wie solche Kompetenzen messbar gemacht werden und zur Weiterentwicklung der Aus- und Weiterbildung in Ethik sowie als Instrument zur Entwicklung diagnostischer Verfahren dienen können.

Accounting for personhood in palliative sedation: the Ring Theory of Personhood

Application of sedation at the end of life has been fraught with ethical and clinical concerns, primarily focused on its potential to hasten death. However, in the face of clinical data that assuage most of these concerns, a new threat to this treatment of last resort has arisen. Concern now pivots on its effects on the personhood of the patient, underpinned by the manner in which personhood has been conceptualised. For many authors, it is consciousness that is seen to be the seat of personhood, thus its loss is seen to rob a patient of their moral and ethical worth, leaving them in a state that cannot ethically be differentiated from death. Here I proffer a clinically based alternative to this view, the Ring Theory of Personhood, which dispels these concerns about sedation at the end of life. The Ring Theory envisages personhood as a coadunation of three domains of concern: the innate, the individual and the relational elements of personhood. The innate element of personhood is held to be present among all humans by virtue of their links with the Divine and or their human characteristics. The individual elements of personhood pivot on the presence of consciousness-dependent features such as self-awareness, self-determination and personality traits. The relational component of personhood envisages an individual as being 'socially embedded' replete with social and familial ties. It is these three equally important inter-related domains that define personhood.

Teaching engineering ethics using BLOCKS game

The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students' opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students' opinions of the Statements.

Professionalism and ethics education on relationships and boundaries: psychiatric residents' training preferences

OBJECTIVE

Awareness of the privileges and limits of one's role as physician, as well as recognition and respect for the patient as a human being, are central to ethical medical practice. The authors were particularly interested in examining the attitudes and perceived needs of psychiatric residents toward education on professional boundaries and relationships given the heightened current focus on professionalism and ethics.

METHODS

Residents from six psychiatric residencies provided views on professionalism and ethics education on a survey encompassing 10 domains of professionalism. The authors focus on residents' perceived need for education on boundaries in the psychiatrist-patient relationship and in peer-peer and supervisor-trainee interactions.

RESULTS

Respondents (N=134) felt that nine relationship and boundary issues arising during training should receive more education: being asked to work with inadequate supervision, resolving conflicts between attendings and trainees, resident health care, adequately caring for patients while adhering to work-hour guidelines, performing work beyond one's competence, mistreatment of residents, sexual/romantic relationships between faculty and trainees, mistreatment of medical students, and sexual/romantic relationships between residents and medical students (p<0.05 in all cases). In addition, 15 relationship and boundary issues arising during clinical practice were felt to warrant more education: responding to impaired colleagues, coping with mistakes in clinical care, reporting mistakes, balancing personal and professional life, resolving conflicts, writing prescriptions for friends or family, allocation of health care resources, providing medical advice to friends and family, physicians' social responsibilities, interacting with families, medicine as a profession, gender bias, being asked to falsify clinical information, accepting gifts from patients, and personal relationships with patients (p<0.05 in all cases).

CONCLUSION

The authors found a perceived need for more education for psychiatric residents for the majority of topics pertaining to boundaries and relationships. Residents who reported encountering ethical dilemmas more frequently wanted more education on these topics.

Awareness and use of direct-to-consumer nutrigenomic tests, United States, 2006

PURPOSE

Direct-to-consumer genetic tests are increasingly available and may improve confidentiality, convenience, and accessibility. Amid ethical concerns and an uncertain regulatory landscape, the future of this mode of delivery is unclear. One class of products, nutrigenomic tests, is used to analyze DNA and lifestyle habits to assess health risks. Little information is available regarding awareness or use of such tests among consumers or physicians.

METHODS

We assessed consumers' awareness and use of nutrigenomic tests in the 2006 HealthStyles national survey (5250 respondents) and awareness among physicians in the 2006 DocStyles national survey (1250 respondents).

RESULTS

In the HealthStyles survey, 14% of respondents were aware of nutrigenomic tests, and 0.6% overall had used these tests. Respondents who were aware of nutrigenomic tests tended to be young and educated with a high income. Many physicians (44%) were aware of nutrigenomic tests, although 41% of these physicians had never had a patient ask about such tests, and most (74%) had never discussed the results of a nutrigenomic test with a patient.

CONCLUSIONS

These results provide insight into current trends in public demand and interest in nutrigenomic tests and will aid in assessing the impact of policies, efforts at public or provider education, and the evolution of the availability and demand for such tests.

Quality-of-life considerations in substitute decision-making for severely disabled neonates: the problem of developing awareness

Substitute decision-makers for severely disabled neonates who can be kept alive but who will require constant medical interventions and will die at the latest in their teens are faced with a difficult decision when trying to decide whether to keep the infant alive. By and large, the primary focus of their decision-making centers on what is in the best interests of the newborn. The best-interests criterion, in turn, is importantly conditioned by quality-of-life considerations. However, the concept of quality of life is logically and ethically different for patients with a developing as opposed to a developed awareness. Unfortunately, this difference is ignored by current quality-of-life considerations, there are no quality-of-life measures that take this difference into account, and decision-making proceeds entirely without acknowledging this fact. This note outlines why this is a problem and why there is a need for a new set of tools that incorporates this distinction if the substitute decision-makers are to apply the best-interest criterion in a meaningful way.

A dynamic model of ethical reasoning in speech pathology

Ten new graduate speech pathologists recounted their experiences in managing workplace ethical dilemmas in semi-structured interviews. Their stories were analysed for elements that described the nature and management of the ethical dilemmas. Ethical reasoning themes were generated to reflect the participants' approaches to managing these dilemmas. Finally, a conceptual model, the Dynamic Model of Ethical Reasoning, was developed. This model incorporates the elements of awareness, independent problem solving, supported problem solving, and decision and outcome evaluation. Features of the model demonstrate the complexity of ethical reasoning and the challenges that new graduates encounter when managing ethical dilemmas. The results have implications for preparing new graduates to manage ethical dilemmas in the workplace.

Ethics and invertebrates: a cephalopod perspective

This paper first explores 3 philosophical bases for attitudes to invertebrates, Contractarian/Kantian, Utilitarian, and Rights-based, and what they lead us to conclude about how we use and care for these animals. We next discuss the problems of evaluating pain and suffering in invertebrates, pointing out that physiological responses to stress are widely similar across the animal kingdom and that most animals show behavioral responses to potentially painful stimuli. Since cephalopods are often used as a test group for consideration of pain, distress and proper conditions for captivity and handling, we evaluate their behavioral and cognitive capacities. Given these capacities, we then discuss practical issues: minimization of their pain and suffering during harvesting for food; ensuring that captive cephalopods are properly cared for, stimulated and allowed to live as full a life as possible; and, lastly, working for their conservation.

The Transparency of Aging

This article is not meant to provide answers but to provoke thinking related to the questions we should be asking about the ethical personhood of aging adults. Are we covering over the rich opportunities to learn from their stories with an invisible cloak of transparency? Health care professionals have a moral obligation to rethink the assumptions that underlie their definitions of quality of life in aging. We cannot know what should be done unless we learn to listen to the life stories of aging people. This may even help us to see what is most real.

Ethics in nursing homes: Experience and casuistry

The purpose of the study was to further explore the methods that nurses use to solve ethically difficult care situations in nursing homes while the aim of this article was to present a model for nursing practice in such situations. Fourteen nurses from three nursing homes in Norway were observed and interviewed in order to discern the strategies they used to deal with ethically difficult care situations. To analyse this information, we used a constant comparative method until a grounded theory emerged. The nurses' principal strategy was to apply earlier experiences while striving for the best outcome for the elderly patients. This article discusses this strategy and compares it to a theory of ethics called casuistry. We suggest that by using the method of experiences combined with casuistry in a more systematic way, nurses can develop acceptable solutions for difficult care situations in nursing homes.

Patient perspectives of medical confidentiality: a review of the literature

OBJECTIVE

To lay the groundwork for a better understanding of patient views on medical confidentiality.

DESIGN

Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included.

MAIN RESULTS

Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information.

CONCLUSIONS

Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients.

Using role playing to increase residents' awareness of medical student mistreatment

The teacher-learner relationship is subject to both internal and external influences that may lead to mistreatment and harassment of the student. The student who is mistreated may mistreat students when he or she becomes a teacher. The author describes an experiential program for residents at Brown Medical School from 1999 to 2002 in which residents, through role playing, helped produce teaching videotapes on medical student mistreatment. Fourteen residents had participated in the program to date. They reported that they had benefited from an increased awareness of the effects of student mistreatment and had learned how to handle mistreatment more effectively. They also reported increased sensitivity to others and improved self-awareness, qualities that they planned to incorporate into their professional identities and that should help them avoid mistreatment of students and residents later in their careers. Because preventing mistreatment from being transmitted to the next generation is an important way to increase medical professionalism, the author recommends that role-playing exercises dealing with mistreatment be a part of all residency education.